RSOC National Report 2013-14 (Final)

Ministry of Women and Child Development, Government of India

TABLE OF CONTENTS

Particulars Page No.

LIST OF TABLES i LIST OF FIGURES v LIST OF ABBREVIATIONS vii EXECUTIVE SUMMARY ix CHAPTER 1 INTRODUCTION 1

1.1 BACKGROUND 1 1.2 CHAPTER CONTENT 2 1.3 STUDY OBJECTIVES 2 1.4 SURVEY DESIGN AND METHODOLOGY 3 1.5 SURVEY TOOLS 7 1.6 IMPLEMENTATION THROUGH CAPI 8 1.7 SURVEY IMPLEMENTATION 9 1.8 DATA PROCESSING AND ANALYSIS 13 1.9 WEALTH INDEX 13 1.10 STRUCTURE OF THE NATIONAL REPORT 14

CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 15 2.1 RESPONSE RATES 16 2.2 HOUSEHOLD POPULATION BY AGE, SEX AND MARITAL STATUS 19 2.3 HOUSEHOLD COMPOSITION BY USUAL MEMBERS 37 2.4 PROFILE OF THE HEAD OF THE HOUSEHOLDS 38 2.5 LITERACY AND EDUCATIONAL ATTAINMENT 42 2.6 HOUSING CHARACTERISTICS 57 2.7 WATER, SANITATION AND HYGIENE PRACTICES OF THE HOUSEHOLD 59 2.8 HOUSEHOLD POSSESSION AND WEALTH INDEX 70 2.9 IODINE LEVELS IN COOKING SALT 75

CHAPTER 3 PROFILE OF EVER MARRIED WOMEN AND CHILDREN 78 3.1 INTRODUCTION 78 3.2 SOCIO-ECONOMIC PROFILE OF EVER MARRIED WOMEN 78 3.3 SCHOOL ENROLMENT OF ADOLESCENT GIRLS 80 3.4 MARITAL STATUS 82 3.5 AGE AT FIRST MARRIAGE 84 3.6 AGE AT FIRST PREGNANCY 86 3.7 TEENAGE CHILDBEARING 90 3.8 CHILDREN EVER BORN AND LIVING 91 3.9 BIRTH ORDER 93 3.10 FAMILY PLANNING PRACTICES 95 3.11 PROFILE OF CHILDREN 97 3.12 BIRTH REGISTRATION 99 3.13 PRE-SCHOOL EDUCATION IN INDIA 104

CHAPTER 4 MATERNAL HEALTHCARE 108 4.1 BACKGROUND 108 4.2 ANTENATAL CARE (ANC) 109 4.3 NATAL CARE 132

Particulars Page No.

4.4 POSTNATAL CARE 152 4.5 ROLE OF AWC IN PRENATAL, NATAL AND POSTNATAL CARE 163

CHAPTER 5 CHILD HEALTHCARE 168 5.1 IMMUNIZATION 168 5.2 CHILDHOOD DISEASES 181 5.3 HEALTH CHECK-UP OF CHILDREN 190 5.4 ROLE OF ANGANWADI CENTRES 192

CHAPTER 6 NUTRITION OF CHILDREN AND ADOLESCENT GIRLS 198 6.1 BIRTH WEIGHT 198 6.2 INFANT AND YOUNG CHILDREN FEEDING (IYCF) PRACTICES 202 6.3 MICRO-NUTRIENT SUPPLEMENTATION 216 6.4 NUTRITIONAL STATUS OF CHILDREN 219 6.5 NUTRITIONAL STATUS OF ADOLESCENT GIRLS 228 6.6 ROLE OF ANGANWADI CENTRES 234

CHAPTER 7 UTILIZATION OF ICDS SERVICES 238 7.1 BACKGROUND 238 7.2 AWARENESS OF SERVICES AVAILABLE AT ANGANWADI CENTRE 238 7.3 UTILIZATION OF AWC SERVICES 242 7.4 REASONS FOR NOT AVAILING AWC SERVICES 246 7.5 REASONS FOR NOT AVAILING SUPPLEMENTARY FOOD 247 7.6 TYPE OF SUPPLEMENTARY FOOD PROVIDED AT AWC 248 7.7 REGULARITY OF RECEIVING SUPPLEMENTARY FOOD 251 7.8 SUPPLEMENTARY FOOD CONSUMPTION PATTERN 252 7.9 PLACE OF CONSUMPTION AND LIKING OF SUPPLEMENTARY FOOD 255 7.10 GROWTH MONITORING 256 7.11 QUANTITY OF FOOD GIVEN TO SEVERELY MALNOURISHED CHILDREN 264 7.12 ATTENDANCE AT PSE AND AGE AT ATTENDING PSE 265 7.13 OTHER SERVICES AT AWC 273

ANNEXURE A SAMPLE SIZE DETERMINATION 278 ANNEXURE TABLES 279

CHAPTER 1 279 CHAPTER 3 287 CHAPTER 5 297 CHAPTER 6 301 CHAPTER 7 306

WEIGHT COMPUTATION 330 ANNEXURE B

SURVEY TOOLS 333

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LIST OF TABLES

Table No. Details Page No.

Table 1.1 Number of households and primary sampling units covered in the RSOC survey, 2013-14

6

Table 2.1 Results of the household and individual interviews and anthropometric measurements

17

Table 2.2 Number of households covered in the survey and ever married women aged 15-49 interviewed and anthropometric measurements taken according to states, RSOC, 2013-14

18

Table 2.3 Household population by age and sex according to residence 20 Table 2.4 Trends in age distribution of household population 21 Table 2.5 Household population by age and state 23 Table 2.6 Sex ratio by states 24 Table 2.7 Marital status of the household population 26 Table 2.8 Early marriage and mean age at marriage by specific characteristics 29 Table 2.9 Early marriage and mean age at marriage by specific characteristics (Comparison) 32

Table 2.10 Marital status of the household population by states: Male 34 Table 2.11 Marital status of the household population by states: Female 35 Table 2.12 Early marriage and mean age at marriage by state 36 Table 2.13 Household size 37 Table 2.14 Characteristics of the head of the household 39 Table 2.15 Characteristics of the head of the household by states 40 Table 2.16 Occupation of the head of the household by state 41

Table 2.17 Literacy and educational attainment of the household population aged 6 and above: Male

43

Table 2.18 Literacy and educational attainment of the household population aged 6 and above: Female

45

Table 2.19 Educational status of the household population aged 6 and above across states: Male

47

Table 2.20 Educational status of the household population aged 6 and above across states: Female

48

Table 2.21 Literacy and educational attainment of the household population aged 7 years and above

49

Table 2.22 Literacy Rate of household population aged 6-24 years 50 Table 2.23 Literacy Rate of household population aged 15-24 years 51 Table 2.24 School attendance ratios 53 Table 2.25 School attendance by sex and residence 55 Table 2.26 School attendance by states 56 Table 2.27 Housing characteristics 58 Table 2.28 Source of drinking water 60 Table 2.29 Source of drinking water 61 Table 2.30 Improving drinking water by state 62 Table 2.31 Usage of household sanitation facilities 63 Table 2.32 Use of toilet facility by social groups and wealth quintiles 64 Table 2.33 Toilet facility by state 65

Table 2.34 Access to improved source of drinking water and use of improved sanitation facility

66

Table 2.35 Access to improved source of drinking water and use of improved sanitation facility by state

67

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Table 2.36 Availability of hand washing facilities 69 Table 2.37 Hand wash facilities in households by states 70 Table 2.38 Household possessions 72 Table 2.39 Wealth Quintiles by Social Group and Religion 73 Table 2.40 Wealth Quintile 74 Table 2.41 Households using adequately iodized salt by selected characteristics 76 Table 2.42 Households using adequately iodized salt by state 77 Table 3.1 Socio-economic and demographic characteristics of respondents 79 Table 3.2 Current educational status of adolescent girls aged 10-19 during 2012-13 81 Table 3.3 Marital status of women 83 Table 3.4 Age at first marriage 84 Table 3.5 Age at first marriage among adolescent girls aged 10-19 85 Table 3.6 Age at first pregnancy 87

Table 3.7 Median age at first marriage, first pregnancy and first live birth by background characteristics

89

Table 3.8 Teenage pregnancy and motherhood 90 Table 3.9 Children ever born and living 92

Table 3.10 Children ever born and living by background characteristics 93 Table 3.11 Birth order 94 Table 3.12 Current use of family planning 96 Table 3.13 Profile of children 98 Table 3.14 Birth registration and possession of birth certificate 101 Table 3.15 Birth registration and possession of birth certificate by state 103 Table 3.16 Pre-school education (PSE) 105 Table 3.17 Pre-school education (PSE) by state 107 Table 4.1 Registration of pregnancy 111 Table 4.2 Registration of pregnancy, timing and MCP card 113 Table 4.3 Antenatal care indicators by state 114 Table 4.4 Utilization of Antenatal care service 116 Table 4.5 Utilization of Antenatal care services 117 Table 4.6 Tetanus Toxoid (TT) vaccination 119 Table 4.7 Receipt and consumption of IFA tablets 121 Table 4.8 Antenatal care indicators 123 Table 4.9 Full ANC 124

Table 4.10 Antenatal check-ups by state 126 Table 4.11 Antenatal care indicators by state 128 Table 4.12 Place of antenatal check-ups and type of service provider 130 Table 4.13 Visit by health functionaries at home during pregnancy 131 Table 4.14 Place of delivery 133 Table 4.15 Assistance during delivery by background characteristics 137 Table 4.16 Institutional and safe delivery 139

Table 4.17 Institutional deliveries according to person who advised to deliver at health facility

141

Table 4.18 Type of delivery 143 Table 4.19 Duration of stay at health facility (for institutional births) 145 Table 4.20 Duration of stay at health facility after delivery (institutional births) by states 147 Table 4.21 Awareness and benefits from JSY and JSSK 149 Table 4.22 Utilization of benefits of JSY and JSSK 151 Table 4.23 Visit by health functionaries after delivery/discharge from health facility 153

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Table 4.24 Timing of first postnatal check-up 156

Table 4.25 Number of postnatal check-ups received by women during first 10 days after delivery

157

Table 4.26 Timing of first postnatal check-up to newborn 160

Table 4.27 Number of postnatal check-ups received by newborn within first 10 days after birth

161

Table 4.28 Postnatal care indicators by states 163 Table 4.29 Role of Anganwadi Centre (AWC) in Maternal Health 165 Table 4.30 Role of AWC in Maternal Health by states 166 Table 5.1 Vaccinations by source of information 171 Table 5.2 Vaccinations by background characteristics 174 Table 5.3 Place of immunization 178 Table 5.4 Vaccinations by state 179 Table 5.5 Receipt of booster dose of DPT and 2nd dose of Measles 180 Table 5.6 Prevalence of diarrhoea, treatment sought and place of treatment 183

Table 5.7 Liquids/fluids given under oral rehydration as a part of diarrhoea treatment and source of ORS

186

Table 5.8 Prevalence and management of fever and symptoms of ARI by selected characteristics

188

Table 5.11 Health check-up of children aged 0-71 months 191 Table 5.13 Role of AWC in child health 194 Table 5.14 Role of AWC in child health by state 197 Table 6.1 Birth weight by selected characteristics 199 Table 6.2 Birth weight by state 201 Table 6.3 Initial breastfeeding among children aged 0-23 months 204 Table 6.4 Type of pre-lacteal liquids given 205 Table 6.5 Breastfeeding practices by state 206 Table 6.6 Exclusive breastfeeding and continued breastfeeding by age one and two 208 Table 6.8 Percentage children 6-8 months who were fed complementary foods 210

Table 6.9 Liquids consumed by children 6-23 months in the day or night preceding the interview

212

Table 6.10 Infant and young child feeding (IYCF) practices 214 Table 6.12 Micro-nutrient supplementation 217 Table 6.14 Nutritional status of children 223 Table 6.15 Nutritional status of children by state 226 Table 6.16 Nutritional status of adolescent girls 230 Table 6.17 Nutritional status of adolescent girls by state 232 Table 6.18 Role of AWC in child nutrition 235 Table 6.19 Role of AWC in Child Nutrition by state 237 Table 7.1 Awareness of services provided at AWC 239 Table 7.2 Awareness of services provided at AWC (any service) 240 Table 7.7 Awareness on services provided at AWC by state 241 Table 7.8 Utilization of AWC services 242 Table 7.9 Utilization of AWC services (any service) 244

Table 7.18 Non-utilization of AWC services by beneficiaries 246 Table 7.19 Non-utilization of AWC services by beneficiaries (reasons) 246 Table 7.20 Reasons for not availing supplementary food 247 Table 7.21 Supplementary food received by children 250 Table 7.24 Frequency of receiving supplementary food 252

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Table 7.29 Supplementary food consumed by mothers of children aged 0-5 months 253 Table 7.30 Supplementary food consumed by children aged 6-35 months 253 Table 7.31 Supplementary food consumed by children aged 36-71 months 254 Table 7.32 Supplementary food consumed by currently pregnant women 255 Table 7.33 Place of consumption and perception on taste of supplementary food consumed 256

Table 7.34 Percentage of children aged 0-71 months for whom growth chart is available and percent distribution of those with growth chart by frequency of weighing in the 3 months preceding the survey, by background characteristics

258

Table 7.35 Awareness of weight of the child 261 Table 7.37 Persons who discussed about child’s nutrition status 263 Table 7.38 Quantity of supplementary food received by severely underweight children 264 Table 7.39 Attendance at pre-school education (PSE) at Anganwadi centre 266 Table 7.40 Regularity and quality of attendance at PSE at Anganwadi centre 268 Table 7.41 PSE—time spent by children on PSE activities in a day at AWC 270 Table 7.42 Reasons for not attending PSE at the AWC 271 Table 7.46 Village Health and Nutrition Day 274 Table 7.47 Home visits by AWW 275 Table 7.48 Other services provided at AWC by state 276

RAPID SURVEY ON CHILDREN 2013-14 LIST OF FIGURES | v

LIST OF FIGURES


Figure 2.1 Age-Sex Pyramid, India, RSOC, 2013-14 22 Figure 2.2 Age-Sex Pyramid, India, Census of India, 2011 22

Figure 2.3 Mean age at marriage based on marriages that have taken place any time in the past vs marriages that took place in the last 5 years

27

Figure 2.4 Proportion getting married below legal age—marriages any time vs marriages in last 5 years

27

Figure 2.5 Proportion of marriages below legal age—marriages any time in the past and marriages in last 5 years

30

Figure 2.6 Mean age at marriage—marriages any time in the past and marriages in the last 5 years

31

Figure 2.7 Mean age at first marriage for females, RSOC, 2013-14 33

Figure 2.8 Median years of schooling completed for population aged 6 years and above, India between RSOC and NFHS-3

46

Figure 2.9 Source of drinking water—comparison with DLHS-3 61 Figure 2.10 Use of toilet facility across social groups 64

Figure 3.1 Percentage of children aged 0-4 whose birth was registered and for whom birth certificate was available, RSOC, 2013-14.

99

Figure 3.2 Birth registration and possession of birth certificate 102 Figure 3.3 Percent distribution of children aged 3-6 by attendance in pre-school education 104 Figure 3.4 Children attending pre-school education 106 Figure 4.1 Percentage of pregnant women having MCP cards 112

Figure 4.2 Percentage of women who received two or more TT injections by wealth quintiles, as per RSOC and DLHS 2007-08

119

Figure 4.3 Percentage of women receiving various components of antenatal care services 125

Figure 4.4 Percentage of women who delivered in a health institution as per RSOC 2013-14 and DLHS 2007-08

135

Figure 4.5 Percentage of women who delivered in an institution, by different social groups, as per RSOC 2013-14 and DLHS 2007-08

135

Figure 4.6 Percentage of women delivering in an institution, belonging different wealth quintiles, as per RSOC 2013-14 and DLHS 2007-08

135

Figure 4.7 Percentage of deliveries conducted by unskilled persons by age group of women 138 Figure 4.8 Percentage of women by type of delivery, state wise, RSOC, 2013-14 144 Figure 4.9 Level of awareness about JSY and JSSK schemes among the women—state wise 150

Figure 4.10 Percentage of women who were visited by a health worker within seven days of delivery or discharge from a health institution after delivery, by states from RSOC, 2013-14

154

Figure 4.11 Percentage of newborn receiving first postnatal check-up within 10 days of discharge from health facility/birth at home

159

Figure 5.1 Percentage of children aged 12-23 months received vaccines, RSOC, 2013-14 171

Figure 5.2 Percentage of children aged 12-23 months received vaccines, RSOC, 2013-14 (Status of Full Immunization)

172

Figure 5.3 Percentage of children aged 12-23 months who are fully immunized and percentage received no immunization by selected characteristics, RSOC, 2013-14

176

Figure 5.4 Percentage of children aged 12-23 months who received full immunization by state, RSOC, 2013-14

180

Figure 6.1 Percentage of children aged 0-59 months who are stunted, wasted and underweight, India, RSOC, 2013-14

221

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Figure 6.2 Change in the child nutritional status 222 Figure 6.3 Percentage of children aged 0-59 months who are stunted by state, RSOC, 2013-14 228 Figure 6.4 The nutritional status of adolescent girls, RSOC, 2013-14 229 Figure 7.1 Percentage of children aged 36-71 months availing any service from AWC 245

Figure 7.2 Percentage of children aged 36-71 months who received supplementary food, by states

251

Figure 7.3 Percentage of children aged 0-35 months covered by an AWC, reported to have growth chart/card by state

257

Figure 7.4 Percentage of children aged 36-71 months covered by an AWC, reported to have growth chart/card by state

257

Figure 7.5 Place of taking weight last time for children aged 0-35 months 260 Figure 7.6 Place of taking weight last time for children aged 36-71 months 260 Figure 7.7 Weight of children aged 0-35 months, by Social Group 262 Figure 7.8 Weight of children aged 36-71 months, by Social Group 262

Figure 7.9 Percentage distribution of children according to number of days attended PSE in one month prior to the survey by place of residence

267

Figure 7.10 State wise percentage of children aged 36-71 months who attended PSE in AWC 272

Figure 7.11 State wise percentage of children aged 36-71 months who attended PSE in AWC for 16 or more days

272

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LIST OF ABBREVIATIONS

AHS Annual Health Survey

ANC Antenatal Check-ups

ANM Auxiliary Nurse Midwife

ARI Acute Respiratory Infections

ASHA Accredited Social Health Activist

AWW Anganwadi Workers

CAPI Computer Aided Personal Interview

CEB Census Enumeration Block

CES Coverage Evaluation Survey

CRC Convention on the Rights of the Child

DHS Demographic Health Survey

ECCE Early Childhood Care and Education

EFA Education for All

EMW Ever Married Women

FC Field Coordinators

FE Field Executives

GAR Gross Attendance Ratios

GMP Growth Monitoring and Promotion

GPI Gender Parity Index

HAF Home Available Fluid

HCM Hot Cooked Meal

HHAS Household Asset Score

HHs Households

HoH Head of the Household

HSC Higher Secondary Certificate

ICDS Integrated Child Development Scheme

IDD Iodine Deficiency Disorders

IFA Iron Folic Acid

IQ Intelligence Quotient

IUD Intra Uterine Device

IYCF Infant and Young Child Feeding

JSSK Janani Shishu Suraksha Karyakram

JSY Janani Suraksha Yojana

LHC Lady Health Visitor

MCP Maternal and Child Protection

MIS Management Information System

MMR Maternal Mortality Ratio

MoHFW Ministry of Health and Family Welfare

MPR Monthly Progress Reports

MWCD Ministry of Women and Child Development

NAR Net Attendance Ratio

NHE Nutrition and Health Education

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NHM National Health Mission

NHRM National Rural Health Mission

ORGI Office of Registrar General of India

ORS Oral Rehydration Solution

ORT Oral Rehydration Therapy

PAPI Pen and Paper Personal Interview

PHC Primary Health Centre

PNC Post-natal Check-up

PPS Probability Proportion to Size

PPSWR Probability Proportional to their Population Size with Replacement

PSE Pre-school Education

PSUs Primary Sampling Units

QA Quality Assurance

RBD Registration of Births and Deaths

RCH Reproductive and Child Health

RMNCH+A Reproductive, Maternal, Newborn, Child and Adolescent

RSOC Rapid Survey of Children

SPSS Statistical Package for Social Science

SSC Secondary School Certificate

TAC Technical Advisory Committee

TBA Trained Birth Attendant

TFR Total Fertility Rate

THR Take Home Ration

ToT Training of Trainers

TPIM Third Party Independent Monitors

TT Tetanus Toxoid

UIP Universal Immunization Programme

VHND Village Health and Nutrition Day

VIP Ventilated Improved Pit Latrine

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EXECUTIVE SUMMARY

INTRODUCTION

The need for reliable survey based information that would enable validation of the information on

implementation of Integrated Child Development Scheme (ICDS) collected through its information

system affirmed the need to conduct the Rapid Survey on Children (RSOC) in 2013-14—a nationwide

household cum facility survey. The Union Ministry of Women and Child Development (MWCD)

requested UNICEF to support in carrying out the RSOC.

The RSOC covered all 28 states (including undivided Andhra Pradesh) and NCT of Delhi. The set of

indicators identified by the MWCD mainly related to the well-being of children below 6 years and

their mothers. It covered aspects of child development, maternal care, school/college attendance

among persons aged 5-24 years, early childhood care and pre-school education and the enabling

environment like access to drinking water, use of toilet facilities and use of iodized salt at household

level. The survey also collected information on ICDS related infrastructural facilities, profiles of

Anganwadi workers, training received, and their knowledge and awareness about critical care

component, besides awareness and utilization of the six services provided under ICDS.

RSOC interviewed head of the households or any adult member of the household for household

based information, all ever married women (EMW) aged 15-49 who had a live birth in the three

years preceding the survey, currently married pregnant women aged 15-49 for maternal and child

health care. The survey took anthropometric measurements for all children below 5 years and

adolescent girls aged 10-18 living in the selected households. RSOC interviewed Anganwadi workers

(AWW) in the selected Anganwadi centres (AWCs).

RSOC collected information from a nationally representative sample of 105,483 households and

5,630 AWCs. At the national level, a total of 1,11,636 EMWs in the age group of 15-49 years were

interviewed in the households. For estimating nutritional status, measurement of height and weight

of 90,908 children aged 0-4 and over 28,000 adolescent girls aged 10-18 were collected across all

states.

The fieldwork for RSOC was completed in around 23 weeks (from 3rd week of November 2013 to

2nd week of May 2014). For data quality several measures were taken including third party

independent monitors.

HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS

The age structure of the household population at the national level is typical of a society

with a youthful population. Broadly, children under age 15 account for 31 percent, while 64

percent of the country’s residents are in the 15-64 years age group and 5 percent are over

65 years. About 10 percent of the population is under age 5.

Females marry at younger ages compared to males. The average age at the time of marriage among females is almost 5 years lesser than that of males. The mean age at marriage for females and males is 18.6 years and 23.3 years respectively.

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| x

Around eight out of every ten households were in the economically active age group of 18-59 years across rural and urban areas. The proportion of female headed households hovered around 10 percent.

About 66 percent of women were literate with a significant rural-urban divide (60 percent against 78 percent). Around 34 percent of women had no education.

Net Attendance Ratio (NAR) is 75 percent at the primary level, 50 percent at middle school, 37 percent at secondary school and 27 percent at higher secondary school. For middle, secondary and higher secondary levels taken together, NAR is 65 percent.

The Gender Parity Index (GPI) based on NAR is 1.00 in urban areas and is 0.99 in rural areas at primary level suggesting a bridging male-female gap. At the middle, secondary and higher secondary level, the GPI exceeds 1.00 both in urban as well as rural areas. However, the GPI based on gross attendance ratio (GAR) is less than 1.00 for primary as well as for secondary levels across rural and urban areas and also for rural areas at higher secondary level. This indicates a noticeable male-female gap due to low access to age-appropriate education for girls as compared to boys.

Access to an improved source of water is nearly universal in India (91 percent) with more than nine out of every ten households both in urban as well as rural areas using improved source of drinking water. The situation is quite similar even in terms of de jure population.

Around 42 percent of households reported using an improved toilet facility. Urban households are more than twice as likely to use an improved toilet facility as compared to rural households. The proportion of households using improved toilets is significantly lesser among Scheduled Castes (SCs)/Scheduled Tribes (STs) as compared to those of Other Backward Classes (OBCs)/‘Others’ across place of residence. Close to 46 percent of households defecate in open with the proportion of rural households being five times more than in comparison to urban households.

Among the households where a designated place of washing hands was observed, 90 percent had the availability of water and 81 percent had the availability of hand washing materials such as soap, detergent or ash. Significantly, a higher proportion of rural households did not have water and soap, detergent or any cleansing agent as compared to urban households.

About 40 percent of ST and 26 percent of SC population falls in the poorest category as compared to 16 percent for OBCs and 10 percent for ‘Others’. Around 43 percent of urban residents were in the highest wealth quintile, as compared with only 11 percent of rural residents.

Sixty seven percent of households were using adequately iodized salt with a notable rural-urban differential (80 percent in urban areas as compared to 61 percent in rural areas).

PROFILE OF EVER MARRIED WOMEN AND CHILDREN

The age-distribution of EMW shows that only a small proportion (3 percent) of them was married at

the age of 15-19 indicating an increase in marriage age in recent years. Majority of the women were

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xi

from the 20-34 age-group. The education profile of EMW shows lack of education among sizeable

proportion of women. Two-fifth of women had no education and 12 percent had completed

Secondary School Certificate (SSC) and 14 percent had completed at least Higher Secondary

Certificate (HSC).

The marital status distribution of women aged 15-49 indicates a rapid increase in the proportion of

EMW from 13 percent in the age-group 15-19 to 68 percent in the age-group 20-24 and further to 92

percent in the age-group 25-29. By age 30, practically all the women were married. Data on age at

first marriage indicates prevalence of marriages at early ages in the past. Among the women aged

20-49, six percent were married before completion of age 15, one-third married before 18—the

legal age at marriage—and 60 percent married in their teens before the age of 20. The median age

at marriage for women aged 20-49 was 18 years. A slow change in the median age at marriage over

the period is observed—increasing from 17.26 years among women aged 45-49 to 18.57 years

among women aged 25-29. The marital status distribution of adolescent girls aged 10-18 shows 6

percent of ever married and 4 percent married before attaining age 18.

Data on the fertility performance shows that among all the EMW aged 15-49, about 8 percent never

became pregnant. Among the 92 percent women who ever became pregnant, 2 percent became

pregnant in the age-group 10-14 and another 48 percent in the age-group 15-19. In other words,

one-half of the ever married women had their first pregnancy when they were in their teen ages.

Median age at first pregnancy among younger women aged 20-29 (20.4) was higher than that

among women aged 40-49 (19.1) only by one year.

Among all the women aged 15-19, 3 percent have had a live-birth, and additional 2 percent had no

live-birth but were pregnant at the time of survey. So, in all, 5 percent of the women aged 15-19 had

started childbearing in their teens. The mean number of ever born children increased from 0.4

among the EMW aged 15-19 to 3.5 among the EMW aged 45-49. The mean number of living children

increased from 0.3 in the age-group 15-19 to 3.1 in the age-group 45-49. The birth order statistics

reflect the low level of current fertility. Among the live-births that occurred three years prior to

survey, almost one-half (47 percent) were the first order births and 30 percent were second order

births.

The contraceptive prevalence rate among the currently married women aged 15-49 was 58 percent.

Most (88 percent) of the women using contraception were using modern contraceptive methods

and remaining 12 percent were using traditional methods. Female sterilization was the most

common method used by two-thirds of the users. Among the modern spacing methods, the most

widely used methods were condom (6 percent) and pills (5 percent).

RSOC collected data of about 121,987 children below 6 years from surveyed households in 28 states

and Delhi. The sex ratio of surveyed children was 934 female children per 1,000 male children. The

sex distribution was almost the same in rural and urban areas. The distribution of children by single

year of age in both rural and urban areas shows slightly lower proportion of younger children below

age two.

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xii

Regarding birth registration, in case of 72 percent of the children below age 5, birth was registered

and for 62 percent of the children registration of the birth was done within 21 days of the birth. For

61 percent of the children birth certificate was available, though only in the case of 37 percent of the

children, respondent could show the birth certificate to the interviewer. The comparison of the birth

registration data with National Family Health Survey-3 (NFHS-3) 2005-06 shows that in the last eight

years since NFHS-3, there has been an increase of 31 percentage points in the extent of birth

registration and of 34 percentage points in possession of birth certificate.

The extent of birth registration varies from the highest of 99 percent in Goa to the lowest of 28

percent in Manipur.

On attendance of pre-school by children aged 3-6, nationally more than two-thirds (70 percent) of

the children aged 3-6 were attending pre-school. Relatively more children (39 percent) aged 3-6

were attending ICDS run pre-schools than privately run pre-schools (31 percent).

There was a large variation in proportion of children attending pre-school across the states ranging

from 19 percent in Nagaland to 90 percent in Tripura. The preference for ICDS run school also varied

substantially from state to state.

MATERNAL HEALTH CARE

Prenatal care

More than four out of every five (84 percent) women registered their pregnancy with health

facilities and AWCs, reflecting greater awareness about maternal health care among women.

Relatively higher proportion of urban women (87 percent) registered their pregnancies in

comparison to rural women (83 percent);

73 percent of all women reported having a Maternal and Child Protection (MCP) card;

Amongst all women, nearly two-third (65 percent) registered their pregnancy during the first

trimester with 71 percent women from the urban areas and 62 percent women residing in

the rural areas;

More than three out of every five (63 percent) women received three or more antenatal

check-ups (ANCs) and almost half (45 percent) reported four or more ANC visits;

Government run health facilities appear to be preferred places of receiving ANC check-ups,

both in rural and the urban areas. Overall, 43 percent of the women had taken check-ups at

government run health facilities. Out of those who received ANC check-ups, more than two-

fifth (84 percent) of the women received the ANC check-ups from a skilled health provider.

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xiii

Place and type of delivery

More than three-fourth (79 percent) women delivered in a health facility (both government

and private). One-fifth of the deliveries took place at home in contrast to about half of

deliveries taking place at home as per District Level Health Surveys (DLHS) 2007-08.

Higher proportion of women (87 percent) residing in the rural areas reported normal

deliveries in comparison to the urban women (75 percent). Close to a fifth of the women (21

percent) delivering their first baby delivered by caesarean section;

Seven out of every ten (71 percent) women were aware about national flagship programme

on safe motherhood—Janani Suraksha Yojana (JSY) whereas only 43 percent were aware of

Janani Shishu Suraksha Karyakram (JSSK). Overall utilization of either JSY or JSSK benefits by

women were around 54 percent.

Postnatal care

Nearly half of the women (51 percent) reported to have been visited by a health care worker

(AWW/Accredited Social Health Activist (ASHA)/Auxiliary Nurse Midwife (ANM)) within one

week of delivery or discharge.

Little less than half of the women (47 percent) received postnatal check-up within 10 days of

delivery at home or discharge from the facility in case of institutional delivery and another 7

percent received postnatal care (PNC) after the stipulated period;

44 percentage of the newborn received first check-up within 10 days of birth at home or

discharge from health facility after birth and another 16 percent received after the

stipulated period.

Role of Anganwadi centre

Among all the women who had a live birth in the three years preceding this survey, 70 percent

registered their pregnancy in an AWC. However, proportion of women ultimately receiving ANC

check-ups at AWCs was much lower (22 percent).

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xiv

CHILD HEALTHCARE

Among all the children aged 12-23 months, the extent of full immunization (comprising BCG, three

doses of DPT and polio and measles vaccine) was 65 percent. Seven percent of children did not

receive a single dose of any of these vaccines and remaining 28 percent received only partial

immunization. The drop-outs in the vaccinations were quite high. From the first to the third dose of

DPT and Polio the drop-out rates were 16 percent and 18 percent respectively. AWCs were the

major source for providing child immunization. Almost half (49 percent) of children who received

some immunization, got immunized in AWCs.

The prevalence of diarrhoea during 15 days prior to the survey was estimated at 6.5 per 100 children

aged below five years. More than three-quarters of children suffering from diarrhoea were treated

and about half of them received Oral Rehydration Solution (ORS) or ORS with zinc. About one-

quarter of children with diarrhoea were given home available fluids like plain water, rice water, dal

water, butter milk etc. Thirty-nine percent were given ORS and 13 percent were given ORS as well as

zinc. Though, generally antibiotics are not prescribed for diarrhoea among children, almost every

second (47 percent) child with diarrhoea received antibiotics. The prevalence of fever among

children below age five was 13.6 percent. Among the children with fever, 15 percent got their blood

test done and 18 percent were given an anti-malaria drug. Almost one in six (16 percent) children

below age 5 had cough during 15 days prior to the survey and 8.6 percent had symptoms of acute

respiratory infections (ARI). For more than three-quarters (77 percent) of the children with ARI,

medical advice/treatment was sought. One in every five children (20 percent) had health check-up in

three months prior to the survey. A large proportion (65 percent) of the children who had health

check-up, were taken to a private health facility.

AWCs provide various health and nutrition services for children. The survey shows that in providing

immunization AWCs were playing a major role. However, in providing curative services in case of

childhood diseases like diarrhoea, fever, or cough or respiratory infections, or referral services, the

role of AWCs was only modest.

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xv

NUTRITION OF CHILDREN AND ADOLESCENT GIRLS

Nearly one-fifth of newborns who were weighed at birth, were low birth-weight babies. A practice of

breastfeeding is almost universal in India and in case of 45 percent of the children breastfeeding was

started within an hour of birth, as recommended. Though for majority of the children breastfeeding was

started after one hour of birth, in case of 86 percent of the children mothers fed them with first yellow

thick milk. The practice of giving pre-lacteal feeding was prevalent. About one-fourth (22 percent) of the

children aged 0-23 months were given pre-lacteal feeds, milk being the most prevalent pre-lacteal feed.

Almost two-thirds (65 percent) of the children aged 0-5 months were exclusively breastfed. Most (85

percent) of the children were breastfed till age one. Even a majority of the children were breastfed till

age two.

Only in case of one-half of the children introduction of complementary food was timely, as 51 percent of

the children aged 6-8 months were introduced to complementary food. Among the children aged 6-23

months, 41 percent received food for minimum number of times, 22 percent were fed food with

minimum dietary diversity and only 11 percent of the children received minimum acceptable diet.

Among all the infants and young children aged 6-23 months, 36 percent consumed foods rich in vitamin

A and 43 percent consumed iron rich food in the day or night preceding the survey.

Less than one-half of children (45 percent) aged 6-59 months received vitamin A supplementation in six

months preceding the survey. Little more than one-fourth of the children received deworming medicine.

The coverage of IFA supplementation was much lower as only 13 percent of the children aged 6-59

months received IFA supplementation in 6 months preceding the survey.

Among the children aged 0-59 months, 39 percent were stunted or short for their age, 15 percent were

wasted or thin for their height and 29 percent were underweight or light for their age. Out of 39 percent

of stunted children, 17 percent were severely stunted, i.e., every sixth child was severely stunted. About

5 percent of the children were severely wasted and 9 percent were severely underweight. These

estimates imply improvement in nutritional status of children since NFHS-3 in 2005-06. The stunting has

decreased by a rate of 1.3 percentage points per year during seven years between 2005-6 and 2013-14,

and underweight proportion has decreased by 2.0 percentage points per year. The level of wasting was

lower compared to that of stunting and underweight and hence decreased at slower rate of 0.7

percentage points per year.

Among adolescent girls, 44 percent of the adolescent girls were severely thin and additional 19 percent

were moderately thin. So in all 63 percent of the girls were thin or under-nourished.

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xvi

UTILIZATION OF ICDS SERVICES

Awareness of Services Available at Anganwadi Centre

Among the mothers of children aged 0-71 months, 94 percent were aware of at least one out of

six services provided from AWCs. Maximum awareness was about supplementary food (89

percent), followed by immunization (58 percent), preschool education (47 percent), and health

check-up (31 percent). Only 13 percent mothers were aware of referral services.

Ten percent mothers of children 0-71 months were aware of all six services available from AWCs

and about 6 percent did not have awareness of any service.

Awareness of at least one service was more among rural mothers of 0-71 month old children (95

percent) than the urban mothers (90 percent). The mothers belonging to the lowest wealth

quintile were more aware of at least one service available from AWC (95 percent) than the

mothers from the highest quintile (91 percent).

Utilization of AWC Services

Forty-eight percent lactating mothers of children aged 0-5 months, 46 percent currently

pregnant women, 54 percent children aged 6-35 months and 48 percent children aged 36-71

months reportedly received at least one service from AWCs. The services received were mainly

supplementary food, pre-school education and health check-up.

Eight percent lactating mothers, 9 percent children aged 6-35 months, 8 percent children aged

36-71 months and 7 percent currently pregnant women reported availing all relevant services

from AWC.

Type of Supplementary Food Received by Beneficiaries

Forty two percent of lactating mothers (mothers of children aged 0-5 months) reported to have

received supplementary food. The proportion of children aged 6-35 months and 36-71 months

received supplementary food from AWC was 49 percent and 44 percent, respectively.

Among the beneficiary groups who received supplementary food, 27 percent lactating mothers,

39 percent children aged 6-35 months and 88 percent children aged 36-71 months reported

receiving Hot Cooked Meal (HCM). More than two-thirds lactating mothers and children aged 6-

35 months received Take Home Ration (THR). Twenty-two percent children aged 36-71 months

reportedly received morning snacks.

Receipt of Supplementary Food

One-fifth of the lactating mothers and mothers of children aged 6-35 months, 31 percent

children aged 36-71 months and 28 percent currently pregnant women reported receiving

supplementary food for 21 or more days.

Among the children aged 36-71 months who received supplementary food from the AWC,

around 68 percent consumed it at the AWC itself and 25 percent consumed it at home. The

RAPID SURVEY ON CHILDREN 2013-14 EXECUTIVE SUMMARY| xvii

proportion of children consuming the supplementary food at the AWC was higher in rural areas

(69 percent) as compared to those in urban areas (60 percent).

Attendance at Pre-school Education (PSE) and age at attending PSE

Thirty-nine percent of the children aged 36-71 months attended PSE at the AWC. More rural

children (43 percent) attended PSE than urban children (27 percent). More ST children (51

percent) attended PSE than SC (41 percent), OBC (35 percent) and children belonging to general

castes (38 percent).

The mean age at which the child started attending the PSE was 39 months.

Among the children attending PSE at the AWC, 58 percent attended the PSE for more than 16

days.

Other Services at AWCs

Close to a fourth (23 percent) of the rural EMW were aware of the VHND (village health and

nutrition day) conducted at AWC and out of them 43 percent reportedly participated in at least

one VHND in three months preceding the survey.

Overall 35 percent of the EMW reported that the AWW had visited them at their home at least

once in the three months preceding the survey.

INTRODUCTION

RAPID SURVEY ON CHILDREN 2013-14 CHAPTER 1 | 1

CHAPTER 1 INTRODUCTION

1.1 BACKGROUND

Considering the children1 at the centre of country’s development, the Government of India re-iterated

its commitment for their well-being through the National Policy for Children,2 2013. It underlines

survival, health, nutrition, development, education, protection and participation as the undeniable

rights of every child. The early childhood period is critical for the survival and development. Recognizing

the need to lay a strong healthy foundation for every child, from an early stage of life and welfare of all

women especially pregnant women and nursing mothers, the Ministry of Women and Child

Development (MWCD) implements several flagship schemes across the country through the state

governments and the Union Territories (UTs). The Integrated Child Development Services (ICDS) scheme,

launched in 1975 is one of the important schemes of the Ministry with the objective to reduce

malnutrition, morbidity, mortality and low learning capacity among children below age six. The ICDS

scheme aims to provide services through a network of village level service centres, named as Anganwadi

centres (AWCs), supported by village level workers, called Anganwadi worker (AWW) and Anganwadi

helper.

The impact of ICDS is measured through an evolving monitoring system for which data from all AWCs

are collected through several registers maintained manually at the AWC level. Like other MIS based

information system, the information system suffers on account of coverage, reliability and timeliness.

During the last 20 years, though many nationwide surveys like National Family Health Survey (NFHS

1992-93, NFHS 1998-99 and NFHS 2005-06) and District Level Health Surveys (DLHS 2007-08) of the

Ministry of Health and Family Welfare (MoHFW), Annual Health Survey (AHS) of Office of the Registrar

General provided useful data on maternal and child health care. These large scale surveys were mainly

planned to focus on family planning, reproductive health of women and child health. It did not cover the

critical information on the implementation of the ICDS scheme. Second, most information that is

available in the public domain on the output/outcome on children and women are not

contemporaneous. This impedes comprehensive analysis of the situation of children and women on a

fixed time frame.

Commitment to achieve the Twelfth Five Year Plan goals by 2017 and the need to measure the progress

made due to Government’s endeavour through national programmes set out the need for up to date

data. This required setting up a robust monitoring mechanism that would enable the triangulation of the

MIS based information. This affirmed the need to conduct the Rapid Survey on Children (RSOC)—a

nationwide household cum facility survey. The MWCD requested UNICEF to support the survey.

1 Persons below 18 years.

2 http://www.wcd.nic.in/policies/nationl-policy-children-2013/ (last accessed 4 January 2016).

INTRODUCTION


The RSOC has been planned as a nationwide household cum facility survey of the Union MWCD. The

Technical Advisory Committee (TAC) set up by the Ministry was chaired by the Joint Secretary, in charge

of ICDS, MWCD and co-chaired by Prof P.M. Kulkarni, a senior Professor in Jawaharlal Nehru University

(JNU). The committee consisted of members from the Ministry of Women and Child development,

Ministry of Health and Family Welfare (MoHFW), National Institute of Public Co-operation and Child

Development (NIPCCD), Nutrition Foundation of India (NFI), International Institute for Population

Sciences (IIPS), Tata Institute of Social Sciences (TISS) and independent subject experts. A series of TAC

meetings were organized at different stages of the survey. Terms of reference of the Committee were as

follows:

To finalize the list of indicators and standardize the meta information;

To finalize the sample design, determination of sample size, the estimation procedure and the

state wise allocation of the sample;

To develop the technical base paper on the survey;

To develop and finalize the survey tools including Training and Field Manuals and pilot it;

To set up the edit rules including quality control in data capture and processing;

To approve the tabulation plan and the output formats;

To approve finally the results.

1.2 CHAPTER CONTENT

This chapter provides information on the following aspects of RSOC, 2013-14.

Objectives of the survey

Study area

Survey design and methodology

Pilots

Implementation of the survey on CAPI

Survey tools

Computation of wealth index

Details of survey implementation

1.3 STUDY OBJECTIVES

The specific objectives of the survey were to assess the situation of well-being of children and women

based on selected list of indicators provided by the Ministry of Women and Child development. The list

included indicators to assess awareness and utilization of ICDS services at the household level along with

coverage and delivery of ICDS related services through AWCs under ICDS scheme. The survey was also

mandated to collect information on the profile of AWCs and its workers, services provided, utilization of

the services, participation and support from health workers, participation/support of community leaders

and extent of convergence.

INTRODUCTION


1.4 SURVEY DESIGN AND METHODOLOGY

1.4.1 Approach

The objectives of the RSOC entailed collection of information at the household as well as at the

Anganwadi level. The survey at the household level was planned to provide information relating to

household population and housing characteristics including literacy, educational attainment and gender

parity among household members, housing conditions, water, sanitation and hygiene practices,

marriage, birth registration and birth certificates, early marriage; maternal health care and its

component; child health care including morbidity and its management, child immunization, infant and

young child feeding practices (IYCF), growth-monitoring, nutritional status of children, body mass index

(BMI) of adolescent girls (age 10-18) as well as awareness and utilization of ICDS services. All information

collected at household level and its analysis has been collated in the national report.

From the AWCs, the survey was designed to collect information pertaining to profile of the AWWs and

physical infrastructure of the AWCs, coverage of the target population under different ICDS services;

delivery and utilization of all the six services provided under ICDS including supplementary food, growth

monitoring, pre-school education, Nutrition and Health Education and VHND and referral services;

convergence with health service providers, referral services; correct knowledge about critical service

components; monitoring and supervision activities including community participation in ICDS services.

1.4.2 Sampling design

The sampling strategy for the survey was designed to provide estimates at the national and state levels.

The survey broadly followed a design recommended by the Demographic Health Survey (DHS) and was

similar to the one followed in the different rounds of National Family Health Survey (NFHS). RSOC is a

multi-stage stratified random sampling survey. Census 2011 was used as the frame for selection of

primary sampling units. Within each PSU, a household listing exercise was carried out for selection of

households.

A. Sample size determination

The decisive indicator chosen for determination of sample size for each state was the ‘proportion of

fully-immunized children aged 12-23 months’, as per the Coverage Evaluation Survey conducted in 2009.

The rationale for selection of this indicator is based on the fact that the full immunization is not only a

critical indicator of the survival of children (requiring robust sample size for estimation) but it also

reflects the efficiency and capacity of the programme management. In addition, it also reflects on the

health seeking behaviour of targeted population. The sample size computed based on this indicator

provided a robust sample size for other child and maternal care indicators too. The sample size for each

state was calculated at 95 percent level of confidence with permissible margin of error of 5 percent,

INTRODUCTION


design effect of 1.5 and adjustment factor of 1.1 for non-response. The state sample so estimated was

deflated3 to arrive at the requisite number of sample households.

The state sample of households was allocated to rural and urban areas, proportional to the size of the

state’s urban and rural population, as per Census 2011. In order to ensure adequate representation of

urban samples in states where level of urbanization is below the national average (31 percent as per

Census 2011) urban samples in these states were increased to the level of national urbanization. On this

analogy, for Delhi which is mainly urban, the rural sample was upwardly adjusted to cover 1,000

households. This was adjusted later by appropriate weights. The state wise samples were further

adjusted by Kish’s compromise allocation to ensure reasonable distribution across the states. Same

methodology was adopted in all states to draw the rural and urban sample separately.

In each state, the rural sample of households were selected in two stages, with the selection of Primary

Sampling Units (PSUs), which are villages, at the first stage, followed by the random selection of

households within PSU in the second stage. In urban areas, a three-stage procedure was followed. In the

first stage, urban wards were selected, followed by random selection of one census enumeration block

(CEB) from each sample ward. In the third stage, households were randomly selected within the

selected CEB.

B. Sampling of Rural PSUs

The list of villages as per Census 2011 was taken as the sampling frame for selection of the rural PSUs.

For selection of PSU in each state, a stratified sampling design was adopted. In order to ensure inclusion

of different socio-economic characteristics, in the sample all districts within a state was divided into

contiguous ‘regions’.4 The state’s required rural sample of villages was allocated to the ‘regions’ in

proportion to their population size. The state wise regions formed for RSOC are given in Table 1.2 at

Annexure A. In each ‘region’ villages were further stratified into ‘clusters’5 on the basis of explicit

stratifying variables (like village size or caste) to maximize homogeneity within the ‘clusters’. Female

literacy was used as an implicit stratification variable.6 The PSUs within each ‘cluster’ were selected

independently following the probability proportion to size (PPS) systematic random sampling procedure.

The state wise comparison of population proportions in the RSOC sample villages with that of Census

2011 by various stratification variables is presented in Table 1.4 of Annexure A. Overall, 2,670 villages

were covered in the survey. Large rural PSUs with 250 households or more were divided into mutually

exclusive and exhaustive segments of more or less of equal size (125 households) and two segments

were selected using systematic random sampling procedure to represent the selected village.

3 Using proportion of EMW age 15-34 per household revealed from DLHS 2007-08.

4 A ‘region’ is a group of contiguous districts within a state.

5 A ‘cluster’ is a group of first stage sampling units (villages) within a region, based on stratification.

6 State-wise best sampling model selected for sampling of rural PSUs is given in Table 1.2 of the Annexure.

INTRODUCTION


C. Sampling of Urban PSUs

In each state, the required urban sample was allocated to each of the ‘regions’ (as described above) in

proportion to its respective urban population size of the region. In each ‘region’, the list of wards, as per

Census 2011 was considered as the sampling frame for selection of wards. Within each region, the

required numbers of wards were selected using PPS systematic random sampling procedure taking

female literacy (as per Census 2011) as the implicit variable. The state wise comparison of population

proportions in the RSOC sample urban wards with that of Census 2011 by various stratification variables

is presented in Table 1.5 at Annexure A. From the selected wards, the list of CEBs along with its

population size was collected from the Office of Registrar General of India (ORGI) and one CEB was

selected randomly following PPS systematic sampling procedure. If the selected ward was a slum ward,

CEB from among the slum localities was selected. Overall, 1,487 CEBs were covered in the survey.

D. Selection of the households (HHs)

In RSOC, households were grouped in two categories—households with at least one child below 6 years

referred to as Category ‘A’ and the other households with no child in the specified age group, referred to

as Category ‘B’. The Category A households provided the base for all maternal and child related

indicators and the Category B households complemented the universe for indicators at household level.

In each PSU (village/selected segment/CEB), a house listing and mapping exercise was carried out to

construct the necessary sampling frames for selection of households (HHs). During listing operation,

head of the household or any adult member of the household was asked whether there was a child

below 6 years in the household. This enabled in developing two sampling frames—of Category A and

Category B households.

Following circular systematic random sampling, 20 HHs from Category A frame and six HHs from

Category B frame were selected from each PSU. In case of missing households (locked, migrated, out

etc.) a substitution process was adopted. It was decided that to select the next eligible household in the

respective listing frame.

E. Selection of Anganwadi Centres (AWCs)

In order to asses infrastructure, availability and utilization of ICDS services and other components, as

stated earlier, such AWCs that were functioning and providing services to the sample households within

the selected rural/urban PSUs were covered in the survey. Thus, in the rural areas, all AWCs in the

selected villages having less than 250 households were covered in the survey. In large villages (having

250 or more households), all such AWCs in both the selected segments were covered. In the selected

urban areas, only those AWCs providing services to the selected CEB were covered. Overall, 5,630 AWCs

were covered in the survey.

INTRODUCTION


The state wise number of sample of households and PSUs covered during the survey is given in Table

1.1.

Table 1.1: Number of households and primary sampling units covered in the RSOC survey, 2013-14

States Number of households covered

Number of primary sampling units (PSUs) covered

Total Urban Rural Total Urban Rural

Andhra Pradesh 4,607 1,519 3,088 189 62 127 Arunachal Pradesh 2,357 688 1,669 96 27 69 Assam 3,187 832 2,355 126 33 93 Bihar 6,833 1,737 5,096 273 71 202 Chhattisgarh 2,710 783 1,927 107 31 76 Delhi 3,277 2,295 982 127 89 38 Goa 2,185 1,359 826 85 53 32 Gujarat 3,783 1,625 2,158 150 64 86 Haryana 2,592 908 1,684 100 35 65 Himachal Pradesh 2,704 696 2,008 105 27 78 Jammu & Kashmir 2,354 700 1,654 91 27 64 Jharkhand 2,983 878 2,105 116 34 82 Karnataka 3,516 1,283 2,233 141 51 90 Kerala 2,722 1,287 1,435 109 52 57 Madhya Pradesh 4,489 1,346 3,143 176 53 123 Maharashtra 6,141 2,750 3,391 244 110 134 Manipur 2,144 653 1,491 85 26 59 Meghalaya 2,424 667 1,757 94 26 68 Mizoram 2,136 1,092 1,044 85 44 41 Nagaland 2,057 644 1,413 86 26 60 Odisha 3,525 955 2,570 137 37 100 Punjab 2,632 982 1,650 102 38 64 Rajasthan 4,481 1,317 3,164 174 51 123 Sikkim 2,320 672 1,648 90 26 64 Tamil Nadu 4,244 2,011 2,233 167 80 87 Tripura 2,212 665 1,547 89 26 63 Uttar Pradesh 13,303 4,980 8,323 520 196 324 Uttarakhand 2,292 690 1,602 89 27 62 West Bengal 5,273 1,681 3,592 204 65 139 All States 1,05,483 37,695 67,788 4,157 1,487 2,670

INTRODUCTION


F. Weight computation

The sampling weights have been computed primarily to enable drawing valid statistical inferences, to

keep the weighted sample distribution close to the actual population distribution, for correcting varying

response rates and varying probability of selection of PSUs and households. This adjusted for (1)

oversampling done while selecting 20 households from category A frame (with at least one child below 6

years) (2) oversampling done in a few states for urban/rural sample and (3) segmentation done in large

villages. For details see Annexure A.

1.5 SURVEY TOOLS

1.5.1 House listing

In order to be able to list all households in the selected village/segment/CEB, a detailed house-listing

was done through a house-listing schedule, along with the mapping operation of the selected PSU. Head

of the household (HoH) or any adult knowledgeable member of the household was the respondent for

this. Identification of Category A, B households and AWCs were done during the listing exercise.

1.5.2 Household Questionnaire

The information at household level was collected through a household questionnaire administered to

the head of the selected household or any other adult knowledgeable person (aged 18 or more years) of

the household. This questionnaire also included a section for collection of information on

anthropometric measurements (height and weight) on children (below 5 years) and the adolescent girls

(10-18 years).

1.5.3 Ever Married Women (EMW) Questionnaire

Individual interviews were conducted among all EMW aged 15-49 in the selected households using an

EMW questionnaire. Interviews were held at the household level. In the selected household the

required information was collected from all EMWs, all children below 5 years,7 all adolescent girls aged

10-18 years, and all currently pregnant women and lactating mothers.

1.5.4 Facility (Anganwadi Centre)

The facility component consisted of interview with AWW based on an Anganwadi questionnaire. All

interviews with AWW were held at the AWCs, as survey required recording of information from the

7 Irrespective whether mother or caregiver were in that household.

INTRODUCTION


records/registers maintained at AWC level, monthly progress reports (MPR) and observation of facility in

the AWC.

Thus, RSOC used the following four questionnaires.

House-listing Schedule;

Household questionnaire;

EMW questionnaire;

AWC questionnaire:

Household and EMW questionnaires were canvassed using Computer Aided Personal Interview (CAPI)

method using a tablet/mini-laptop and the AWC questionnaire was canvassed through the traditional

Pen and Paper Personal Interview (PAPI) method. All questionnaires were translated in 18 Indian

vernacular languages and each questionnaire was in bilingual format—English and another Indian

vernacular language, specific to that state. Questionnaires are in Annexure D.

1.5.5 Pilots—finalizing survey tool

Questionnaires were piloted in four states, i.e., Rajasthan, Uttar Pradesh, West Bengal and Madhya

Pradesh. In each state, two PSUs8 (one rural and one urban) were covered. The pilot survey was

undertaken to check relevance of response options, flow/sequence of questions, appropriateness of

translation, and appropriateness of local terminology used, time taken for the interview and problems

encountered in approaching the respondents. The inputs from the pilot exercise were documented and

shared with TAC, and tools were modified wherever required.

1.6 IMPLEMENTATION THROUGH CAPI

The software application developed for the CAPI based questionnaires was pilot tested in the states of

Odisha and West Bengal. In each state, two PSUs (one rural and one urban) were covered. From each

PSU, 50 households (40 households having children 0-6 years and 10 other households) were selected

(using the sampling frame prepared on the basis of the mapping and listing exercise) and the household

and EMW questionnaire were canvassed in CAPI. The observations during the pilot testing on each of

the questions, skips, validation instructions, logic and range checks, ease of navigation of the questions

on CAPI. Software applications were suitably modified and finalized. The translations were loaded onto

the software application and reviewed. The final bilingual CAPI software applications were also tested.

For field implementation of pilot, a team of enumerators (in all four persons) were formed. Each of the

two enumerators (other than the health investigator and the supervisor) was given a mini laptop with

additional battery backup, with the bilingual software loaded on the laptops.

8 These were other than the selected PSUs for the survey.

INTRODUCTION


1.7 SURVEY IMPLEMENTATION

1.7.1 Survey team composition

Each mapping and listing team consisted of two persons and two teams were supervised by an

experienced supervisor. For the main data collection, a survey field team consisted of four members

(two females and one health investigator for taking anthropometric measurements and the supervisor

for the team). Supervisor was a senior person with at least five years of experience. Team members

(enumerators) had basic educational qualification as graduate or higher and at least 2-3 years’

experience of HH surveys like NFHS,9 DLHS,10 AHS11 etc. All enumerators were recruited from the

respective states in order to be familiar with the local language.

1.7.2 Preparation of survey manuals

In order to maintain standardized survey procedures across states and also to minimize non-sampling

errors, two training manuals—(1) manual for household listing and mapping and (2) the interviewer’s

manual for the main survey covering canvassing of household, EMW questionnaire and the facility

(AWC) survey were developed. The manuals had explanations of all questions, their relevance, the

related concepts, terminologies etc. The manuals were also translated into Hindi.

1.7.3 Training of survey teams

Training of Trainers

An extensive 6-day Training of Trainers (ToT) was held in New Delhi. Close to 80 trainers were trained

during the ToT. Officials from UNICEF Delhi and 13 state offices; officials from the MWCD, subject

specialists/professionals from the field, research agencies12 and lead agency, and independent field

monitors attended the TOT. The senior professionals from the lead agency, subject experts from

UNICEF, senior professors from IIPS13 and senior officials from the government imparted the trainings.

The ToT involved detailed discussions on field procedures and protocols, contents of survey instruments,

use of CAPI. General discussions on issues related to health and nutrition were delivered by invited

experts from the respective fields. The training sessions also covered basic information on usage and

care of mini laptops, preparation and set-up of the devices for survey implementation and

demonstration of interviews using CAPI software. Overall training included pedagogy, mock interviews

9 National Family Health Survey.

10 District Level Household Survey.

11 Annual Health Survey.

12 Three agencies were engaged for fieldwork.

13 International Institute for Population Sciences.

INTRODUCTION


and practices. Separate demonstration and practice sessions were organized to orient the trainees

about the use of various anthropometric equipments.

Standardized presentations were developed for different sessions of the ToT which were subsequently

used in the state-level trainings. To ensure standardization in state trainings, sessions during the ToT

were video recorded and the same were used during state-level trainings. Professionals from field and

research agencies who participated in the ToT subsequently trained field staff in their respective states

according to the standard procedures discussed in the ToT. State trainings were conducted in all 29

states.

1.7.4 State level trainings

A. State-level trainings for mapping and listing

All listers, mappers and supervisors were given a 3-day training (including one day of field practice) by

the persons trained in the ToT. The training included detailed discussions on procedures to be followed

during mapping and house-listing operations, preparation of location and lay out maps, segmentation

and explanations of each question in the listing schedule.

B. State-level training of field staff for main survey

The enumerators, health investigators and the supervisors recruited for RSOC were given intensive

training by the persons trained in the ToT. Fifty-seven batches of state level trainings were held covering

all the 29 states mainly because in a few big states the state level trainings were organized in more than

two batches. Typically a batch size varied between 35-40 trainees. The state level trainings were

conducted by three trainers, mainly consisting of two trainers from the field agency and one was from

the UNICEF and/or Department of Women and Child Development (DWCD) of the respective state

Government. The state-level trainings were monitored and facilitated by the subject experts from

UNICEF and/or state-level officers from the DWCD and the independent monitor engaged by UNICEF.

The state training agenda was on the lines of the ToT. State-level trainings were given in local language,

using the bilingual questionnaires. In many states, the training extended up to 10 days.

The health investigators were provided special training on taking measurement of height and weight of

children aged 0-5 years and adolescent girls aged 10-18 years, filling up bio-marker forms and

transferring the data from paper schedule to the CAPI. Investigators were also trained about the need

for calibration of the equipment every day before the start of the survey and technique to be used.

Separate training sessions were organized for the supervisors to train them in canvassing the AWC

questionnaire as well as monitoring the work of the interviewers. On the completion of the training

programme, a test was conducted among all the trainees and only those trainees who scored at least 60

percent marks were selected for carrying out the field work of RSOC.

INTRODUCTION


1.7.5 Field Work

A. Field work for mapping and house listing

A total of 170 mapping and listing teams were deployed by the three zonal field research agencies in the

29 states. The listing and mapping operations in the different states were carried out during the

period—November 2013 to January 2014.

B. Field work for main survey

The field work for main survey in the states was carried out during the period—November 2013 to May

2014. A total of 168 field survey teams were deployed in all the 29 states and the survey was

undertaken with approximately 350 CAPI devices.

1.7.6 Field Monitoring and Quality Control

Since household interviews were conducted using CAPI method, the software application took care of a

majority of the logical checks (validation of inputs) at the time of data input during the interview itself.

Besides, there were four other layers of quality assurance.

A. Monitoring by the supervisor of the field team

The supervisors, on a sample basis, made accompanied calls, spot-checks and back-checks in 20 per cent

of the households that were completed by the enumerators in the teams. The team supervisors were

provided with a printed version of the questionnaire highlighting 25-30 specific critical questions for the

back checks. Further, the CAPI was programmed in a manner to make voice recording14 for the initial

introduction, including consent of respondent to undertake the interview and for a few identified critical

questions that were to be back-checked by the supervisors. The supervisors checked the audio-

responses vis-à-vis the data collected during back-check and checked the relevance, quality of protocol

followed and accuracy of the responses entered in the CAPI. In case of data mismatch, the supervisors

intimated the change to the investigators who in turn corrected the responses in their master datasets

in presence of the supervisors.

The supervisors organized regular de-briefing sessions at the end of each day with the teams to

overcome the common errors and other field problems encountered by the team.

14 Permission was taken from the respondent for recording the responses.

INTRODUCTION


B. Monitoring by Field Executives or Field Coordinators of field research agency

The activities entrusted to the teams’ supervisors were monitored by Field Executives (FEs) or Field

Coordinators (FC) of the field research agencies. The FEs were responsible for the quality of data

collected and were the focal points of co-ordination between the research staff15 and the field teams

from the agency side.

C. Independent monitors (Third Party Independent Monitors)

Independent monitors (TPIM) comprising officers from UNICEF state offices, Population Research

Centres (PRC)16, NIPCCD17 and SIHFW18 were engaged for ensuring overall quality of the RSOC field

survey. The tasks of the monitors were to ensure quality in recruitment of enumerators and team

supervisors, supervision of state trainings; monitoring adherence of the survey protocols and ethical

issues; assessing quality of house-listing operation, achieving desired response rates; ensuring data

consistency, and adherence to timelines in completing survey. In the field, monitors’ activities involved

concurrent observation of the interview (wherever possible and ethically correct) and give feedback to

UNICEF through the fastest available communication mode followed by a written feedbacks within three

days of completion of inspection. Clarifications on technical issues wherever found incorrect or

inadequate were broadcasted on the same day to all the supervisors.

D. Analysis based on field-check tables:

Further, to validate the field data, field check tables were generated for key indicators based on data

downloaded from the server on a weekly basis for all states. This enabled monitoring of the collected

data, team wise. Based on the data analysis, instructions were issued to the respective field agencies on

low response rates of target population, errors in age structure, heaping of age, errors in data recording,

missing data from different sections of the questionnaire etc.

15 Research staffs were mainly located in Delhi which managed the overall performance of the survey including quality of data.

This staff was mainly responsible for data analysis after the data collection was over. 16

A team of researchers/demographers from different universities. 17

National Institute of Public Cooperation and Child Development, popularly known as NIPCCD, is a premier organization devoted to promotion of voluntary action research, training and documentation in the overall domain of women and child development. 18

State Institute for Health and family Welfare, Government of Odisha.

INTRODUCTION


1.8 DATA PROCESSING AND ANALYSIS

1.8.1 Processing data collected through CAPI

The data collected through CAPI software was converted into SPSS (Statistical Package for Social

Science) data format for storage, processing and analysis. The data for key indicators like household

composition and other demography, access to improved water and improved toilets, percentage of

children aged 3-6 years attending PSE at AWC, registration of pregnancy for ANC, proportion of women

who have given a live birth in last three years, receipt of at least 3 and 4 ANCs, institutional birth,

immunization indicators, morbidity indicators, etc., were validated with available secondary data.

In order to have a set of standard and uniform validation rules, three data processing and validation

workshops were organized.

1.8.2 Processing of data collected through PAPI

The AWC data collected in PAPI mode was scrutinized and coded in the field before data entry. A data-

entry programme was developed in CS Pro 4.1 with requisite validation for routing, skipping and range

checks. Data was converted into SPSS for storage, processing and analysis.

1.8.3 National and state level sample weights

In order to present weighted results at the National and State level the sample weights were computed

at the household level as well as at AWC level. The procedure adopted for computation of household

and AWC level weights has been presented in Annexure B.

1.9 WEALTH INDEX

In the absence of income and expenditure measures for measuring economic status, household wealth

Index serves as an effective mean to determine a household’s relative economic status. This helps in

assessing the inequalities in household characteristics and their differential impact with respect to

health outcomes or other service utilization. It has been empirically demonstrated that household

wealth index is consistent with expenditure and income measures (Rutstein, 1999). In RSOC, following

DHS pattern like in NFHS 2005-06 questions at household level were asked about household ownership

of certain assets, amenities, facilities and consumer durable items to determine wealth/asset quintiles.

The wealth index used in this survey has been constructed using data on household possession of assets,

infrastructure and housing characteristics collected in the household questionnaire.

INTRODUCTION


Based on principal component analysis technique each of the household assets/facilities has been

assigned a weight or a factor loading.19 The Asset Scores have then been computed for each household

by using the following formula:

[Value of Asset Variable- Mean of Asset Variable]

HH Asset Score (AS) = _______________________________________ x Weight of component

Standard deviation of Asset Variable

Subsequently, the Asset Scores of all the variables is added at the household level to get the Total Asset

Score for each household. Thereafter, the households are ranked according to their individual

Household Asset Score (HHAS) and divided into five quintiles at the national level. This provides the cut

off points for each quintile.

1.10 STRUCTURE OF THE NATIONAL REPORT

As stated earlier, the RSOC national report has been structured as follows.

CHAPTER 2: Household Population and Housing Characteristics

CHAPTER 3: Profile of Ever Married Women and Children

CHAPTER 4: Maternal Health Care

CHAPTER 5: Child Health

CHAPTER 6: Nutrition of Children and Adolescent Girls

CHAPTER 7: Utilization of ICDS—Coverage of Target groups and services availed from Anganwadi

Centres (mother of children 0-71 months and currently pregnant and lactating women)

ANNEXURES

Annexure A: Sample design details and Tables (containing tables20 from all chapters) and weight

computation.

Annexure B: Survey Tools

19 The RSOC wealth index is based on the following 39 assets and housing characteristics: type of dwelling, number of rooms

used for sleeping, availability of a separate kitchen for the household, type of flooring; material of exterior walls; type of roofing, ownership of the house, electrification of the household, ownership of a mattress, a pressure cooker, a chair, a cot/bed, a table, an electric fan, a radio/transistor, a black and white television, a colour television, a sewing machine, a mobile telephone, any other telephone, a desktop computer, a laptop computer, an air cooler, an air conditioner, a washing machine, a refrigerator, a watch or clock, a bicycle, a motorcycle or scooter, an animal-drawn cart, a car/jeep, a water pump, a thresher,

and a tractor; drinking water source; location of the water source, type of toilet facility and main type of cooking fuel used.

20 Tables have been numbered according to the chapter to which it belongs; for example a Table from Chapter 4 has been

numbered as Table 4.XX.



CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS

This chapter presents the demographic profile and socio-economic characteristics of the sample

households covered under the Rapid Survey on Children (RSOC) 2013-14. The demographic profile and

socio-economic characteristics include population composition in terms of age, sex and marital status,

literacy level and educational attainment, and school/college attending status for those in the age group

5-24 years during 2012-13 as well as 2011-12 and reasons for dropping out. The marital status and

questions to ascertain literacy level and educational attainment were probed from usual residents (de

jure population) in the age-groups 10 years and above and 5 years and above respectively. Information

on social group and religion was collected from the head of the household.

This chapter also provides an overview of the socio-economic characteristics of the household on critical

parameters such as housing conditions (type of dwelling, number of rooms used for sleeping, ownership

of house etc.), having a bank account, availability of electricity, possession of durable goods, means of

transport, type of fuel used, main source of drinking water, sanitation facilities and hand washing.

Information on household assets is used to create a wealth index as an indicator of household economic

status.

Further, the chapter depicts the results of the test done to assess whether the salt used for cooking by

the household is adequately fortified with iodine. As a part of this survey, anthropometric

measurements of children between 0 to 59 months and adolescent girls in the age group of 10 to 18

years were taken to assess their nutritional status and results on these have been discussed in

subsequent chapters.

A household was defined as a group of persons who may be related by blood, marriage or adoption or

unrelated but staying together under the same roof and having food from the same kitchen. A usual

resident of the household was defined as a person who had been living in the household—under the

same roof and sharing the same kitchen for the last six months or more or had an intention to stay here

for the next six months as on the date of survey. Head of the household is a person who is a usual

member of the household; bears the chief responsibility for managing the affairs of the household and

takes decision on behalf of the household and is recognized as such by the household.

The information in this chapter is intended to facilitate interpretation of the key demographic, socio-

economic, and various other themes on the well-being of children and women presented later in the

report. It is also intended to assist in the assessment of the representativeness of the survey sample.



The chapter is structured into the following sub-sections:

2.1 Response Rates

2.2 Household population by age, sex and marital status

2.3 Household composition by usual members

2.4 Profile of the head of the household

2.5 Literacy, education attainment and gender parity of household members

2.6 Housing conditions

2.7 Water, sanitation and hygiene practices of the household

2.8 Household possession and wealth quintiles

2.9 Iodine levels in cooking salt

2.1 RESPONSE RATES

A total of 1,08,082 households were selected in the sample, of which 1,05,483 were successfully

interviewed yielding a household response rate of 97.6 percent. A total of 1,18,027 ever married women

(EMW) aged 15-49 were identified in the 1,05,483 households interviewed (an average of 1.12 EMW per

household). Of the eligible EMW, 1,11,636 were successfully interviewed, yielding a response rate of

94.6 percent. The principal reason for non-response among eligible women was the failure to find

individuals at home despite repeated visits to the household. As per the survey protocol, three visits per

household were mandatory. Table 2.1 presents the response rates for different categories of

respondent groups.

A sample of 99,396 children aged 0-59 months was identified in the interviewed households. Of these,

anthropometric measurements on height and weight were taken for 90,908 rendering a response rate

of 91.5 percent. Under RSOC, all children of this age group were covered for anthropometric

measurements including such children whose mother/caregiver were not living in the household at the

time of survey and also those children whose mother/caregiver had died.

Against 34,704 adolescent girls aged 10-18 identified across households interviewed, the height and

weight could be measured of 28,521 girls, yielding a response rate of 82.2 percent. The non-response

was mainly due to the fact that girls in this age group were not at home during the survey time because

of various reasons, such as being in schools and colleges. Repeat visits (at least three visits) were made

as per the survey protocol. Overall, the response rates do not vary much across urban and rural areas as

seen in Table 2.1.



Table 2.1: Results of the household and individual interviews and anthropometric measurements

Results Residence

Urban Rural Total

Household interviews

Households selected 38,662 69,420 1,08,082

Households interviewed 37,695 67,788 1,05,483

Household response rate 97.5 97.6 97.6

Interviews with ever married women aged 15-49

Number of eligible women in the households 42,472 75,555 1,18,027

Number of eligible women interviewed 40,333 71,303 1,11,636

Eligible women response rate 95.0 94.4 94.6

Anthropometric measurement with children aged 0-59 months

Number of children aged 0-59 months identified in the interviewed households

33,819 65,577 99,396

Number of children aged 0-59 months measured 30,974 59,934 90,908

Anthropometric measurement Response rate 91.6 91.4 91.5

Anthropometric measurement of adolescent girls aged 10-18

Number of adolescent girls aged 10-18 in the interviewed households 10,963 23,741 34,704

Number of adolescent girls aged 10-18 measured 9,147 19,374 28,521

Anthropometric measurement of adolescent girls response rate 83.4 81.6 82.2

Household Response Rate: Households interviewed/households selected *100 Individual Response Rate: Respondents interviewed/eligible respondents *100

Table 2.2 presents the all India and state-wise number of persons interviewed and their response rates

with respect to both category of households, EMW aged 15-49, children aged 0-59 months and

adolescent girls aged 10-18 whose anthropometric measurements were taken.

For category ‘A’ households (with at least one child below six years of age) which provided the base for

all maternal and child related indicators a response rate of 97.6 percent was achieved at the national

level. For category ‘B’ households (without any child below six years of age) which complemented the

universe for indicators at household level the response rate at national level was also around 97.5

percent. Further details on category ‘A’ and ‘B’ households are given in Chapter 1.



Table 2.2: Number of households covered in the survey and ever married women aged 15-49 interviewed and anthropometric measurements taken according to states, RSOC, 2013-14

State

Category A HHs

interviewed

Category B HHs

interviewed

EMW aged 15-49

interviewed

Anthropometric measurements taken

Children 0-59

months

Adolescent girls

aged 10-18

Number RR Number RR Number RR Number RR Number RR

India

Andhra Pradesh

Karnataka

Kerala

Tamil Nadu

Goa

Gujarat

Maharashtra

Chhattisgarh

Madhya Pradesh

Jharkhand

Punjab

Rajasthan

Delhi

Haryana

Himachal Pradesh

Jammu & Kashmir

Uttar Pradesh

Uttarakhand

Assam

Arunachal Pradesh

Manipur

Meghalaya

Mizoram

Nagaland

Sikkim

Tripura

West Bengal

Bihar

Odisha

81,169

3,634

2,736

2,081

3,296

1,685

2,965

4,785

2,106

3,464

2,287

2,020

3,437

2,515

1,992

2,074

1,808

10,183

1,758

2,432

1,781

1,634

1,860

1,633

1,578

1,780

1,678

4,049

5,215

2,703

97.6

96.1

97.0

95.5

98.7

99.1

98.8

98.1

98.4

98.4

98.6

99.0

98.8

99.0

99.6

98.8

99.3

97.9

98.8

96.5

92.8

96.1

98.9

96.1

91.7

98.9

94.3

99.2

95.5

98.6

24,314

973

780

641

948

500

818

1,356

604

1,025

696

612

1,044

762

600

630

546

3,120

534

755

576

510

564

503

479

540

534

1,224

1,618

822

97.5

85.8

92.2

98.0

94.6

98.0

90.9

92.6

94.1

97.1

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

99.9

100.0

100.0

100.0

98.6

92.8

100.0

100.0

100.0

98.8

100.0

1,11,636

4,636

3,716

2,680

4,037

2,186

4,287

6,477

2,788

5,030

3,193

2,965

5,077

3,647

2,966

2,897

2,576

14,728

2,515

3,157

2,291

2,082

2,226

2,117

1,924

2,428

2,430

6,068

6,992

3,520

94.6

95.4

90.3

87.6

91.8

93.9

94.8

91.4

94.6

94.3

99.2

98.6

92.5

96.4

97.6

96.2

97.2

94.8

97.5

93.8

96.7

97.8

89.6

95.2

94.8

94.7

98.8

97.8

92.0

97.0

90,908

4,293

3,285

1,717

3,131

1,802

3,529

5,589

2,481

4,184

2,658

2,208

3,979

2,627

2,443

2,300

2,111

11,781

1,989

2,372

1,953

1,736

2,030

1,611

2,283

1,767

1,637

4,056

6,509

2,847

91.5

94.4

94.6

83.6

81.6

94.7

92.8

92.8

92.3

91.9

95.6

95.2

84.8

90.0

91.5

93.4

88.7

87.6

88.8

94.2

93.4

95.6

95.1

91.5

98.2

93.7

95.1

94.9

92.3

94.1

28,521

655

565

311

721

333

964

1,287

815

1,556

1,111

593

1,591

832

650

531

686

5,587

602

883

519

592

640

313

454

585

405

1,292

2,618

830

82.2

93.8

64.8

67.6

100.0

83.0

86.8

87.7

82.4

86.5

94.4

86.1

82.3

88.8

90.3

80.9

73.1

78.3

75.9

85.2

79.7

89.6

88.4

81.7

99.3

72.0

83.3

86.7

75.2

81.2

The response rates for anthropometric measurements of adolescent girls aged 10-18 across a large number of states is comparatively on the lower side. There are 16 states where it ranges in 80-90 percentage, six states in 70-80 percentage and two states in 60-70 percentage. Across the states, it was seen that the girls were not found at home despite the mandatory three visits to households. Most of the times, girls were either in school or college or were engaged in economic/household activities which rendered them away from home.



2.2 HOUSEHOLD POPULATION BY AGE, SEX AND MARITAL STATUS

Age and sex are the two most critical demographic variables that lay the foundation of demographic

classifications in vital statistics, censuses and surveys. In general, a cross-classification by sex and age is

essential for carrying out an effective analysis of all crucial indicators obtained in surveys. A closer

examination of the age and sex distribution also aids in assessing the quality and statistical rigour of the

entire survey process.

Table 2.3 shows the distribution of the household population by five-year age groups, according to

urban-rural residence and sex. The total estimated population covered in the RSOC 2013-14 was 4,

95,571 (2, 50,566 males and 2, 45,005 females) across 1, 05,483 interviewed households.

The age structure of the household population at the national level is typical of a society with a youthful

population. The sex and age distribution of the population is shown in the population pyramid in Figure

2.1. It depicts a pyramidal age structure due to large number of children below age 15. It is evident that

the pyramid is broad based with the lowest two bases (0- 4 years and 5-9 years) being narrower than 10-

14 years in a reverse order, a pattern that is typically associated with faster decline in fertility in more

recent history. Broadly, children under age 15 account for 31 percent, while 64 percent of the country’s

residents are in the 15-64 age group and 5 percent are over 65.



Table 2.3: Household population by age and sex according to residence

Percent distribution of household population by five-year age groups, according to sex and residence, India, RSOC, 2013-14

Age Urban Rural Total

Male Female Total Male Female Total Male Female Total

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Total

0-2

3-5

0-5

15-24

<18

18+

Number

Sex ratio, all ages1

Sex ratio, age 0-4 years1

Sex ratio, age 0-6 years1*

9.2

9.5

10.0

9.1

8.5

8.9

8.7

7.9

6.6

5.6

5.0

3.5

3.0

1.8

1.3

0.6

0.7

100.0

5.5

5.9

11.5

17.6

34.2

65.8

80,379

na

na

na

8.9

9.3

9.1

8.9

10.1

10.6

8.6

7.9

5.8

6.4

4.1

3.3

2.8

1.8

1.1

0.6

0.8

100.0

5.3

5.7

11.0

19.0

32.7

67.3

77,371

na

na

na

9.1

9.4

9.6

9.0

9.3

9.7

8.7

7.9

6.2

6.0

4.6

3.4

2.9

1.8

1.2

0.6

0.7

100.0

5.4

5.8

11.2

18.3

33.4

66.6

1,57,750

963

931

923

10.8

11.2

11.3

9.8

8.3

7.8

7.0

6.9

5.6

5.2

4.6

3.3

3.1

2.1

1.6

0.7

0.7

100.0

6.6

6.9

13.4

18.1

39.3

60.7

1,70,187

na

na

na

10.3

10.9

10.8

10.2

9.1

9.0

7.3

6.6

5.2

6.0

3.8

3.0

2.9

1.9

1.5

0.6

0.9

100.0

6.2

6.4

12.6

19.3

38.4

61.6

1,67,634

na

na

na

10.6

11.1

11.1

10.0

8.7

8.4

7.2

6.7

5.4

5.6

4.2

3.2

3.0

2.0

1.5

0.7

0.8

100.0

6.4

6.6

13.0

18.7

38.8

61.2

3,37,821

985

936

928

10.3

10.6

10.9

9.6

8.3

8.1

7.6

7.2

5.9

5.3

4.7

3.4

3.1

2.0

1.5

0.7

0.7

100.0

6.2

6.5

12.8

17.9

37.6

62.4

2,50,566

na

na

na

9.8

10.4

10.3

9.8

9.4

9.5

7.7

7.0

5.4

6.1

3.9

3.1

2.9

1.9

1.4

0.6

0.9

100.0

5.9

6.2

12.1

19.2

36.6

63.4

2,45,005

na

na

na

10.1

10.5

10.6

9.7

8.9

8.8

7.7

7.1

5.7

5.7

4.3

3.2

3.0

1.9

1.4

0.6

0.8

100.0

6.1

6.4

12.5

18.6

37.1

62.9

4,95,571

978

934

927

na = Not applicable. 1

Females per 1,000 males. *Inclusive both age groups



Although the proportion of the population under age 15 remains large (31 percent), this proportion has

been declining consistently since 1991 (38 percent), 2001 (36 percent), 2005-06 (35 percent) and 2011

(31 percent). The proportion of the population under age 15 is somewhat lower in urban areas (28

percent) than in rural areas (33 percent), a pattern consistent with higher fertility in rural than urban

areas. About 10 percent of the population is under age 5.

The proportion in other critical age groups such as adolescents (10-19 years) stands at 20 percent, young

(15-24 years) at 19 percent and adults (18 years or more) at 63 percent. Table 2.4 shows that trend in

age distribution of household population by five year age groups and overall sex ratio at the national

level from 1991 to 2013-14.

Table 2.4: Trends in age distribution of household population

Percent distribution of household population by five-year age groups, overall sex ratio, India, 1991-

2013-14.

Age group Census,

1991

NFHS-1,

1992-93

NFHS-2,

1998-99

Census,

2001

NFHS-3,

2005-06

Census,

2011

NSS 60th

Round, 2006

RSOC,

2013-14

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Total

Sex ratio1

12.3

13.4

11.8

9.5

8.9

8.3

7.0

6.3

5.1

4.3

3.7

2.6

2.7

1.5

1.3

0.5

0.8

100.0

928

12.5

13.4

12.1

10.3

9.1

8.0

6.5

5.9

4.5

3.8

3.1

3.1

2.9

1.9

1.5

0.6

0.8

100.0

957

11.4

12.7

12.0

10.4

8.9

8.2

6.8

6.4

4.9

4.3

3.2

2.9

2.9

2.0

1.6

0.6

0.8

100.0

960

10.8

12.5

12.2

9.8

8.8

8.1

7.2

6.9

5.4

4.6

3.6

2.7

2.7

1.9

1.4

0.6

0.8

100.0

933

10.9

12.0

12.0

9.5

8.6

8.0

6.7

6.8

5.3

4.5

3.7

3.4

3.1

2.2

1.6

0.7

0.9

100.0

1000

9.4

10.5

11.0

10.0

9.2

8.4

7.3

7.1

6.0

5.2

4.1

3.2

3.1

2.2

1.6

0.8

0.9

100.0

943

11.1

12.0

11.7

9.4

8.7

8.2

7.4

6.9

5.5

4.7

3.7

3.7

2.5

2.0

2.4

na

na

100.0

952

10.1

10.5

10.6

9.7

8.9

8.8

7.7

7.1

5.7

5.7

4.3

3.2

3.0

1.9

1.4

0.6

0.8

100.0

978 1Females per 1000 males. na: not applicable.

Further, a comparison of the RSOC age-sex distribution (Figure 2.1) with that of Census 2011 (Figure 2.2)

reveals a very close pattern across age groups which reassures about the robustness of the population

structure revealed through the survey.



Figure 2.1: Age-Sex Pyramid, India, 2013-14 Figure 2.2: Age-Sex Pyramid, India, Census of India, 2011

Table 2.5 portrays the percent distribution of household population by broad age-groups according to

states and all India. A perusal of population composition across these age groups distinctly highlights the

fact that states are at different stages of demographic transition and the overall pattern seems to be

broadly consistent with Census 2011 data. On one hand, there are states like Kerala, Punjab, Goa

reporting less than 25 percent below age 15 population and on the other hand, states like UP,

Meghalaya, Arunachal Pradesh, Jharkhand and Bihar report in excess of 35 percent, Bihar in particular

crossing 40 percent mark.

12 10 8 6 4 2 0 2 4 6 8 10 12

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Percent

Female

Male

12 10 8 6 4 2 0 2 4 6 8 10 12

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80+

Percent

Female

Male



Table 2.5: Household Population by age and state

Percent distribution of household population by broad age-groups, according to states and India, RSOC, 2013-14

State Age group

Total 0-4 5-9 10-14 15-19 20-24 25-64 65+

India

North

Delhi

Haryana

Himachal Pradesh

Jammu & Kashmir

Punjab

Uttar Pradesh

Uttarakhand

Central

Chhattisgarh

Madhya Pradesh

East

Bihar

Jharkhand

Odisha

West Bengal

Northeast

Arunachal Pradesh

Assam

Manipur

Meghalaya

Mizoram

Nagaland

Sikkim

Tripura

West

Rajasthan

Goa

Gujarat

Maharashtra

South

Andhra Pradesh

Karnataka

Kerala

Tamil Nadu

10.1

9.6

11.1

8.0

9.4

7.2

11.2

9.6

10.3

10.4

13.5

12.2

9.2

8.3

14.3

9.7

11.3

14.8

9.6

18.7

7.5

8.9

11.0

8.3

10.3

9.1

9.3

8.9

7.7

8.5

10.5

9.8

9.5

8.4

10.8

8.1

12.2

10.4

9.5

10.8

14.1

13.7

9.7

8.6

13.8

12.0

11.5

12.8

11.2

7.4

8.5

8.5

12.3

7.7

9.1

8.6

10.1

8.7

8.2

9.4

10.6

9.5

9.0

9.2

10.6

8.5

13.0

12.1

10.5

10.8

13.4

12.1

9.3

9.4

8.8

11.5

10.0

9.1

7.2

5.2

12.5

8.5

11.6

8.3

9.7

9.2

8.4

9.2

7.7

9.9

9.7

9.9

9.6

8.4

10.6

9.7

11.9

11.6

10.6

10.3

9.3

9.8

8.6

10.1

9.1

9.0

7.1

8.8

9.5

15.7

10.9

8.4

9.8

6.2

9.2

8.8

8.6

8.8

7.3

8.5

8.9

9.3

10.4

8.5

8.7

9.5

9.0

8.6

10.2

8.8

6.5

8.3

8.6

9.8

7.4

9.5

8.3

9.9

9.3

10.0

8.9

9.9

8.8

8.0

9.4

9.7

9.9

9.3

7.4

7.4

45.5

48.7

45.3

51.1

44.2

49.5

38.5

42.1

44.5

44.2

38.9

40.5

47.6

48.8

44.9

45.4

47.1

43.1

51.3

42.6

46.8

51.7

41.0

55.7

48.5

49.0

51.1

49.7

54.5

51.4

4.8

3.2

5.0

6.4

5.7

7.5

4.3

5.6

4.3

4.6

4.4

3.4

7.0

5.0

1.6

2.9

4.8

1.6

1.9

0.4

5.0

4.1

5.5

5.8

3.9

5.7

2.8

5.5

7.3

4.9

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

100.0

The overall sex ratio is 978 females per 1000 males implying a shortage of 22 females for every 1000

males in the enumerated population. The sex ratio is much higher in rural areas (985 females per 1000

males) than in urban areas (963 females per 1000 males) where it is based on expected lines of more

males migrating to urban areas for work. The sex ratio for population aged 0-6 is 927 girls per 1000 boys

which is quite close to 919 girls per 1000 boys as revealed by Census 2011. RSOC which was done about

three years after Census 2011 hints towards a reversal of trend at least at the national level both in rural

(928 against 923 in Census) as well as urban areas (923 against 905 in the Census). A sleuth of



population policy measures initiated after the provisional figure of 914 girls per 1000 boys (lowest in the

history of censuses) was released may have helped in this correction. Table 2.6 compares the overall sex

ratio and sex ratio for children aged 0-6 for India and states by residence. The table displays some

worryingly high male to female sex ratios in the 0-6 age group. It is less than 900 in 12 states.

Table 2.6: Sex ratio by states

Sex ratio1 among household population by age-groups and residence, according to states, India, RSOC, 2013-14.

State All ages Age 0-6

Urban Rural Total Urban Rural Total

India

North

Delhi

Haryana

Himachal Pradesh

Jammu & Kashmir

Punjab

Uttar Pradesh

Uttarakhand

Central

Chhattisgarh

Madhya Pradesh

East

Bihar

Jharkhand

Odisha

West Bengal

Northeast

Arunachal Pradesh

Assam

Manipur

Meghalaya

Mizoram

Nagaland

Sikkim

Tripura

West

Rajasthan

Goa

Gujarat

Maharashtra

South

Andhra Pradesh

Karnataka

Kerala

Tamil Nadu

963

913

908

886

934

866

924

1,011

919

962

925

939

1,005

1,000

989

1,005

1,016

998

1,009

1,023

1,027

1,010

979

1,015

928

904

1,072

994

1,060

1,009

985

891

916

1,021

923

908

971

1,014

1,017

970

981

1,019

1,025

985

890

944

975

972

785

985

992

971

998

953

966

943

1,034

1,033

1,087

1,008

978

913

913

1,007

926

892

961

1,013

995

968

974

1,002

1,022

990

915

953

989

978

906

999

1,002

981

994

992

948

924

1,047

1,017

1,074

1,008

923

820

935

1,118

805

868

884

849

907

960

906

922

946

1,045

982

923

912

907

961

874

933

1,127

908

951

865

826

1,032

961

1,135

957

929

821

825

978

824

878

934

917

997

893

905

1,125

895

1,047

848

894

899

855

712

858

944

982

823

920

953

844

1,001

973

1,024

960

927

820

857

990

819

874

924

898

979

910

905

1,091

902

1,046

883

898

903

863

844

862

941

1,008

842

940

913

835

1,013

968

1,075

958



Marriage

Marriage is one of the factors that has a direct bearing on the level of fertility as marriage signals the

onset of exposure to the risk of pregnancy for most women and therefore their age at the time of

marriage is considered as a proximate determinant of fertility. The practice of marriage and the age at

the time of marriage in India is quite varied and diverse across different sections of population

differentiated on the lines castes, tribes, religion and beliefs. Levels of education and economic status

are other factors which also considerably influence such behaviour.

Information on age at first marriage was collected in respect of all ever married usual residents of age 10

years and more. Ever married persons include those who are currently married or got married any time

in the past. The first category, i.e., currently married also includes usual residents who are married but

for whom gauna has not yet been performed. Gauna is a tradition particularly practiced in northern

Indian states where a young bride lives with her parents till a certain period after which she goes to stay

with her husband. The second category of formerly married includes widowed, divorced or separated.

Table 2.7 presents the percentage of ever-married population by broad age groups, mean age at first

marriage, median age at first marriage and proportion having got married below legal age of marriage (<

21 years for males and < 18 years for females) in respect of those who got married any time prior to the

survey, according to sex and residence. About 62 percent of males and 72 percent of females got

married any time in the past almost maintaining a similar proportion across rural and urban areas. In

general, the proportion of ever married population increases sharply with the increase in age and

touches more than 90 percent at age-group 35-39 years. Sixty-four percent of males and 78 percent of

females aged 15-49 were married any time in the past.

The results further show that females marry at a younger ages compared to males. For example, a

higher proportion of teenage girls aged 15-19 (13 percent) are married against their counter parts

among boys (2 percent) with almost a similar pattern emerging in rural as well as urban areas. The

average age at marriage among females is almost five years lesser than that of males (mean age at

marriage for females and males is 18.6 years and 23.3 years respectively). As regards median age at first

marriage, it also shows a similar differential between females and males both in rural as well as urban

areas.

Marriage in India defines the onset of the socially acceptable time for childbearing and as already stated

the age at marriage varies substantially across states echoing the prevalent diversity. However, the legal

age of marriage is 18 years for females and 21 years for males. Despite the fact that the average age at

marriage in India has been rising gradually over the past twenty years, the practice of child marriage is

still widespread and young girls suffer most as a result of it. Early marriage of females not only renders

them susceptible to the risks of maternal mortality but also affects the health and nutrition conditions of

newborns, which is a major factor for high child mortality.



About 41 percent of females got married before the legal age (< 18 years) as compared to 32 percent

males getting married below 21 years. There is a marked distinction in prevalence between rural and

urban areas. Against 47 percent of females getting married before legal age in rural areas, 30 percent

got married in urban areas. Similarly, 38 percent of males got married before legal age in rural areas as

compared to 21 percent in urban areas.

Table 2.7: Marital status of the household population

Percentage of ever married persons (age 10 and above) by broad age-groups and among those married any time prior to

survey, median age at first marriage, mean age at first marriage and percentage of those married below legal age,

according to gender and residence, RSOC, 2013-14.

Age

Residence Total

Urban Rural

Male Female Male Female Male Female

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55+

Total

15-49

15-54

Median age at first marriage

Mean age at marriage

Married below legal age at marriage1

0.1

0.7

17.6

64.6

89.8

96.2

97.8

98.0

98.8

99.2

62.1

62.7

65.7

24.6

24.7

21.3

0.1

8.9

59.8

89.4

97.4

98.6

98.8

99.5

98.8

98.9

71.9

76.4

77.9

18.6

19.7

29.9

0.1

2.1

30.0

76.8

93.2

97.8

98.1

98.6

98.9

99.2

62.2

64.3

67.2

22.0

22.7

37.9

0.4

14.4

75.0

95.7

98.5

99.3

99.3

99.8

99.6

99.2

71.5

78.3

79.7

17.2

18.0

47.4

0.1

1.7

26.0

72.5

91.9

97.2

98.0

98.4

98.9

99.2

62.2

63.8

66.7

22.9

23.3

32.4

0.3

12.8

69.8

93.5

98.1

99.1

99.1

99.7

99.4

99.1

71.6

77.7

79.1

17.6

18.6

41.7 1 Men < 21 years, Women < 18 years.

Note: Table based on persons married any time prior to survey.

Since mean age at first marriage and percentage of those who got married below legal age discussed in

the preceding section is based on marriages that took place any time in the past, a comparison of the

same with recent marriages (marriages that have taken place in the last five years) would help in

assessing the shift and highlight the current situation. Figure 2.3 depicts that the mean age at first

marriage is about two and half years higher in case of females based on marriages that have taken place

in the last five years (21.1 years) vis-à-vis marriages that took place any time in the past (18.6 years). The

corresponding difference in case of males is about one and a half year (25.0 years and 23.3 years).



Figure 2.3: Mean age at marriage based on marriages that have taken place any time in the past vs marriages that took place in the last 5 years

Figure 2.4 highlights such variations in case of percentage of females and males who got married below

their respective legal ages. The prevalence of below legal age marriage in case of females (< 18 years)

based on recent marriages (that took place in the last 5 years) is 16 percent as compared to 42 percent

based on all marriages, exhibiting a decline of almost 2.6 times. A sharper decline is seen in case of

urban females (30 percent and 9 percent) as well as rural females (47 percent and 20 percent). Almost a

similar pattern is seen in case of males also across rural and urban areas.

Figure 2.4: Proportion getting married below legal age—marriages any time vs marriages in last 5 years

The data suggests a close association between the mean age at first marriage and social groups as

shown in Table 2.8. There seems to be a stronger shift towards late marriage among Other Backward

Classes (OBCs) and Others as compared to SCs and STs both for males and females in rural as well as

urban areas. The mean age at first marriage for women belonging to Others category is at least one year

24.7

19.7

22.7

18.0

23.3

18.6

26.3

22.2

24.3

20.5

25.0

21.1


Urban Rural Total

Marriage any time Marriage in last 5 years

21

30

38

47

32

42

9 9

22 20 18 16


Urban Rural TotalMarriage any time Marriage in last 5 years



later than that of SCs. This is more marked in case of males showing a shift of 1.2 years for rural, 1.6

years for urban and 1.7 years for total.

Further analysis of the data on mean age at marriage by wealth quintiles as seen in Table 2.8 indicates a

positive and significant relationship between these two. For example, the mean age at marriage for

females belonging to the lowest quintile in rural areas is 17.3 years and it increases gradually with

increase in economic status, the corresponding figure being 19.4 years for the females belonging to the

richest quintile. Almost a similar pattern is seen in case of mean age of marriage for females in urban

areas. The situation with regard to mean age at marriage for males both in rural and urban is also on

expected lines.

A close association is also seen between percentage of men and women getting married below the legal

age and social groups. There is a variation of about 14 percentage points in the proportion of women

getting married before 18 years belonging to SC category (49 percent) than those belonging to Others

(35 percent). Similarly, there is a corresponding variation exceeding 15 percentage points in case of men

getting married before 21 years. Differentiated by the highest and the lowest wealth quintiles, there is a

variation of 31 and 28 percentage points for women and men getting married before their respective

legal age.



Table 2.8: Early marriage and mean age at marriage by specific characteristics

Percentage of ever married men and women (age 10 and above) who got married any time prior to the survey mean age at marriage and percentage of those

married below legal age by social-group and wealth index, according to residence, RSOC, 2013-14.

Characteristic

Residence Total

Urban Rural

Men Women Men Women Men Women

Married

<21

Mean

age at

marriage

Married

<18

Mean

age at

marriage

Married

<21

Mean

age at

marriage

Married

<18

Mean

age at

marriage

Married

<21

Mean

age at

marriage

Married

<18

Mean

age at

marriage

Social—Group

Scheduled Caste

Scheduled Tribe

OBC

Other

No response

Wealth Index

Lowest

Second

Middle

Fourth

Highest

Total

27.8

25.6

22.0

17.0

27.5

37.8

30.0

26.0

21.7

16.7

21.3

24.0

24.1

24.6

25.2

23.9

22.5

23.4

24.0

24.7

25.3

24.7

38.6

29.2

29.3

26.6

54.5

47.6

41.4

37.5

31.5

22.8

29.9

18.9

19.6

19.7

20.0

18.0

17.8

18.6

19.1

19.5

20.4

19.7

42.8

38.6

41.8

27.7

30.5

48.5

40.4

34.9

31.1

26.4

37.9

22.1

22.7

22.3

23.7

23.2

21.6

22.3

22.8

23.4

24.2

22.7

53.5

43.2

49.1

41.5

63.1

57.4

50.6

46.1

40.6

32.1

47.4

17.5

18.5

17.8

18.5

16.8

17.3

17.7

18.0

18.5

19.4

18.0

38.7

36.3

35.3

23.2

29.6

47.8

39.0

32.6

26.9

20.0

32.4

22.6

23.0

23.0

24.3

23.4

21.6

22.5

23.1

24.0

24.9

23.3

49.4

40.7

42.8

35.3

60.4

56.8

49.4

43.9

36.6

26.1

41.7

17.8

18.7

18.4

19.1

17.2

17.3

17.8

18.3

18.9

20.0

18.6

Note: Table based on persons married any time prior to survey.



Figure 2.5 shows the decline in proportion of those getting married below the legal age based on recent

marriages vis-à-vis marriages that took place any time in the past among males and females by their social group

status and also by the lowest and the highest quintiles. Similarly, Figure 2.6 depicts the shift in mean age at first

marriage among males and females of corresponding groups. There is a marked improvement on both the

counts across all categories which is an encouraging sign.

Figure 2.5: Proportion of marriages below legal age—marriages any time in the past and marriages in the last 5 years

`

39 36 35

23

48

20

32

20 23

20

11

31

7

18

49

41 43

35

57

26

42

20

16 17

13

28

6

16

ScheduledCaste

ScheduledTribe

OBC Other Lowest Highest Total

Male Male Female Female



Figure 2.6: Mean Age at Marriage—marriages any time in the past and marriages in last 5 years

In order to map the improvement in the average age at marriage and also the progress made in reducing the proportion of those getting married below the legal age, a comparison of RSOC results has been done with District Level Health Survey-3 (DLHS-3), which was done in 2007-08. Table 2.9 shows significant improvement on both the parameters and it is encouraging to note that progress has taken place across all categories of social groups and wealth quintiles. Overall, there has been a gain by 1.6 year in case of women and 1.3 year for men in the average age at marriage. It is revealing to note that the gain in terms of delayed marriage for SC (1.7 year), ST (1.9 year) and OBC (2.0 year) women has been more than two times of what is seen in case of women belonging to ‘Others’ category (0.8 year). Almost a similar pattern is noticed across wealth quintiles wherein the gain in case of women belonging to the lowest and the second to lowest quintiles is of 2.9 years and 2.1 years respectively against 0.9 year seen in case of women belonging to the highest quintile. The situation in case of men is also on the same lines. Women marrying below the legal age (< 18 years) has come down by 8 percent points and the reduction is sharper in case of SC (10 percent points), ST (7 percent points), OBC (11 percentage points) women as compared to women pertaining to Others category (2 percent points). The decline across wealth quintiles shows a gradual trend with the maximum reduction observed in case of women belonging to the lowest quintile (19 percent points) and no change, in the highest quintile (0.1 percent points). In case of men marrying below the legal age (< 21 years), almost a similar pattern can be seen both in case of social groups and wealth quintiles.

23 23 23

24

22

25

23

25 25 25

26

24

27

25

18 19 18

19

17

20

19

21 21

21 22

20

23

21

Scheduled Caste Scheduled Tribe OBC Other Lowest Highest Total

Male Male Female Female



Table 2.9: Early marriage and mean age at marriage by specific characteristics (Comparison)

Mean age at marriage and percentage of those married below legal age for ever married men and women (age 10 years and above) by social groups and wealth Index RSOC, 2013-14 and DLHS-3, 2007-08.

Characteristic

Men married

< 21 year

Women married

< 18 years

Mean age at

marriage for men

Mean age at marriage

for women

RSOC,

2013-14

DLHS-3,

2007-08

RSOC,

2013-14

DLHS-3,

2007-08

RSOC,

2013-14

DLHS-3,

2007-08

RSOC,

2013-14

DLHS-3,

2007-08

Social - Group

Scheduled Caste

Scheduled Tribe

OBC

Other

Wealth Index

Lowest

Second

Middle

Fourth

Highest

Total

18.4

23.2

18.6

9.1

29.5

22.4

19.7

12.4

4.7

16.2

28.7

28.2

26.2

13.5

44.8

37.9

27.8

18.6

7.8

23.2

16.9

14.4

14.3

10.9

25.6

23.0

15.1

9.6

3.9

14.1

27.3

21.9

25.3

12.9

44.5

36.1

24.1

13.6

4.0

21.9

24.8

24.9

25.0

26.2

24.0

24.1

24.5

25.8

27.4

25.3

23.2

23.6

23.7

25.2

21.7

22.2

23.2

24.4

26.1

24.0

20.8

21.9

21.3

21.7

20.5

20.3

20.6

21.6

23.2

21.4

19.1

20.0

19.3

20.9

17.6

18.2

19.2

20.3

22.3

19.8

Note: Table based on person married three years prior to survey.

Table 2.10 depicts the percentage of ever married men (age 10 and above) by broad age-groups, mean age at first marriage, percentage of those marrying below the legal age and median age at first marriage by India and states. The Table shows that by and large in all states the marriages are not taking presently in the ages up to 19 years. The only states where a smaller proportion of males (5-9 percent) got married in the age group of 15-19 are Rajasthan and Nagaland. The mean age at first marriage varies widely across the states exhibiting a range of 8.8 years between Goa (28.6 years) and Rajasthan (19.8 years). The variability in proportion of males getting married below the legal age (< 21 years) varies acutely across states. On one hand, there are states like Kerala and Goa which report just 4.1 percent and 5.8 percent of males having got married below the legal age respectively. On the other hand, more than 50 percent of males got married below the legal age in states like Madhya Pradesh, Bihar, Uttar Pradesh and Rajasthan. Table 2.11 presents similar information for ever married women (age 10 and above). In contrast to males, significant proportions of females are getting married in the age group 15-19 years in states like Bihar, Jharkhand, West Bengal, Assam, Nagaland, Tripura and Rajasthan. Other states including the advanced ones like Kerala, Maharashtra and Tamil Nadu also report marriages in this age group to the tune of 7-10 percent. As observed in the case of males, the mean age at first marriage in case of females also varies substantially across the states. The average age at marriage in Goa, the state reporting the highest (24.5 years), is more than 8 years higher than Rajasthan, the state reporting the lowest (16.3 years). Figure 2.7 portrays the state-wise variation in mean age at marriage.



Figure 2.7: Mean age at first marriage for females, RSOC 2013-14

16

.3

16

.4

17

.3

17

.6

17

.7

18

.0

18

.3

18

.5

18

.6

18

.6

18

.6

18

.7

18

.9

19

.2

19

.7

19

.8

19

.8

19

.9

19

.9

20

.0

20

.0

20

.2

20

.2

20

.5

20

.7

22

.0

22

.3

22

.6

22

.8

24

.5

Raj

asth

an

Bih

ar

Wes

t B

enga

l

Utt

ar P

rad

esh

Ch

hat

tisg

arh

Mad

hya

Pra

de

sh

Jhar

khan

d

Od

ish

a

Ind

ia

Utt

arak

han

d

An

dh

ra P

rad

esh

Trip

ura

Har

yan

a

Mah

aras

htr

a

Del

hi

Him

ach

al P

rad

esh

Sikk

im

Pu

nja

b

Ass

am

Gu

jara

t

Tam

il N

adu

Jam

mu

& K

ash

mir

Kar

nat

aka

Aru

nac

hal

Pra

des

h

Meg

hal

aya

Man

ipu

r

Nag

alan

d

Ker

ala

Miz

ora

m

Go

a



Table 2.10: Marital status of the household population by states: Male

Percentage of ever married male (age 10 and above) by age, mean age at marriage, percentage married below legal age at marriage and median age at first marriage, according

to states, RSOC, 2013-14.

State 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Total Mean age

at marriage

Percentage below legal age at

marriage (< 21 Years)

15-54 Median

age at first marriage

India North

Delhi Haryana Himachal Pradesh Jammu & Kashmir Punjab Uttar Pradesh Uttarakhand

Central Chhattisgarh Madhya Pradesh

East Bihar Jharkhand Orissa (Odisha) West Bengal

Northeast Arunachal Pradesh Assam Manipur Meghalaya Mizoram Nagaland Sikkim Tripura

West Rajasthan Goa Gujarat Maharashtra

South Andhra Pradesh Karnataka Kerala Tamil Nadu

0.1

0.1 0.0 0.0 0.0 0.0 0.0 0.1

0.0 0.0

0.0 0.2 0.0 0.0

0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0

1.0 0.0 0.5 0.0

0.0 0.0 0.0 0.0

1.7

0.1 2.1 0.2 1.4 0.3 1.2 0.0

0.4 1.2

2.2 0.7 0.2 3.2

0.4 2.7 0.6 0.9 0.1 5.7 2.1 2.4

7.9 0.0 3.4 0.3

0.5 0.3 0.1 0.0

26.0

26.4 30.9 15.0 12.4 13.8 30.0 31.9

30.4 36.7

35.8 42.7 13.8 29.2

19.4 20.7 23.5 28.3 10.8 60.5 24.4 20.7

46.8

4.5 34.7 14.0

22.5 12.4

4.7 11.1

72.5

70.6 76.2 58.1 49.0 62.9 77.1 68.6

74.7 82.5

87.7 76.9 60.0 68.0

70.9 71.7 55.1 76.2 65.4 92.5 71.4 58.3

79.0 27.7 81.4 65.3

82.4 52.8 48.1 64.6

91.9

90.1 94.4 92.7 86.3 87.6 93.8 92.7

94.0 95.5

96.4 95.2 86.3 85.1

92.2 81.8 82.9 90.3 82.1 96.7 89.2 91.1

95.4 66.4 92.1 93.8

96.8 90.5 86.1 87.6

97.2

95.5 96.4 98.6 96.1 95.7 96.6 95.9

97.0 98.6

99.7 98.6 97.0 94.1

97.7 94.2 94.6 95.4 93.7 99.0 98.4 98.8

96.2 85.8 98.1 98.9

99.3 97.7 93.2 97.7

98.0

98.9 97.8 99.1 99.4 95.9 97.4 98.9

98.6 99.5

99.7 98.5 99.5 97.2

98.3 98.1 97.6 96.3 98.5 97.8 93.6 98.6

97.3 94.1 97.0 97.5

96.9 99.3 96.9 98.5

98.4

97.5 97.9 99.5 98.9 99.6 98.6

100.0

99.1 99.6

99.9 99.1 99.3 98.8

97.4 95.4 95.4 96.8 97.0

100.0 99.3 99.6

96.8 97.5 93.4 98.2

100.0

97.5 99.1 99.0

98.9

100.0 99.1 99.9 98.0 97.5 97.6

100.0

100.0 99.8

99.1

100.0 98.1 99.2

97.1 98.6

100.0 97.0 99.9

100.0 96.7 98.5

99.7 99.6 97.1 99.7

100.0

99.3 99.0 98.4

99.2

99.9 98.4 98.7 98.5 97.2 98.1 99.6

99.8 98.8

99.4 99.9 99.7 98.9

98.4 98.2 99.8 98.7 98.9 99.1 97.7

100.0

99.2 99.1 99.4 99.7

99.6 99.8 99.8

100.0

62.2

62.8 63.1 64.3 56.6 60.6 55.6 58.4

60.9 63.2

61.9 60.5 63.6 62.9

62.5 59.8 61.6 60.9 58.2 73.3 60.2 64.8

63.1 59.8 64.8 62.5

69.6 63.0 67.3 65.3

23.3

23.5 22.3 24.5 24.1 23.4 20.8 23.2

22.1 21.4

21.0 21.9 24.4 24.6

25.6 26.3 26.6 24.9 25.8 26.5 24.6 25.8

19.8 28.6 23.2 24.6

23.8 26.3 28.2 26.4

32.4

25.6 35.3 17.4 24.4 27.3 54.2 26.7

41.9 50.4

52.0 45.8 21.0 21.6

16.4 14.6 11.4 16.8 11.1

6.0 24.6 17.2

62.1

5.8 28.9 17.8

25.2 12.2

4.1 11.2

66.7

66.2 65.9 66.9 59.2 60.9 61.9 63.4

65.8 69.2

70.4 68.0 64.4 66.1

68.6 65.6 66.2 67.2 61.5 76.7 66.1 66.2

69.2 58.8 69.9 64.6

74.8 64.4 67.0 69.5

22.9

24.1 21.9 24.4 24.8 23.6 20.9 23.1

21.7 20.6

20.1 21.4 23.7 24.4

26.0 26.5 27.1 25.5 27.2 26.9 24.7 25.8

19.6 28.8 22.4 24.1

23.2 25.9 27.2 26.1

Note: Table based on marriages taken place anytime in the past.



Table 2.11: Marital status of the household population by states: Female Percentage of ever married female (age 10 and above) by age, mean age at marriage, percentage married below legal age at marriage and median age at first marriage,

according to states, RSOC, 2013-14.

State 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Total Mean age at

marriage

Percentage below legal age at marriage

(< 18 Years) 15-49

Median age at first

marriage

India North



East Bihar Jharkhand Orissa (Odisha) West Bengal




0.3

0.1 0.0 0.0 0.0 0.0 0.2 0.0

0.0 0.0

0.1 0.2 0.0 0.1

0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.9

3.2 0.0 0.8 0.0

0.0 0.1 0.0 0.0

12.8

4.0 9.8 3.5 2.8 5.2 8.5 6.8

6.7 8.5

17.9 17.0

8.3 31.0

8.3

14.1 9.3 8.8 1.8

44.0 10.5 25.6

21.3

2.7 11.5

9.5

13.8 13.5

8.9 7.2

69.8

56.2 71.6 52.6 38.1 40.7 64.9 54.4

67.2 73.4

90.1 75.3 64.1 80.0

67.4 63.1 48.8 64.5 38.2 57.6 55.7 73.6

79.7 30.0 71.7 69.0

73.8 66.1 48.6 69.4

93.5

90.9 94.7 91.2 79.5 87.1 95.2 91.0

93.2 94.9

99.1 96.2 88.6 90.6

93.1 90.5 77.8 91.1 84.5 95.8 83.2 95.4

97.6 68.7 95.0 93.4

97.8 86.3 93.2 90.5

98.1

98.0 99.2 98.5 94.9 97.6 99.2 99.2

98.1 99.1

99.7 99.1 96.4 98.2

96.3 93.6 90.8 94.0 90.1 97.7 93.4 95.5

98.3 94.3 96.8 97.1

99.5 97.8 97.8 97.4

99.1

99.6 100.0

99.0 99.0 99.0 99.8

100.0

97.2 98.8

99.8 99.6 94.6 98.9

98.8 98.5 95.4 97.9 96.7

100.0 96.0 98.0

100.0

97.3 99.6 99.4

98.7 97.7 98.2 99.9

99.1

99.3 100.0 100.0

97.5 99.9 99.7 99.8

99.9 99.5

99.8 99.8 95.7 99.2

98.1 99.4 94.0 99.1 95.6

100.0 97.1 97.9

99.9 95.1 98.3 99.8

99.0 95.5 99.4 99.9

99.7

99.3 100.0 100.0

99.0 99.9 99.9 98.1

99.3

100.0

100.0 99.9 99.4 99.4

99.8 99.0 96.8 97.9 98.5 99.6 97.8 99.9

100.0

97.5 98.9 99.9

99.9 99.3 99.2 99.8

99.4

99.1 100.0

98.1 99.9 99.5 99.7 99.6

100.0

99.7

99.9 99.8 99.0 98.6

100.0

99.5 98.1

100.0 97.7

100.0 90.4

100.0

99.3 98.6 99.2 99.7

99.9 98.8 97.2 99.3

99.1

100.0 99.7 99.9 97.5 99.6 98.7 98.5

99.5 99.6

99.7 98.1 99.5 98.7

97.2 98.5 98.3 99.4 98.9

100.0 98.0 99.3

99.1 97.6 99.0 98.8

99.1 99.2 98.3

100.0

71.6

69.5 73.9 74.3 64.2 72.9 64.5 66.3

69.8 71.2

70.1 69.9 72.4 76.7

70.7 68.0 68.5 68.3 70.3 70.6 64.7 77.4

73.2 71.3 74.5 75.0

74.3 72.0 77.0 73.4

18.6

19.7 18.9 19.8 20.2 19.9 17.6 18.6

17.7 18.0

16.4 18.3 18.5 17.3

20.5 19.9 22.0 20.7 22.8 22.3 19.8 18.7

16.3 24.5 20.0 19.2

18.6 20.2 22.6 20.0

41.7

27.5 29.4 21.7 25.2 20.4 49.5 35.4

52.8 52.3

67.5 40.2 44.3 59.4

28.8 31.0 16.3 16.2

3.0 12.9 29.3 42.3

61.2 10.1 20.0 34.8

35.9 27.3 13.1 28.7

77.7

75.7 77.8 75.8 67.2 73.8 71.7 70.7

74.2 77.5

82.0 79.7 74.2 82.5

77.5 75.9 72.5 74.9 71.8 76.1 72.7 83.3

81.1 72.1 79.1 79.6

79.8 77.1 79.5 78.5

17.6

19.3 18.2 19.0 19.7 19.3 17.3 18.1

17.0 16.9

15.6 17.5 17.3 16.1

20.2 19.4 21.1 20.0 22.5 23.1 19.5 17.6

15.5 22.1 18.9 17.6

17.9 18.2 19.8 18.8

Note: Table based on marriages taken place anytime in the past.



In order to reflect the temporal change in terms of improvement in the average age at marriage as also the reduction in the proportion of those getting married below the legal age, these two indicators have also been computed on the basis of marriages that have taken place during the last five years preceding the date of survey. A state-wise comparison between the two is presented in Table 2.12. It shows that there have been substantial improvements in mean age at marriage and proportion getting married below the legal age in case of recent marriages as compared to marriages that took place any time in the past across states.

Table 2.12: Early marriage and mean age at marriage by state

Percentage of ever married men and women (age 10 and above) who married any time in the past and those married five

years prior to the survey; mean age at marriage and percentage married below legal age by state, India, RSOC, 2013-14.

State

Men Women

Married any time Married in 5 years

preceding the survey Married any time

Married in 5 years

preceding the survey

Married

<21

Mean age at

marriage

Married

<21

Mean age

at marriage

Married

<18

Mean age

at marriage

Married

<18

Mean age

at marriage

India

North

Delhi

Haryana

Himachal Pradesh

Jammu & Kashmir

Punjab

Uttar Pradesh

Uttarakhand

Central

Chhattisgarh

Madhya Pradesh

East

Bihar

Jharkhand

Odisha

West Bengal

Northeast

Arunachal Pradesh

Assam

Manipur

Meghalaya

Mizoram

Nagaland

Sikkim

Tripura

West

Rajasthan

Goa

Gujarat

Maharashtra

South

Andhra Pradesh

Karnataka

Kerala

Tamil Nadu

32.4

25.6

35.3

17.4

24.4

27.3

54.2

26.7

41.9

50.4

52.0

45.8

21.0

21.6

16.4

14.6

11.4

16.8

11.1

6.0

24.6

17.2

62.1

5.8

28.9

17.8

25.2

12.2

4.1

11.2

23.3

23.5

22.3

24.5

24.1

23.4

20.8

23.2

22.1

21.4

21.0

21.9

24.4

24.6

25.6

26.3

26.6

24.9

25.8

26.5

24.6

25.8

19.8

28.6

23.2

24.6

23.8

26.3

28.2

26.4

17.5

9.6

20.8

6.7

8.4

10.6

26.3

19.0

19.2

33.8

33.3

27.1

9.5

15.6

8.9

8.1

6.5

11.9

7.0

8.5

16.0

10.4

41.1

1.8

23.9

6.6

11.4

8.5

0.7

2.7

25.0

25.1

23.7

26.3

26.3

25.5

23.1

24.3

24.1

23.4

22.5

23.4

26.3

25.8

27.0

27.1

27.7

25.2

26.7

24.9

26.0

26.9

22.0

31.0

24.0

26.1

25.2

27.0

29.6

28.0

41.7

27.5

29.4

21.7

25.2

20.4

49.5

35.4

52.8

52.3

67.5

40.2

44.3

59.4

28.8

31.0

16.3

16.2

3.0

12.9

29.3

42.3

61.2

10.1

20.0

34.8

35.9

27.3

13.1

28.7

18.6

19.7

18.9

19.8

20.2

19.9

17.6

18.6

17.7

18.0

16.4

18.3

18.5

17.3

20.5

19.9

22.0

20.7

22.8

22.3

19.8

18.7

16.3

24.5

20.0

19.2

18.6

20.2

22.6

20.0

16.3

6.3

9.2

3.0

5.3

3.8

15.3

4.6

13.0

17.0

35.0

20.8

16.0

31.1

17.3

16.9

8.6

9.6

1.3

21.3

13.7

22.0

30.7

2.1

8.9

10.5

13.1

13.5

2.4

8.0

21.1

22.1

20.7

22.3

23.1

22.3

20.2

21.1

20.5

21.2

18.8

19.8

20.9

19.9

22.3

21.4

24.0

21.6

24.6

20.8

21.9

21.0

19.3

29.1

22.2

22.0

20.4

22.4

25.1

22.4



2.3 HOUSEHOLD COMPOSITION BY USUAL MEMBERS

Household composition is a critical factor for understanding family size which is also a determinant of health status and well-being. The household is considered to be the basic social and economic unit of a society, and changes in household composition have repercussions for the family and the economy. Such changes also impact the distribution of goods and services and on the planning and requirements of community institutions, schools, housing stock and health infrastructure. Table 2.13 presents the percent distribution of the households by number of usual members in the household according to residence. The average household size, which is a function of so many social and economic factors, is close to five in India as per Census 2011 (Total 4.8, Rural-4.9 and Urban-4.6). The mean household size as revealed from the survey is 4.7 with rural average household size (4.8) being marginally higher than the urban (4.5). The emergence of nuclear families in the rural areas is seen as a probable reason for this diminishing difference in urban and rural household size over the years. The median as well as modal number of usual members both in rural as well as urban areas is 4. Close to 71 percent of households have two to five members, while 27 percent have more than five members and just 2 percent are single member households. In rural areas, the proportion of households having two to five members is about 9 percentage points less than urban areas is reflected in corresponding increase in case of households with five or more members. Table 2.13: Household size Percent distribution of the households by number of usual members in the household according to residence, India, RSOC, 2013-14.

Characteristic Residence

Total Urban Rural

Number of usual members

1

2

3

4

5

6

7

8

9+

Total percent

Number of households

Mean household size

1.7

7.9

18.7

29.8

19.7

10.3

5.1

2.6

4.1

100.0

34,775

4.5

2.4

9.8

14.2

23.9

19.7

13.2

7.8

4.0

5.0

100.0

70,707

4.8

2.2

9.1

15.7

25.8

19.7

12.3

6.9

3.5

4.7

100.0

1,05,482

4.7



2.4 PROFILE OF THE HEAD OF THE HOUSEHOLDS The profile of the head of the household is crucial to understand the overall socio-economic background of other members of the household. Besides the age and sex distribution, other critical factors like social group and religion to which she/he belongs to, her/his education and occupation status determines the trajectory of day-to-day life of the household members. Further, it also aids in mapping the shift in proportion of male headed households to female headed households. Under RSOC, information on social group and religion was collected in respect of the head of household only as in the Indian context variation between head of household and other members would be very minimal. Similarly, the occupational status was also probed in respect of the head of the household only. This was done keeping in view the objective of the survey and the potential use of all this information at the time of analysis stage.

In this section, the age and sex-wise distribution, social group and religious affiliation, educational attainment,

occupational status and distribution by wealth quintiles of head of the households have been discussed.

Table 2.14 shows the percent distribution of households by the age, sex, religion, social group, education, occupation and wealth index of the head of the households according to residence. Around eight out of every ten households were in the economically active age group of 18-59 years across rural and urban areas. The proportion of female headed households hovered around 10 percent. About 81 percent of the head of households followed Hinduism, 13 percent Islam and 3 percent Christianity. Head of households following other religions such as Sikhism, Jainism, and Buddhism etc. accounted for the remaining 3 percent.

The maximum proportion of households (40 percent) belonged to OBC followed by ‘Others’ constituting 29 percent. Scheduled Castes and Scheduled Tribes comprised 19 percent and 11 percent respectively together constituting another 30 percent, which is broadly in consonance with Census 2011 figures (SCs 17 percent and STs 9 percent). As high as 34 percent of head of households had no education with another 8 percent studied up to below primary level. About 16 percent of head of households had attained educational level of higher secondary and above. There is a marked rural-urban differential across educational categories. There is a wide variation in occupational status of the head of households across rural and urban areas. Against 73 percent reported as cultivators or wage labourer in rural areas, 58 percent of head of households were working as self-employed (excluding cultivators) or regular salaried/wage employee in urban areas. Since occupation level of the head of household is one of the key drivers affecting the overall economic status of a household, these differentials would profoundly impact the levels of well-being of women and children captured in this survey. In the absence of household data on income or expenditure, wealth quintiles are relied on as an effective substitute to mirror the economic status of households. The details on how wealth quintiles have been computed under RSOC is discussed in Chapter 1. The distribution of head of households in rural and urban areas follows a strikingly opposite pattern. In contrast to close to 28 percent of the head of the households in rural areas belonging to the poorest quintile, more than 40 percent in urban areas were in the richest quintile.



Table 2.14: Characteristics of the head of the household

Percent distribution of the households by selected characteristics of the Head of the Household, according to residence, India, RSOC, 2013-14.

Characteristic Residence

Total Urban Rural

Age-group 18-59 60+

Sex Male Female

Education No Education Below Primary Completed Primary Completed Middle Completed Secondary Completed Higher Secondary and above

Religion Hinduism Islam Christianity Sikhism Jain Buddhism No religion Others

Social - Group Scheduled Caste Scheduled Tribe OBC Other No Response

Occupation Cultivator Agricultural wage labourer Non-agricultural wage labourer Self-employed (excluding cultivators) Regular salaried/wage employee Rentier, pensioner, other remittance recipients Did not work Domestic Chores Others

Wealth index Lowest Second Middle Fourth Highest Total

Total Number of Households

81.9 18.1

89.6 10.4

20.6

6.0 14.3 13.0 19.3 26.9

78.2 15.0

3.4 1.3 0.5 1.1 0.1 0.4

16.0

6.2 39.8 37.3

0.7

3.0 6.6

18.8 30.9 27.2

5.5 4.2 2.4 1.3

4.2 8.7

17.0 28.9 41.2

100.0 34,775

80.0 20.0

90.1

9.9

40.8 8.6

15.7 12.8 11.9 10.2

82.3 12.1

2.6 1.7 0.2 0.6 0.1 0.4

20.9 13.5 39.8 25.0

0.8

30.7 18.6 23.6 11.5

7.2 2.4 3.2 2.2 0.6

27.7 25.6 21.5 15.6

9.6 100.0

70,707

80.6 19.4

89.9 10.1

34.1

7.7 15.3 12.9 14.3 15.7

80.9 13.1

2.9 1.6 0.3 0.8 0.1 0.4

19.3 11.1 39.8 29.0

0.8

21.5 14.6 22.0 17.9 13.8

3.5 3.5 2.3 0.8

20.0 20.0 20.0 20.0 20.0

100.0 105,482

State-wise distribution of head of households by their religious and social group affiliations and occupational status is presented in Tables 2.15 and 2.16 respectively.



Table 2.15: Characteristics of the head of the household by states Percent distribution of the households by religion and caste of the head of the household, according to states, RSOC, 2013-14.

State

Religion Social category

Hindu Islam Christian Sikh Jain Buddhism No

religion Other

Scheduled Caste

Scheduled Tribe

OBC Others No

Response Total

India North



East Bihar Jharkhand Odisha West Bengal




80.9

84.9 89.7 98.8 30.1 41.7 81.7 79.1

95.1 92.0

85.1 72.8 96.3 72.2

42.0 66.3 51.1 11.8

1.9 8.7

57.4 83.9

90.4 71.2 89.3 79.8

81.5 81.7 63.8 86.1

13.1

11.6 5.5 0.6

67.0 1.6

17.5 19.1

2.6 7.3

14.5 18.9

1.0 26.3

1.6

28.2 4.2 3.4 0.0 2.1 1.3 9.6

7.6 8.0 9.1

10.4

9.4 14.0 22.5

6.7

2.9

0.2 0.4 0.1 0.0 1.2 0.0 0.1

1.3 0.2

0.2 4.8 2.5 0.9

27.5

4.7 33.0 81.3 94.7 89.2 13.0

3.3

0.1 19.3

1.1 0.8

6.6 3.1

13.2 6.9

1.6

1.9 4.3 0.4 1.0

54.8 0.2 1.5

0.5 0.1

0.1 0.0 0.1 0.0

0.0 0.1 0.0 0.4 0.0 0.0 0.1 0.1

1.5 0.2 0.0 0.2

0.7 0.1 0.1 0.1

0.3

0.2 0.0 0.0 0.0 0.7 0.2 0.2

0.0 0.3

0.0 0.0 0.0 0.0

0.1 0.1 0.0 0.0 0.1 0.0 0.3 0.2

0.3 0.1 0.2 0.9

1.0 0.3 0.3 0.0

0.8

0.1 0.0 0.1 1.4 0.0 0.0 0.0

0.4 0.1

0.0 0.1 0.0 0.0

13.5

0.5 0.0 0.1 3.2 0.0

27.7 2.8

0.0 0.0 0.0 6.7

0.3 0.2 0.0 0.1

0.1

0.1 0.0 0.0 0.0 0.0 0.1 0.0

0.0 0.0

0.0 0.4 0.0 0.0

0.2 0.0 0.7 2.3 0.2 0.0 0.0 0.1

0.0 0.0 0.0 0.1

0.2 0.0 0.0 0.1

0.4

0.9 0.0 0.0 0.5 0.0 0.2 0.1

0.1 0.0

0.0 2.9 0.0 0.6

15.1

0.0 11.0

0.7 0.0 0.0 0.4 0.0

0.1 1.1 0.1 1.0

0.3 0.6 0.1 0.0

19.3

21.1 24.1 26.5

8.9 27.2 23.7 13.8

17.3 17.6

24.1 13.7 18.4 25.9

3.6

11.6 0.6 5.2 0.7 5.1 9.5

26.5

18.5 2.4

11.3 14.0

22.2 11.7

7.6 25.3

11.1

2.9 8.8 4.6

10.2 6.6 2.8 6.5

34.5 22.5

2.1

31.7 24.6

5.8

79.2 17.7 32.0 85.4 96.7 86.9 36.5 26.5

13.2

8.6 20.3 10.8

8.8 9.2 4.0 6.1

39.8

28.8 27.5 15.4 16.6 20.0 51.9 20.9

40.0 44.3

55.2 43.5 27.3

7.6

3.5 19.0 27.0

0.8 2.6 5.3

34.4 16.1

47.9 30.7 30.2 32.7

50.1 36.2 67.6 57.5

29.0

47.0 39.4 53.4 63.4 46.0 21.4 57.7

7.5

15.6

18.5 10.6 29.7 55.3

13.7 51.1 39.4

8.5 0.0 2.0

12.5 30.6

20.0 57.7 37.5 42.0

18.6 41.7 20.6 11.0

0.8

0.2 0.3 0.0 0.9 0.2 0.1 1.0

0.6 0.1

0.1 0.5 0.0 5.4

0.0 0.6 1.0 0.1 0.0 0.6 7.1 0.3

0.3 0.7 0.7 0.5

0.4 1.2 0.3 0.1

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0



Table 2.16: Occupation of the head of the household by state Percentage distribution of the head of the household by occupation according to states, RSOC, 2013-14.

State

Occupation

Total Cultivator

Agricultural wage

labourer

Non-agricultural wage labourer

Self-employed (excluding cultivators)

Regular salaried/ wage employee

Rentier, pensioner, other remittance

recipients

Did not

work

Domestic Chores

Others

India North







21.5

1.0 16.2 20.6 16.1 15.3 28.6 14.1

32.8 33.4

20.5 21.5 30.9 13.0

48.3 28.7 28.0 24.8 16.4 15.2 29.4 15.5

32.1

3.1 20.1 27.9

10.8 30.0

5.2 5.8

14.6

0.4 6.1 5.0

11.5 5.0 8.7 5.7

6.4

15.1

10.5 19.8 11.3 14.1

2.7 2.7 4.2 4.4 2.8 5.7 3.3

11.8

5.4 2.0

13.7 13.2

39.8 15.6 11.9 28.1

22.0

11.2 24.0 17.6 19.0 24.2 27.8 17.0

29.5 21.9

38.0 22.4 24.6 25.5

4.4

31.2 11.5 10.3

1.7 3.6

14.9 24.2

21.1

9.6 12.6

9.9

17.6 10.2 27.0 22.2

17.9

26.6 22.3 11.5 19.9 20.5 17.6 18.2

11.1 11.4

16.2 14.4 15.4 18.9

24.8 21.4 28.3 26.1 49.4 43.5 16.4 24.0

14.4 31.1 33.6 20.3

17.5 18.7 20.1 10.3

13.8

48.8 18.2 22.2 14.6 18.3

9.3 21.5

12.6 10.2

5.8

12.8 8.5

12.6

17.5 9.6

13.3 18.1 25.7 24.3 25.4 16.4

12.8 34.5 13.0 21.4

9.7

15.6 14.1 22.3

3.5

6.6 2.9

10.1 7.6 6.5 1.8

13.8

4.2 3.7

1.7 1.4 3.1 4.3

1.2 3.8 6.1 2.3 2.9 1.2 4.0 3.3

7.8

10.5 1.7 2.6

3.0 3.4 5.6 3.0

3.5

3.9 6.7 7.1 3.2 5.8 2.6 2.2

2.5 2.2

2.9 3.7 3.9 6.3

0.2 0.2 5.1 5.1 0.3 5.6 3.9 3.5

2.7 6.7 3.0 2.6

0.6 2.5 9.1 6.7

2.3

1.1 2.9 5.0 2.7 3.7 3.0 6.2

0.6 1.7

3.4 3.3 1.6 3.2

0.4 1.6 1.6 3.1 0.3 0.8 0.8 0.2

3.3 1.5 1.8 1.5

0.6 1.8 6.6 0.7

0.8

0.3 0.6 0.9 5.3 0.7 0.6 1.3

0.3 0.4

0.9 0.7 0.7 2.0

0.6 0.8 2.0 5.6 0.4 0.1 2.0 1.0

0.3 0.9 0.7 0.6

0.4 2.0 0.4 0.8

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0



2.5 LITERACY AND EDUCATIONAL ATTAINMENT The importance of literacy benefitting both individuals and society hardly needs any reiteration and is widely acknowledged so. It is also associated with a number of positive demographic, health and nutrition outcomes. In this survey, literacy status was determined by usual residents’ ability to read and write as perceived by the respondent of the household questionnaire, who was either the head of household or any knowledgeable adult member. This was probed in respect of all usual residents of age 5 years and above. Tables 2.17 and 2.18 present differentials in the educational attainment of males and females by broad age groups, residence and wealth quintiles. Table 2.17 shows that the highest literacy rate is seen for the age group 10-24 years wherein more than nine out of every 10 male household members were literate. This is followed by a gradual fall as the cohort grows older. The low literacy rate in case of 6 to 9 years olds indicated that not all boys are exposed to the basic level of education which can enable them to read and write even in their local language. Table 2.17 further shows that 19 percent of men had no education, 16 percent completed grades below primary, 17 percent primary, 15 percent middle, 14 percent secondary and 19 percent higher secondary and above. There is a gradual drop in the proportions as the level of education goes up. A comparison of educational attainment levels with the NFHS-3 (2005-06) shows that the proportion of men with no education and below primary has declined while there has been an increase in higher classes over time. The proportion of males with no schooling was the lowest in the 10-14 age group, and as expected, it gradually increased in subsequent age groups. The level of education for those in below primary and who had completed primary was the highest in the 10-14 age group, and for those who had completed middle and secondary in the 15-19 age group indicating that school attendance and continuation of education up to secondary levels have improved substantially among younger males in recent years. There is a strong relationship between age and level of schooling which is reflected in decreasing school attendance with age. The percentage of males who have completed below primary, primary and middle was higher in case of rural areas while the percentage of those having completed secondary and higher secondary & above was higher in urban areas. This indicates that a large proportion of rural men complete only middle level of schooling whereas those in urban areas are more likely to continue their education beyond the middle and secondary levels. A perceptible difference in literacy rate, levels of education and median years of completed education is noticed between rural and urban areas. As seen in Table 2.17, literacy rate in urban areas was 12 percent points higher than rural areas (88 percent against 77 percent). Similarly, differentials are significant under ‘no education’, ‘below primary’ and ‘completed higher secondary and above’ across rural and urban areas and they show that urban men are far more likely to be educated than rural men. As regards median years of completed schooling, there was a variation of 3 years in favour of urban men. Ninety-four percent of males in the highest wealth quintile were literate as against 63 percent in the lowest quintile. The differential between the lowest and the highest sharpens from no education category to those having completed higher secondary and above. Similarly, a gap of almost three times was observed in the median years of completed schooling between the lowest and the highest wealth quintiles.



Table 2.17: Literacy and educational attainment of the household population of age 6 and above: Male

Percentage of males literate, percent distribution of males aged 6 or more by the highest level of education completed, and median years of schooling completed, according to age and residence, RSOC, 2013-14.

Age/ Residence

Literacy

rate

Level of education Median years of

completed schooling

Number of

males No

education Below

Primary Completed

Primary Completed

Middle Completed Secondary

Completed Higher

Secondary and above

Total

Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Residence Urban Rural

Wealth Index Lowest Second Middle Fourth Highest

Total

81.3 93.9 92.8 90.8 85.9 82.9 78.6 74.5 70.3 66.3 64.0 61.5 55.5

88.5 76.8

63.4 73.7 81.4 87.7 94.3 80.6

14.3

5.0 7.0 9.1

14.7 17.8 21.9 26.4 30.5 33.9 36.7 39.1 45.2

11.5 22.9

35.5 25.8 18.6 12.7

5.8 19.2

83.7 29.9

3.9 4.2 4.6 5.2 6.5 5.9 7.7 8.7 8.2 8.8

10.8

13.5 17.8

21.7 19.9 16.7 13.6 11.0 16.4

2.1

47.2 13.1 11.3 14.1 14.4 15.0 14.4 14.2 14.7 15.2 16.3 15.0

15.6 17.7

19.2 19.3 19.4 16.4 11.6 17.0

0.0

16.8 30.0 17.6 17.4 16.9 15.5 14.0 14.2 11.9 10.4

9.2 8.2

14.6 15.3

12.8 16.5 17.8 16.4 12.0 15.1

0.0 1.1

28.2 15.4 16.8 17.8 17.6 17.4 15.9 14.7 15.1 13.6 11.6

17.0 12.5

6.6

10.1 13.6 18.4 19.8 13.9

0.0 0.0

17.9 42.4 32.3 27.9 23.5 21.9 17.6 16.1 14.5 12.9

9.2

27.8 13.8

4.2 8.4

13.8 22.5 39.7 18.4

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0

0.9 4.9 8.8 9.7 8.9 8.4 7.7 7.4 6.4 4.9 4.6 4.2 2.6

8.2 5.3

2.8 4.5 6.2 7.8 9.6 6.5

20,460 27,247 24,062 20,882 20,417 19,000 18,046 14,836 13,336 11,840

8,514 7,766

12,123

71,172 1,47,359

39,808 43,605 43,603 44,335 47,180

2,18,531



Table 2.18 presents that 66 percent of women were literate with a significant rural-urban divide (60 percent against 78 percent). The literacy level varies widely across age-groups exhibiting a gradual decline with increase in age. The pace of decline, however, is sharper as compared to males. As expected, a wide variation is also seen in levels of literacy by wealth quintiles. Against 85 percent of women being literate in the highest quintile, there were just 43 percent in the lowest one. Table 2.18 further presents that 34 percent of women had no education, 15 percent had completed below primary, another 16 percent had completed primary, 12 percent had a middle level education, 10 percent had completed secondary and 12 percent had completed higher level of education. The proportion of female population with no education was higher in rural areas (40 percent) than in urban areas (22 percent). Fewer proportion of rural females continue higher level of education after primary level of education as compared to urban females. As observed in the case of males, a decline in proportion with no education and completed below primary is also noticed in case of women in comparison to corresponding educational attainment levels of NFHS-3 (2005-06) over time. However, there is only a marginal rise in educational levels in higher levels of educational attainment. The proportion of females with no schooling across different age-groups followed almost an identical pattern as that of males. The highest proportion of completion for primary, middle and secondary schooling was reported in the 10-19 age group for females also. This is an encouraging sign suggesting that improvement in school attendance and continuation of education up to secondary levels have also benefitted females particularly the younger ones. Significant rural-urban differentials are observed across different levels of educational attainments and this clearly shows that urban women are far more likely to be educated than rural women. With regard to median years of completed schooling, there was a variation of 4.2 years in favour of urban women, almost 2 years more than what was observed between urban and rural men. Against a gap of almost ten times observed between the lowest and the highest wealth quintiles in case of males having completed higher secondary education and above, the corresponding gap in case of females is almost 15 times. The situation is grave in case of women belonging to the lowest wealth quintile category who reported ‘0’ median years of completed schooling. Tables 2.17 and 2.18 indicate that, overall, the levels of educational attainment are higher in urban than in rural areas; the proportions of men and women with no education are lower in urban than in rural areas, while the proportions with a secondary or higher education are greater in urban areas. On an average, men and women living in urban areas had completed at least three more years of schooling than those living in rural areas. A comparison of the NFHS-3 (2005-06) and RSOC (2013-14) surveys show a marked rise in completed median years of schooling, with the median among men and women increasing from 4.9 to 6.5 years and from 1.9 to 4.1 years respectively during this period. Such a comparison is depicted in Figure 2.8.



Table 2.18: Literacy and educational attainment of the household population aged 6 and above: Female

Percentage of females literate, percent distribution of females age 6 or more by the highest level of education completed, and median years of schooling completed, according to age and residence, RSOC, 2013-14.

Age/ Residence

Literacy

rate

Level of education Median years of

completed schooling

Number of

females No

education Below

Primary Completed

Primary Completed

Middle Completed Secondary

Completed Higher

Secondary and above

Total

Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+



Total

80.0 93.0 90.7 80.3 72.0 63.9 55.9 48.6 43.9 35.8 34.6 26.5 22.4

78.3 59.8

43.3 56.2 64.8 75.5 85.3 65.7

15.3

6.4 9.4

19.7 28.3 36.3 44.8 51.4 56.6 65.2 65.4 73.9 78.4

21.8 39.7

55.7 43.3 34.7 25.0 14.8 34.0

82.5 26.2

2.8 4.0 5.2 5.7 6.7 6.8 7.5 7.1 7.8 7.2 7.1

13.3 16.1

18.1 18.1 15.6 13.6 11.0 15.2

2.2

48.1 13.2 13.8 14.7 14.8 14.6 12.8 13.8 11.4 10.8

8.0 7.4

15.9 16.2

13.5 17.2 18.1 17.8 13.9 16.1

0.0

17.8 26.1 15.9 15.2 13.3 11.3

9.6 7.7 5.5 6.0 4.2 3.2

13.5 11.7

8.1

11.5 13.6 15.1 12.8 12.3

0.0 1.5

29.9 14.5 14.1 13.0 10.4

9.8 8.1 6.0 5.8 4.0 2.2

14.3

8.6

3.0 6.2

10.1 14.5 17.3 10.4

0.0 0.0

18.7 32.2 22.5 16.8 12.2

9.7 6.3 4.7 4.2 2.7 1.7

21.2

7.7

1.6 3.7 7.9

14.1 30.3 12.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0

1.0 5.1 8.9 8.5 7.2 5.1 3.5 0.0 0.0 0.0 0.0 0.0 0.0

6.8 2.6

0.0 1.5 3.9 6.0 8.5 4.1

19,953 25,186 23,959 23,099 23,227 18,945 17,080 13,197 15,001

9,556 7,524 7,027

11,553

68,848 1,46,460

39,583 42,704 42,886 43,823 46,312

2,15,308



Figure 2.8: Median years of schooling completed for population age 6 years and above, India between RSOC and NFHS-3

The state-wise results on literates, percentage distribution of population aged 6 and more by level of education, and median years of schooling completed according to sex are presented in Tables 2.19 and 2.20 respectively. The state-wise results are broadly on expected lines. However, what concerns the most is the variation in median years of completed schooling across states particularly in case of females.

8.2

5.3

6.5 6.8

2.6

4.1

7.6

4.0

4.9 5.5

0.0

1.9

Urban Rural Total Urban Rural Total

Male Female

RSOC, 2013-14 NFHS-3, 2005-06



Table 2.19: Educational status of the household population aged 6 and above across states: Male

Percentage of males literate, percent distribution of males aged 6 or more by level of education and median years of schooling

completed, by states, RSOC, 2013-14.

State

Level of Education Median years of

completed schooling

No Education

Below Primary

Completed Primary

Completed Middle

Completed Secondary

Completed Higher

Secondary and above

Total

India North







19.2

9.5 17.4

7.2 20.9 17.8 22.9 12.6

15.2 19.9

27.9 23.3 19.8 16.0

16.1 17.1

7.3 13.3

2.6 16.4 11.8

9.1

19.7 6.5

14.6 13.9

33.4 19.7

3.5 11.3

16.4

10.0 11.5 10.4 13.6 10.6 16.7 16.0

18.5 16.6

21.9 18.2 18.8 22.3

21.0 25.3 15.3 22.7 14.4

7.1 21.5 19.5

18.4 14.4 15.5 14.5

10.0 14.2 10.9 13.8

17.0

12.9 14.9 16.1 13.5 14.6 15.6 17.1

19.8 20.3

15.1 18.1 20.5 19.0

17.9 20.3 14.8 17.0 15.4

8.2 23.3 20.8

18.1 13.8 19.5 14.8

14.4 15.3 16.8 21.2

15.1

12.5 12.9 13.6 19.9 14.5 16.0 18.8

20.9 19.0

13.0 15.9 18.8 18.8

18.6 17.5 21.6 17.0 16.6 15.0 18.2 23.0

15.2 15.2 16.5 12.7

6.8

10.3 14.1 17.3

13.9

18.1 17.0 24.0 15.3 20.1 11.2 15.1

10.2 10.0

11.3 11.2

9.2 9.9

13.3

8.6 16.4 12.8 22.2 20.3 11.2 13.4

11.4 20.2 16.2 19.9

14.5 17.2 27.5 16.3

18.4

37.0 26.3 28.7 16.7 22.4 17.7 20.4

15.4 14.2

10.9 13.4 13.0 14.0

13.2 11.1 24.6 17.0 28.8 33.0 14.0 14.2

17.2 29.9 17.7 24.1

21.0 23.3 27.2 20.2

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

6.5

9.3 7.7 9.1 7.2 7.7 5.4 7.3

6.4 5.6

4.0 5.1 5.7 5.8

6.3 5.0 8.3 6.4 9.1 9.2 6.0 7.1

5.7 9.0 7.1 8.2

5.3 7.2 9.2 7.4



Table 2.20: Educational status of the household population aged 6 and above across states: Female

Percentage of females literate, percent distribution of females age 6 or more by level of education and median years of

schooling completed, by states, RSOC, 2013-14.

State

Level of Education Median years of completed schooling

No Education

Below Primary

Completed Primary

Completed Middle

Completed Secondary

Completed Higher Secondary and above

Total

India North







34.0

21.0 33.9 21.7 39.5 27.5 42.0 28.0

37.2 38.3

47.1 41.5 37.6 27.6

23.2 24.8 19.8 17.7

4.1 17.8 20.8 16.9

44.1 15.2 32.1 25.7

41.4 29.5

6.7 20.6

15.2

10.8 11.9

9.6 11.1

9.7 14.8 12.5

15.8 15.0

19.6 19.4 16.4 20.8

24.6 23.6 16.0 22.0 14.7

9.1 18.8 20.6

15.3 14.5 15.0 15.1

9.4

12.9 13.0 12.7

16.1

13.3 14.3 17.7 11.4 15.5 13.4 14.5

17.8 16.7

13.9 14.2 17.4 17.4

19.6 18.0 13.9 19.5 18.4 12.0 20.8 20.4

15.4 14.8 19.4 18.1

15.4 17.7 15.4 18.9

12.3

12.1 11.5 13.0 15.2 12.1 11.0 14.6

15.5 14.7

8.9

10.6 15.1 16.8

15.3 19.8 20.1 15.3 17.7 20.3 17.8 25.2

10.4 15.1 12.1 12.5

7.4 8.1

10.4 16.6

10.4

13.6 11.0 15.0 10.6 15.9

7.4 11.5

6.1 6.4

6.2 6.8 7.4 9.3

9.8 6.7

12.3 13.1 26.2 19.0 11.0

9.4

6.2 18.8

9.9 14.4

13.8 16.8 23.5 14.2

12.0

29.2 17.3 23.0 12.2 19.3 11.5 18.9

7.6 8.9

4.3 7.5 6.1 8.2

7.4 7.1

18.0 12.4 19.0 21.9 10.9

7.5

8.5 21.7 11.5 14.1

12.6 15.0 30.9 17.0

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

4.1

7.6 4.5 7.1 3.7 6.3 1.8 5.0

3.2 3.2

0.1 1.6 2.9 4.3

4.2 4.3 7.1 5.4 8.4 8.0 5.4 5.7

1.3 7.6 4.5 6.0

3.7 5.6 9.2 6.6

The effective literacy as measured from Census is based on population aged 7 and above. Table 2.21 presents the literacy and educational attainment of the household population (7 years and more) by background characteristics. The literacy rates as revealed from RSOC are quite close to Census 2011 figures (Total: 73.0 percent; Male: 80.9 percent; Female: 64.6 percent; Rural: 67.8 percent and Urban: 84.1 percent).



Table 2.21 Literacy and educational attainment of the household population aged 7 and above

Percentage of literate and percent distribution of the household population aged 7 or more by level of education, and median years of schooling completed by selected characteristics, RSOC, 2013-14.

Characteristics

Literacy

rate

Level of Education Median

years of

completed

schooling

Sample HH

population

aged 7

years &

above

No

Education

Below

Primary

Completed

Primary

Completed

Middle

Completed

Secondary

Completed

Higher

Secondary

and above

Total

Sex

Male 81.0 19.0 15.1 17.4 15.5 14.3 18.8 100.0 6.7 2,13,504

Female 65.8 34.1 14.0 16.5 12.6 10.7 12.2 100.0 4.3 2,10,652

Residence

Urban 83.7 16.4 12.2 16.1 14.4 16.0 25.0 100.0 7.7 1,37,267

Rural 68.5 31.3 15.6 17.4 13.9 10.8 11.0 100.0 4.4 2,86,889

Caste

Scheduled Caste 67.4 32.2 15.5 17.5 14.5 9.9 10.4 100.0 4.3 81,172

Scheduled Tribe 63.2 37.2 15.4 16.3 12.9 9.1 9.2 100.0 3.5 45,634

Other Backward Class 73.9 26.0 14.2 17.4 13.9 13.0 15.5 100.0 5.5 1,71,084

Other 80.7 19.4 13.8 16.1 14.3 14.9 21.5 100.0 7.1 1,23,317

Do not know 68.5 29.4 25.5 19.0 12.8 7.5 5.8 100.0 3.5 2,949

Wealth index

Lowest 53.5 45.7 18.8 16.8 10.8 4.9 3.0 100.0 1.1 77,213

Second 65.2 34.5 17.8 18.7 14.4 8.4 6.2 100.0 3.6 84,233

Middle 73.3 26.6 14.8 19.2 16.1 12.1 11.1 100.0 5.0 84,466

Fourth 81.8 18.7 12.2 17.4 16.1 16.8 18.8 100.0 7.2 86,290

Highest 90.0 10.1 9.8 12.9 12.6 18.9 35.6 100.0 9.3 91,954

Total 73.4 26.5 14.5 17.0 14.0 12.5 15.5 100.0 5.4 4,24,156



Table 2.22: Literacy Rate of household population aged 6-24

Percentage of literate and percentage currently attending school/college (in the year 2012-13) among household population aged 6-24 by different age groups according to sex, residence, age, social-group, RSOC, 2013-14.

Background characteristic

6-11 12-14 15-17 15-24 6--24 Total

persons age 6-24

Literate Attending

school/ college

Literate Attending

school/ college

Literate Attending

school/ college

Literate Attending

school/ college

Literate Attending

school/ college

Residence Urban 90.2 83.3 95.9 92.1 95.3 80.8 92.5 52.0 92.3 68.5 55,357

Rural 82.7 77.9 92.8 87.3 91.6 72.1 87.0 44.0 86.6 63.0 129,491

Sex

Male 85.4 79.5 94.3 89.1 93.3 74.6 91.9 50.2 90.1 67.0 92,651

Female 84.2 79.4 93.0 88.3 92.1 74.7 85.6 42.9 86.4 62.3 92,197

Caste

Scheduled Caste 82.7 78.1 92.0 86.8 91.2 72.0 86.2 42.9 86.0 62.4 37,550

Scheduled Tribe 80.4 76.3 91.1 83.9 88.9 64.2 81.5 38.0 82.8 59.1 20,618

Other Backward Class 84.3 79.4 93.9 89.9 92.9 76.6 89.1 48.9 88.4 66.4 75,583

Others 89.5 81.9 95.8 90.6 95.3 78.6 92.8 49.3 92.2 66.3 49,697

Do Not Know 86.9 82.4 95.1 83.8 87.6 53.2 83.1 25.6 86.1 54.5 1,400

Wealth Index

Lowest 74.8 71.3 86.9 79.3 83.1 57.8 74.3 33.3 76.9 56.8 36,788

Second 83.0 79.5 92.4 86.1 91.2 68.4 84.3 39.0 85.3 61.5 39,992

Middle 86.7 80.8 95.1 90.4 94.3 74.4 90.5 42.9 90.1 62.9 37,969

Fourth 90.2 83.0 97.4 93.9 97.0 82.7 94.1 51.3 93.5 68.1 36,089

Highest 93.7 85.7 98.5 97.0 98.4 91.9 97.5 63.7 96.6 75.1 34,010

Total 84.8 79.5 93.7 88.7 92.7 74.7 88.7 46.5 88.3 64.7 1,84,848



Table 2.23: Literacy Rate of household population aged 15-24

Percentage of literate among household population aged 15-24 by sex, residence and state, India, RSOC 2013-14.

State

Residence Total

Urban Rural


India North







93.8

95.3 96.4 99.0 96.8 90.3 88.7 92.4

95.9 96.1

85.8 95.5 92.9 93.9

97.7 99.2 98.7 98.7 99.9 96.5 99.0 99.4

92.8 98.5 94.0 96.3

92.5 95.2 98.7 95.5

91.2

92.4 92.0 96.1 90.6 92.5 85.0 92.9

96.2 94.1

82.3 92.0 90.4 91.4

95.6 94.5 92.6 96.4

100.0 95.7 97.6 96.8

87.9 97.9 89.2 96.4

82.4 92.9 99.5 96.9

92.5

93.9 94.3 97.7 93.7 91.2 86.9 92.7

96.1 95.1

84.1 93.7 91.6 92.6

96.4 96.6 95.6 97.5 99.9 96.0 98.3 98.2

90.2 98.2 91.5 96.3

86.4 94.0 99.1 96.3

91.0

96.2 92.5 99.0 96.7 91.5 85.7 97.7

95.3 87.5

86.6 89.8 93.1 94.0

94.1 95.6 99.1 92.6 99.8 98.0 98.2 97.0

91.7

100.0 92.3 96.8

90.1 90.7 99.3 98.8

83.1

94.2 85.8 99.2 86.5 90.7 76.4 94.5

85.1 82.7

71.3 72.4 85.0 89.4

92.6 89.7 97.6 93.0 96.6 95.3 97.2 96.0

75.4 99.1 80.6 92.3

86.1 88.3 96.7 95.5

87.0

95.3 89.2 99.1 91.7 91.1 81.0 96.0

89.9 85.1

78.6 81.3 88.8 91.6

93.4 92.5 98.3 92.8 98.5 96.5 97.7 96.5

83.5 99.5 86.6 94.6

87.8 89.5 97.9 96.9

91.9

95.3 93.9 99.0 96.7 91.0 86.4 96.3

95.5 89.9

86.5 91.0 93.1 94.0

94.9 96.0 99.0 94.4 99.9 97.4 98.4 97.6

91.9 99.0 93.0 96.5

90.9 92.4 99.0 97.2

85.6

92.4 87.9 99.0 87.5 91.3 78.3 94.0

87.4 85.9

72.7 76.8 85.9 90.1

93.5 90.4 96.1 93.9 98.5 95.4 97.3 96.2

78.6 98.4 84.5 94.3

84.9 90.2 98.0 96.1

88.7

93.9 91.0 99.0 92.2 91.1 82.3 95.1

91.3 88.0

79.4 84.0 89.3 91.9

94.2 93.0 97.4 94.2 99.3 96.3 97.8 96.9

85.2 98.7 88.8 95.5

87.3 91.3 98.5 96.6



Recognizing the importance of literacy among youths (15-24 years) it is considered as one of the Millennium Development Goal (MDG) indicators to track the progress on achieving universal education under Goal 2. Table 2.22 shows the percentage of literates and those currently attending school/college during 2012-13 among population aged 6-24 by selected background characteristics. The youth literacy is pegged at 89 percent with respective figures for males and females being 92 percent and 86 percent. The differentials are in favour of males over females, persons living in urban areas against those living in rural areas, others/OBCs over SCs/STs and population belonging to the richest quintile vis-à-vis poorest quintile. As expected, these estimates are slightly higher than Census 2011 figures (Total -86.1 percent; Male- 90.0 percent; Female- 81.8 percent) and conform to the projected trend based on census data (Censuses 1991, 2001 and 2011). The state-wise youth literacy by sex and residence is presented in Table 2.23. School Attendance Ratios Data on school and college attendance any time during the academic year 2012-13 was collected for the usual residents’ age 5-24 years. However, the analysis of the net attendance ratios (NARs) and gross attendance ratios (GARs) in this section has been restricted to the official school going age group of 6-17 years only. The NAR measures the participation in primary schooling (classes 1-5 ) for the population aged 6-10, in middle school (classes 6-8) for the population aged 11-13, secondary school (classes 9-10) for the population aged 14-15, and higher secondary school (classes 11-12) for the population age 16-17 years. The GAR on the other hand indicates participation at each level of schooling among those of any age. The GAR therefore is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level. An NAR of 100 percent would indicate that all of those in the official age range are attending school at that level. The GAR can exceed 100 percent if there is significant over-age or under-age participation at a given level of schooling. Table 2.24 provides NARs and GARs by sex, residence and by levels of schooling. NAR is 75 percent at the primary level, 50 percent at middle school, 37 percent at secondary school and 27 percent at higher secondary school. For middle, secondary and higher secondary levels taken together, NAR is 65 percent. Though there is a negligible gap of less than 1 percentage point in favour of males at primary level, the situation has reversed at the middle, secondary and higher secondary level which is an encouraging sign. At all the levels of schooling, NARs in urban areas are better than NARs in rural areas. As presented in Table 2.24, the GAR is close to 101 percent (102 percent for males and 99 percent for females) at the primary level, 90 percent (89 percent for males and 90 percent for females) at middle school, 84 percent (85 percent for males and 82 percent for females) at secondary school, and 67 percent (73 percent for males and 62 percent for females) at higher secondary level. For middle, secondary and higher secondary taken together, it was 82 percent (84 percent for males and 80 percent for females). Again GARs are higher for urban areas in comparison to rural at all levels of schooling. Table 2.24 also shows that the Gender Parity Index (GPI), which represents the ratio of the NAR and GAR for females to the corresponding NAR and GAR for males. It is a more precise indicator of gender differences in school attendance rates. A GPI greater than 1.00 indicates that a higher proportion of females than males attend school. The GPI based on NAR is 1.00 in urban areas and is 0.99 in rural areas at primary level suggesting a bridging male-female gap. At the middle, secondary and higher secondary level, the GPI exceeds 1.00 both in urban as well as rural areas. However, the GPI based on GAR is less than 1.00 for primary as well as for secondary levels across rural and urban



areas and also for rural areas at higher secondary level. This indicates a noticeable male-female gap due to low access to age-appropriate education for girls as compared to boys.

Table 2.24: School attendance ratios

Net attendance ratios (NAR), gross attendance ratios (GAR), and Gender Parity Index (GPI) for the household population aged 6-17 by level of schooling and sex, according to residence, RSOC, 2013-14.

Residence

Net attendance ratio1

Gender Parity Index

3

from NAR

Gross attendance ratio2

Gender Parity Index

3

from GAR Male Female Total Male Female Total

Primary School

Urban Rural Total

79.1 73.9 75.3

78.9 73.4 74.9

79.0 73.7 75.1

1.00 0.99 0.99

103.1 101.7 102.1

100.0 98.9 99.2

101.6 100.3 100.7

0.97 0.97 0.97

Middle School

Urban Rural Total

55.6 46.3 49.0

59.3 48.7 51.7

57.3 47.5 50.3

1.07 1.05 1.05

92.9 87.1 88.8

95.2 88.4 90.3

94.0 87.7 89.5

1.02 1.02 1.02

Secondary School

Urban Rural Total

42.5 32.6 35.5

47.7 34.8 38.5

45.1 33.7 37.0

1.12 1.07 1.09

96.9 80.2 85.1

89.0 79.1 82.0

93.0 79.7 83.6

0.92 0.99 0.96

1 The NAR for primary school (standards 1-5) is the percentage of the primary-school age population (6-10 years)

that is attending primary school. The numerator is number of household members aged 6 to 10 years attending standards 1 to 5. The denominator is primary school age population aged 6 to 10 years. The NAR for middle school (standards 6-8) is the percentage of the population in the appropriate age group for those school levels (11-13 years) that is attending those school levels. The numerator is number of household members aged 11 to 13 years attending standards 6 to 8. The denominator is middle school age population aged 11 to 13 years. The NAR for secondary school (standards 9-10) is the percentage of the population in the appropriate age group for those school levels (14-15 years) that is attending those school levels. The numerator is number of household members aged 14 to 15 years attending standards 9 to 10. The denominator is secondary school age population aged 14 to 15 years.

2 The GAR for primary school (standards 1-5) is the total number of primary school students, expressed as a

percentage of the official primary-school-age population (6-10 years). The numerator is number of household members attending standards 1-5. The denominator is primary school age population aged 6-10 years. The GAR for middle school (standards 6-8) is the total number of students in those school levels, expressed as a percentage of the official population that is the appropriate age to be attending those school levels. The numerator is number of household members attending standards 6-8. The denominator is primary school age population aged 11-13 years. The GAR for secondary school (standards 9-10) is the total number of students in those school levels, expressed as a percentage of the official population that is the appropriate age to be attending those school levels. The numerator is number of household members attending standards 9-10. The denominator is primary school age population aged 14-15 years.

3The GPI for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males.

The GPI for middle school is the ratio of the NAR (GAR) for females to the NAR (GAR) for males. The GPI for secondary school is the ratio of the NAR (GAR) for females to the NAR (GAR) for males.

Continued…



Table 2.24: School attendance ratios-Continued

Net attendance ratios (NAR), gross attendance ratios (GAR), and Gender Parity Index (GPI) for the household population aged 6-17 by level of schooling and sex, according to residence, RSOC, 2013-14.

Residence

Net attendance ratio1

Gender Parity Index

3

from NAR

Gross attendance ratio2

Gender Parity Index

3

from GAR Male Female Total Male Female Total

Higher Secondary School

Urban Rural Total

29.6 22.5 24.8

39.0 24.2 28.4

34.1 23.4 26.6

1.31 1.07 1.14

82.2 68.6 72.9

85.2 52.8 62.0

83.6 60.4 67.4

1.04 0.77 0.85

Middle, Secondary and Higher Secondary School

Urban Rural Total

70.6 61.0 63.9

72.9 62.2 65.3

71.7 61.6 64.6

1.03 1.02 1.02

91.1 80.4 83.6

90.6 75.9 80.0

90.8 78.1 81.8

0.99 0.94 0.96

1 The NAR for higher secondary school (standards 11-12) is the percentage of the population in the appropriate age

group for those school levels (16-17 years) that is attending those school levels. The numerator is number of household members aged 16 to 17 years attending standards 11 to 12. The denominator is higher secondary school age population aged 16 to 17 years. The NAR for middle, secondary, and higher secondary school (standards 6-12) is the percentage of the population in the appropriate age group for those school levels (11-17 years) that is attending those school levels. The numerator is number of household members aged between 11 to 17 years attending standards 6 to 12. The denominator is primary school age population aged 11 to 17 years.

2

The GAR for higher secondary school (standards 11-12) is the total number of students in those school levels, expressed as a percentage of the official population that is the appropriate age to be attending those school levels. The numerator is number of household members attending standards 11-12. The denominator is primary school age population aged 16-17 years. The GAR for middle, secondary, and higher secondary school (standards 6-12) is the total number of students in those school levels, expressed as a percentage of the official population that is the appropriate age to be attending those school levels. The numerator is number of household members attending standards 6-12. The denominator is primary school age population aged 11-17 years. 3 The GPI for higher secondary school is the ratio of the NAR (GAR) for females to the NAR (GAR) for males. The GPI

for middle school, secondary school, and higher secondary school is the ratio of the NAR (GAR) for females to the NAR (GAR) for males at those levels of school.

Table 2.25 presents the percentage of population aged 6-24 who attended school/college during 2012-13 by broad age-groups according to residence and sex. The proportion of children attending school was higher in urban areas than in rural areas, for both males and females. The highest proportion of children attending school is in the age group 11-13 years, with girls attending in higher proportions in urban as well as in rural areas. Overall, close to two-thirds (65 percent) are attending school clearly hinting at the likely challenges in achieving universal schooling status which is a precursor to universal literacy. The most concerning fact is that as high as 23 percent of children in the age group 6-10 years were not attending the school on the date of survey. This assumes significance in the light of compulsory universal education being promoted by government of India.



Table 2.25: School attendance by sex and residence

Percentage of household population aged 6-24 attended school in the year 2012-13 by broad age-groups according to residence and sex, RSOC, 2013-14.

Age groups

Residence Total

Urban Rural


6-10 11-13 14-17 6-13 6-17 15-24 6-24 Total Persons 6-24

81.4 93.2 83.2 85.8 84.9 55.0 70.5

28,028

81.5 94.2 83.3 86.2 85.2 49.1 66.3

27,329

75.9 89.2 76.0 80.7 79.2 48.1 65.5

64,623

75.9 89.0 75.0 80.6 78.8 40.0 60.5

64,867

77.5 90.4 78.2 82.2 80.9 50.2 67.0

92,651

77.4 90.5 77.4 82.2 80.6 42.9 62.3

92,197

When seen from the lens of gender equality, the gap between males and females attendance seems to receding particularly for official age-group 6-17 years. However, the pronounced societal preference towards educating boys and not girls is visible for the age groups 15-24 years which in turn also distorts the situation for 6-24 years. This trend is found across urban and rural areas. With the enactment of Right to Education Act, government has bestowed the right of free and compulsory education for children of age 6-13 years across the country. In order to reflect the current situation, state-wise data on school attendance for children of age 6-13 years is presented in Table 2.26. It is evident from above that low performance in states with high population burden such as Uttar Pradesh, Bihar, Jharkhand, Jammu & Kashmir and Rajasthan pulls the national average down. However, what is heartening is the fact that the attendance in rural areas of 11 states is higher than urban areas and in another 6 states, the gaps is below 3 percentage points. Equally heartening is the fact that the female attendance is higher than their counterparts in urban areas of 12 states and rural areas of 14 states.



Table 2.26: School attendance by states

Percentage of household population aged 6-13 that attended school during the year 2012-13 by states according to residence and sex, RSOC, 2013-14.

State

Residence Total

Urban Rural


India 85.8 86.2 86.0 80.7 80.6 80.7 82.2 82.2 82.2 North

Delhi 87.5 91.2 89.3 91.4 92.8 92.0 87.6 91.2 89.4 Haryana 87.8 84.3 86.2 88.4 85.7 87.1 88.2 85.3 86.8 Himachal Pradesh 92.9 81.1 87.5 98.1 94.7 96.5 97.6 93.4 95.7 Jammu & Kashmir 81.4 86.7 83.7 76.0 83.2 79.4 77.2 83.9 80.3 Punjab 88.0 87.1 87.6 89.4 85.3 87.5 88.8 86.0 87.6 Uttar Pradesh 75.5 76.5 76.0 71.9 73.2 72.5 72.6 73.8 73.2 Uttarakhand 88.9 83.8 86.5 81.9 84.3 83.1 84.0 84.2 84.1

Central Chhattisgarh 84.1 86.6 85.2 85.3 79.6 82.5 85.0 80.9 83.0 Madhya Pradesh 88.8 88.6 88.7 83.4 83.2 83.3 84.9 84.5 84.7

East Bihar 72.5 73.9 73.2 75.1 74.4 74.8 74.8 74.4 74.6 Jharkhand 88.2 87.5 87.9 80.1 79.6 79.9 81.8 80.9 81.3 Odisha 89.1 89.8 89.5 82.2 83.0 82.6 83.2 84.0 83.6 West Bengal 87.7 84.6 86.3 84.1 88.8 86.4 85.2 87.7 86.4

Northeast Arunachal Pradesh 98.5 92.8 95.7 91.8 92.3 92.0 93.7 92.4 93.1 Assam 91.0 95.6 93.4 94.1 92.7 93.4 93.7 93.1 93.4 Manipur 84.1 75.1 79.7 88.8 89.4 89.1 87.3 84.3 85.9 Meghalaya 84.7 86.3 85.4 87.1 89.9 88.4 86.5 89.0 87.7 Mizoram 89.0 89.0 89.0 85.4 88.7 86.5 87.5 88.9 88.1 Nagaland 84.1 89.0 86.7 79.2 74.2 76.6 81.1 80.2 80.6 Sikkim 89.8 92.4 91.2 94.4 95.4 94.9 93.2 94.5 93.9 Tripura 90.9 86.2 88.1 86.5 85.2 85.9 87.3 85.5 86.4

West Rajasthan 83.5 85.3 84.3 82.9 78.5 80.8 83.0 80.1 81.6 Goa 90.4 90.6 90.5 97.8 89.3 93.7 92.9 90.2 91.6 Gujarat 90.2 87.3 88.9 86.5 84.7 85.6 88.2 85.8 87.1 Maharashtra 89.2 91.1 90.1 80.6 80.7 80.7 84.4 85.1 84.7

South Andhra Pradesh 82.4 79.9 81.1 83.8 80.0 81.8 83.2 80.0 81.5 Karnataka 87.4 88.4 87.9 83.6 87.2 85.6 85.4 87.7 86.6 Kerala 90.4 92.9 91.7 91.5 91.7 91.6 91.0 92.2 91.6 Tamil Nadu 92.4 95.3 93.7 94.9 95.4 95.1 93.6 95.3 94.4



2.6 HOUSING CHARACTERISTICS The housing characteristics of a household include access to basic utilities, sources of drinking water, type of and usage of sanitation facilities and housing structure (type of house). The crowding of dwelling spaces (number of rooms used for sleeping), availability of separate kitchen, electricity, type of fuel used for cooking, access to bank account, ownership of the house etc. are the characteristics of a household used to assess the general well-being and socio-economic status of its members. These conditions also provide a deeper understanding of the choices and options available to the household in terms of standard of living, health and educational opportunities. This section therefore provides information on type of house, number of rooms used for sleeping, availability of separate kitchen, availability of electricity, type of cooking fuel, availability of bank account, ownership of the house collected through household questionnaire. Table 2.27 provides information on household characteristics such as type of house, number of rooms used for sleeping, having a separate kitchen for cooking, availability of electricity, type of fuel used for cooking, availability of bank account and ownership status of the house. The categorization of households living in pucca, semi-pucca and kutcha houses was done through observation on the basis of materials used for construction. RSOC reports that about 19 percent of the households in this country were still residing in kutcha houses, another 31 percent in semi-pucca houses and the remaining 50 percent in pucca houses. Against 61 percent of households residing in kutcha and semi-pucca houses in rural areas, there were just 29 percent households living in such houses in urban areas. The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding affects environment and hygiene and therefore increases the risk of contracting infectious diseases, which particularly affect children and older household members. About 44 percent of households had just one room for sleeping followed by 38 percent with two sleeping rooms and 11 percent with three sleeping rooms. While less than 1 percent reported having no room for sleeping against 6 percent with 4 or more rooms. The data does not show any significant rural-urban differentials. Indoor air pollution has an important implication for the health of the household members. Having a separate place of cooking and the type of fuel used are all related to indoor air quality and the degree to which household members are exposed to the risk of respiratory infections and other diseases. More than half (59 percent) of the households had a separate kitchen with a higher proportion (74 percent) in urban areas in comparison to 52 percent in rural areas. Overall, more than half of the households (55 percent) used solid fuels for cooking. There are substantial urban –rural differences in the use of solid fuel. In urban areas, only 23 percent of households used solid fuel for cooking, while the majority of rural households (71 percent) used solid fuel, including coal or lignite, charcoal, wood, straw, shrubs, grass and animal dung that generate smoke and are unhealthy to breathe. The percentage of households relying on wood for fuel decreased from 53 percent in DLHS-3 (2007-08) to 46 percent 2013-14. As expected, use of LPG/natural gas had gone up to 36 percent from 24 percent in 2007-08 with 72 percent households using it in urban areas against just 16 percent in rural areas. Around 86 percent of the households had access to electricity, compared to 70 percent in 2007-08. The rise has been sharper in case of rural areas (from 60 percent to 81 percent) as compared to urban areas (from 92 percent to 97 percent). As presented in Table 2.24, overall, 78 percent of the



households had access to at least one bank account. Higher proportions of households from urban India had bank accounts in comparison to rural.

More than four out of five (82 percent) of the households were either living in their own house or

owned a house somewhere else. As expected, more households in rural areas owned a house as

compared to urban.

Table 2.27: Housing characteristics

Percent distribution of the households by type of house, number of rooms used for sleeping and other housing

characteristics according to residence, India, RSOC, 2013-14.

Housing characteristics Residence

Total De jure

population Urban Rural

Type of house Kutcha Semi-pucca Pucca Total

Number of rooms used for sleeping No room 1 2 3 4+ Total Mean number of rooms used for sleeping

Kitchen Separate room used as a kitchen

Electricity HH has electricity

Fuel used for cooking Electricity LPG/Natural Gas Biogas/Gobar gas Kerosene Coke/Coal/Lignite Charcoal Wood Straw/Shrubs/Grass Agricultural Crop Waste Dung Cakes Others No food cooked in the Household Total

Bank Account Has a bank account

Ownership of house Ownership of house*

Total Number of Households

5.9

22.6 71.5

100.0

0.4 42.3 37.9 13.0

6.3 100.0

1.9

74.1

97.3

0.9

71.8 2.5 3.2 1.4 1.7

16.3 0.3 0.2 1.3 0.3 0.1

100.0

83.1

76.5 34,775

24.7 35.6 39.7

100.0

0.5 45.0 38.2 10.8

5.5 100.0

1.8

52.3

80.5

0.5

16.1 0.8 0.5 0.3 1.9

60.9 4.0 3.8

10.1 1.0 0.1

100.0

74.8

85.3 70,707

18.5 31.3 50.2

100.0

0.5 44.1 38.1 11.6

5.7 100.0

1.8

59.5

86.0

0.6

34.5 1.4 1.4 0.6 1.9

46.2 2.8 2.6 7.2 0.7 0.1

100.0

77.5

82.4 1,05,482

18.0 30.7 51.3

100.0

0.4 37.8 39.6 14.0

8.3 100.0

-

59.6

85.6

0.6 32.8

1.3 1.2 0.7 1.8

47.3 2.8 2.5 8.3 0.6 0.1

100.0

79.2

82.3 4,95,571

*Ownership of this house or any other house.



2.7 WATER, SANITATION AND HYGIENE PRACTICES OF THE HOUSEHOLD

Access to safe water, sanitation and hygiene practices are basic determinants of better health. They help to understand the health related vulnerabilities of the population and suggests critical remedial steps to alleviate them from skin diseases, acute respiratory infections (ARIs), and diarrhoeal diseases. ARIs and diarrhoeal diseases cause substantial number of under five deaths globally and also in India, which otherwise is preventable. Recognizing that access to safe drinking water and improved sanitation is essential for improving the overall health condition of all, this was included as one of the MDGs. 2.7.1 Source of drinking water and access to improved drinking water Table 2.28 presents the percent distribution of households by place of residence and source of drinking water. In this survey, sources that are likely to provide water suitable for drinking are identified as improved sources. These include a piped source within dwelling, yard or plot; a public tap/stand pipe; tube well or borehole; hand pump; a protected well; spring water; and rain water. This is in conformity with WHO and UNICEF definition as adopted under Joint Monitoring Programme for Water Supply and Sanitation. Access to an improved source of water is nearly universal in India (91 percent) with more than nine out of every ten households both in urban as well as rural areas using improved source of drinking water. About 44 percent of households in rural areas relied on hand pump against just 12 percent relying in urban areas. While 39 percent of households depended on piped water supply into dwelling/yard/plot in urban areas, this was 11 percent in case of rural areas. Only in case of 24 percent households, the source of drinking water was within their own dwellings.



Table 2.28: Source of drinking water

Percent distribution of households by source of drinking water according to residence, RSOC, 2013-14.

Type of water source Residence

Total De jure


Improved Sources 92.8 90.2 91.0 91.3

Piped water supply into Dwelling/Yard/Plot 38.8 11.0 20.1 20.0

Public tap/stand pipe 31.5 23.0 25.8 24.1

Tube well or bore well 7.7 8.7 8.4 8.3

Hand pump 12.1 43.6 33.2 35.4

Dug well—protected 2.2 3.3 2.9 2.8

Spring—protected 0.4 0.5 0.4 0.4

Rain water 0.2 0.1 0.2 0.2

Unimproved sources 7.2 9.8 9.0 8.7

Unprotected spring 0.6 1.1 0.9 0.9

Unprotected dug well 1.4 5.4 4.1 4.2

Cart with small tank/Dum 0.8 0.4 0.6 0.5

Tanker/Truck 1.3 0.6 0.8 0.8

Surface water (River/Dam/Lake/Pond/Canal) 0.4 1.0 0.8 0.8

Bottled water 2.2 1.1 1.5 1.2

Others 0.4 0.2 0.2 0.3

Number of households 34,775 70,707 1,05,482 4,95,571

Location of the water source

In own dwelling 34.4 20.1 23.7 24.7

In own yard/plot 21.1 21.4 21.3 22.1

Elsewhere 44.5 58.5 55.0 53.3

Total 100.0 100.0 100.0 100.0

Number of households with no piped water into dwelling/yard/plot

21,294 62,939 84,233 3,96,238

Figure 2.9 shows that there has been an improvement in proportion of households using improved source of drinking water vis-à-vis DLHS-3 (2007-08) primarily on account of increase in rural areas. The situation as revealed under RSOC is quite close to Census 2011 (88 percent) and NSS (2012) (Rural: 88.5 percent and Urban: 95.3 percent) and India is on track to achieve the target of halving the proportion of households without access to safe drinking water.



Figure 2.9: Source of drinking water—Comparison with DLHS-3

Table 2.29 presents the percent distribution of households by source of improved and unimproved source of drinking water by residence, social groups and wealth quintiles. As expected, the access to improved source of drinking water is the least for ST households among social groups and poorest households by wealth quintiles. Table 2.29: Source of drinking water Percent distribution of households by source of improved drinking and unimproved drinking water according to selected characteristics, RSOC, 2013-14. The state wise picture on proportion of households using improved source of drinking water is presented in Table 2.30. As can be seen, slightly more than half of the states are found to be above the national average.

84 91

80 90 94 93

DLHS-3 (Total) RSOC (Total) DLHS-3 (Rural) RSOC (Rural) DLHS-3(Urban)

RSOC (Urban)

Improved Source

Characteristic

Households having

improved drinking water

1

Households having

unimproved drinking

water

Total Number of households




Total

92.8 90.2

92.7 85.3 90.3 93.1 91.9

88.7 91.7 92.6 90.9 91.2 91.0

7.2 9.8

7.3

14.7 9.7 6.9 8.1

11.3

8.3 7.4 9.1 8.8 9.0

100.0 100.0

100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0

34,775 70,707

20,378 11,733 41,955 30,613

802

21,096 21,096 21,099 21,096 21,095

1,05,482 1Improved drinking water includes piped water supply into dwelling/yard/plot, public tap/stand

pipe, tube well or bore well, hand pump, dug well—protected, spring—protected and rain water.



Table 2.30: Improving drinking water, by state

Percentage of households using improved drinking water by residence, de jure population and state, RSOC, 2013-14.

State Residence

Total De jure


India North







92.8

90.3 92.1 98.6 96.6 99.8 98.8 99.9

97.0 91.7

98.0 89.1 88.8 95.9

99.9 93.2 60.6 81.0 84.8 60.0 83.4 97.7

96.2 92.4 97.9 99.4

84.2 96.0 55.5 92.5

90.2

78.0 96.1 96.8 83.1 98.7 97.1 96.9

87.7 86.2

97.7 64.8 86.7 94.1

95.5 86.1 41.5 54.0 56.8 63.0 66.4 83.1

85.2 84.5 95.3 91.4

85.7 94.3 48.5 97.7

91.0

90.0 94.6 97.0 86.7 99.1 97.5 97.8

89.8 87.7

97.7 70.0 87.1 94.7

96.7 87.2 48.1 60.1 72.0 62.0 71.3 87.2

88.0 89.5 96.6 95.1

85.2 95.0 51.8 95.1

91.3

89.8 94.7 97.6 85.2 99.1 97.7 97.9

89.3 86.9

97.8 68.5 86.9 94.7

96.5 87.5 47.8 62.3 70.6 64.3 71.6 87.2

87.9 88.6 96.3 95.2

85.8 94.8 51.9 95.0

Improved drinking water includes piped water supply into dwelling/yard/plot, public

tap/stand pipe, tube well or bore well, hand pump, dug well—protected, spring—

protected and rain water.



2.7.2 Usage of toilet facility Under RSOC, the information on usage of toilet facility was collected through a combination of three questions—kind of toilet facility used by the household, do all members use this facility or not; and whether this facility is shared with other households. This helped in eliciting comprehensive response sets on the basis of which households have been categorized into those using improved toilet facilities and otherwise. A household is classified as having an improved toilet if it is used only by the household members (is not shared with another household) and if it separates waste from human contact. Besides flush/pour flush toilets, ventilated improved pit latrine (VIP), pit latrine with slab and composting toilets are clubbed under improved category. This definition is in conformity with WHO and UNICEF JMP’s standards on water supply and sanitation. Table 2.31 shows the percent distribution of households by type of toilet/latrine facilities and residence. A total of 42 percent of households reported having an improved toilet facility. Urban households are more than twice as likely to use an improved toilet facility as compared to rural households. Flush/pour flush to –septic tank was the most widely used type of toilet across rural and urban households. Close to 46 percent of households defecate in open with the proportion of rural households being five times more than in comparison to urban households. Table 2.31: Usage of household sanitation facilities Percent distribution of households by usage of improved or unimproved toilet facilities, according to residence and de jure population, India, RSOC, 2013-14.

Type of toilet facility Residence

Total

De jure


Improved toilet

Flush/pour flush to - piped sewer system

Flush/pour flush to -septic tank

Flush/pour flush to - pit latrine

Ventilated improved pit latrine (VIP)

Pit latrine with slab

Composting toilet

Non-improved toilet

Any facility shared with other households

Flush/pour flush to -elsewhere

Flush/pour flush to - unknown place

Pit latrine without slab/open pit

Bucket

Hanging toilet/hanging latrine

Others

No facilities or bush or field

Total Households

All Members use this toilet

Share the toilet facility with other households

Number of households using a toilet

66.0

18.6

32.0

7.7

2.7

4.7

0.3

34.0

20.1

0.3

0.2

0.3

0.1

0.1

0.1

12.8

34,775

98.1

23.0

30,332

29.9

2.4

13.6

6.6

2.5

4.3

0.5

70.1

6.8

0.2

0.1

0.7

0.1

0.4

0.0

61.6

70,707

94.4

17.6

27,145

41.8

7.7

19.7

7.0

2.5

4.4

0.5

58.2

11.2

0.2

0.1

0.6

0.1

0.3

0.1

45.5

1,05,482

96.3

20.5

57,477

42.0

7.7

19.5

7.6

2.6

4.2

0.5

58.0

10.2

0.2

0.2

0.6

0.1

0.4

0.1

46.1

4,95,571

96.0

19.0

2,66,952



Table 2.32 captures the variability in usage of sanitation facilities across different social groups and wealth quintiles. As expected, the proportion of households using improved toilets is significantly lesser among SCs/STs as compared to those of OBC/Others across place of residence. The situation is worse in case of STs. Figure 2.10 highlights the differential in use of toilet facilities among social groups distinctly.

Figure 2.10: Use of toilet facility across social groups

Table 2.32: Use of toilet facility by social groups and wealth quintiles Percentage of households using toilet facility according to selected characteristics, RSOC, 2013-14 When examined by wealth quintiles, the differential in proportion of households using improved sanitation becomes sharper both in rural as well as urban households. Against a gap of almost ten times between households belonging to the poorest and the richest quintiles in terms of usage of improved toilet facility seen in case of urban areas, there was a variation of more than 16 times in favour of richest households in rural areas.

Characteristic

Households having access to improved

sanitation

Households having access

to non-improved sanitation

Households not having access to sanitation





Total

66.0 29.9

29.8 22.2 43.3 55.4 35.5

4.5

18.7 37.6 63.6 84.5 41.8

20.6

8.4

11.8 8.7

10.7 16.3 23.6

4.2 9.6

16.0 19.1 13.1 12.4

12.8 61.6

58.1 68.9 45.7 28.0 40.3

91.1 71.4 45.9 16.9

2.3 45.5

34,775 70,707

20,378 11,733 41,955 30,613

802

21,096 21,096 21,099 21,096 21,095

1,05,482

30 22

43

55

12 9 11 16

58

69

46

28

Schedule Caste Schedule Tribe Other BackwardClass

Other

Using improved toilets Using unimproved toilets Open defecation



The state-wise depiction of sanitation situation in terms usage of any toilet facility and using improved toilet facility is given in Table 2.33. Seven states namely Odisha, Jharkhand, Bihar, Chhattisgarh, Madhya Pradesh, Rajasthan and Uttar Pradesh have proportion of households using any type of toilet below the all India figure. These seven states also rest at the lowest spectrum in terms of using improved toilet facility. On the other hand, at least 9 out of every 10 households in states like Punjab, Sikkim, Mizoram, Tripura, Delhi and Kerala use any type of toilet and consequently they rank very high in terms of using improved toilets also. Table 2.33: Toilet facility by State Percentage of households using any type of toilet facility and using improved toilet facility by residence, de jure population and state, RSOC, 2013-14.

State

Using any type of toilet facility Using improved toilet facility1

Urban Rural Total De jure population

Urban Rural Total De jure population

India North







87.2

97.6 91.7 93.3 92.8 97.5 88.8 96.9

74.8 81.2

67.6 65.4 64.3 92.6

95.6 97.0 96.9 97.0 99.3 96.0 98.6 99.2

87.5 90.1 87.8 85.2

86.7 89.2 99.9 83.9

38.4

93.4 64.3 76.4 57.4 85.8 28.3 70.0

17.6 19.7

19.8 13.2 14.3 61.4

58.1 56.1 82.3 61.4 92.5 80.6 94.4 95.4

25.1 79.3 38.4 44.2

46.3 51.0 96.6 30.0

54.5

97.5 74.4 78.2 66.9 90.3 42.3 78.4

30.4 36.6

25.2 24.4 22.3 71.7

68.3 62.5 87.4 69.4 96.2 86.1 95.6 96.5

40.9 86.1 61.9 63.5

60.5 66.8 98.1 56.6

53.9

97.3 75.4 78.2 68.3 90.2 43.3 79.7

31.8 38.8

25.5 25.5 22.3 72.4

68.0 62.1 87.9 70.3 96.1 84.8 96.0 96.6

41.4 86.2 61.2 63.7

61.1 66.2 98.3 55.9

66.0

68.0 74.3 73.3 71.9 74.1 68.2 71.1

44.1 65.6

45.0 51.6 50.1 52.0

80.1 60.1 46.3 60.6 96.8 80.0 68.8 71.7

64.6 68.1 76.6 55.4

75.7 71.4 93.9 66.6

29.9

67.3 55.5 62.3 33.9 71.1 22.5 47.3

10.9 15.8

14.9

5.0 10.7 39.0

45.7 39.1 39.0 40.6 88.3 76.5 75.0 52.7

19.8 64.9 35.8 32.9

39.3 44.3 89.3 26.8

41.8

68.0 62.4 63.5 44.1 72.3 33.1 54.7

18.4 29.5

18.3 15.0 17.0 43.3

55.1 42.4 41.5 45.1 92.9 77.7 73.2 58.0

31.1 67.0 55.2 43.5

52.2 55.5 91.4 46.4

42.0

69.8 64.6 64.6 45.4 74.4 34.8 57.0

20.9 31.9

18.8 15.8 17.5 45.9

54.3 43.2 44.2 45.9 93.1 77.0 74.9 57.9

32.2 66.7 55.3 43.5

53.1 55.7 91.9 46.7

1Improved toilet facility includes f lush/pour flush to—piped sewer system, flush/pour flush to septic tank, flush/pour flush to—pit

latrine, ventilated improved pit latrine (VIP), pit latrine with slab, composting toilet and toilet not shared with any other household.



Table 2.34 shows that 38 percent of households are using both improved source of drinking water and improved sanitation facilities. As seen in case of improved sanitation, there is a marked rural-urban differential in favour of urban households. Among social groups, the proportion of such households is the least for STs followed by SCs. By wealth quintiles, there is a gap of 18 times between the poorest and the richest households. Table 2.35 presents the state-wise picture. There are 20 states where proportion of households having access to improved source of drinking water and also using improved sanitation is higher than the national average. Table 2.34: Access to improved source of drinking water and use of improved sanitation facility Percentage of households having access to improved source of drinking water and using improved toilet facility according to selected characteristics, RSOC, 2013-14.

Characteristic

Households having access to improved source

of drinking water1

Households using improved

sanitation2

Households having improved source of drinking water and

using improved sanitation





Total

92.8 90.2

92.7 85.3 90.3 93.1 91.9

88.7 91.7 92.6 90.9 91.2 91.0

66.0 29.9

29.8 22.2 43.3 55.4 35.5

4.5

18.7 37.6 63.6 84.5 41.8

60.7 26.7

27.8 19.4 38.3 51.4 32.8

4.2

17.2 34.8 56.8 76.6 37.9

34,775 70,707

20,378 11,733 41,955 30,613

802

21,096 21,096 21,099 21,096 21,095

1,05,482 1

Improved drinking water includes piped water supply into dwelling/yard/plot, public tap/stand pipe, tube well or bore well, hand pump, dug well—protected, spring—protected and rain water. 2Improved toilet facility includes flush/pour flush to—piped sewer system, flush/pour flush to—septic

tank, flush/pour flush to—pit latrine, ventilated improved pit latrine (VIP), pit latrine with slab, composting toilet and toilet not shared with any other household.



Table 2.35: Access to improved source of drinking water and use of improved sanitation facility by state Percentage of households having access to improved source of drinking water and using improved sanitation by de jure population and state, RSOC, 2013-14.

State

Households having access to improved

source of drinking water

1

De jure population

Households using

improved sanitation

2

De jure population

Households having improved

source of drinking water and using

improved sanitation

De jure population

India North







91.0

90.0 94.6 97.0 86.7 99.1 97.5 97.8

89.8 87.7

97.7 70.0 87.1 94.7

96.7 87.2 48.1 60.1 72.0 62.0 71.3 87.2

88.0 89.5 96.6 95.1

85.2 95.0 51.8 95.1

91.3

89.8 94.7 97.6 85.2 99.1 97.7 97.9

89.3 86.9

97.8 68.5 86.9 94.7

96.5 87.5 47.8 62.3 70.6 64.3 71.6 87.2

87.9 88.6 96.3 95.2

85.8 94.8 51.9 95.0

41.8

68.0 62.4 63.5 44.1 72.3 33.1 54.7

18.4 29.5

18.3 15.0 17.0 43.3

55.1 42.4 41.5 45.1 92.9 77.7 73.2 58.0

31.1 67.0 55.2 43.5

52.2 55.5 91.4 46.4

42.0

69.8 64.6 64.6 45.4 74.4 34.8 57.0

20.9 31.9

18.8 15.8 17.5 45.9

54.3 43.2 44.2 45.9 93.1 77.0 74.9 57.9

32.2 66.7 55.3 43.5

53.1 55.7 91.9 46.7

37.9

62.4 59.4 62.5 39.7 71.7 32.6 53.9

17.4 26.8

18.2 12.7 15.7 40.7

54.7 38.9 22.1 33.2 69.3 48.1 53.8 54.9

28.4 60.8 53.7 42.3

44.2 51.8 46.9 43.4

38.4

63.9 61.5 63.7 40.1 73.8 34.3 56.2

19.6 28.6

18.7 13.2 16.2 43.1

53.9 39.6 23.0 33.9 68.2 49.9 55.6 54.9

29.4 59.8 53.8 42.4

45.5 51.8 47.3 43.5

1 Improved drinking water includes piped water supply into dwelling/yard/plot, public tap/stand pipe, tube well or bore well,

hand pump, dug well—protected, spring—protected and rain water. 2

Improved toilet facility includes f lush/pour flush to—piped sewer system, flush/pour flush to septic tank, flush/pour flush to—pit latrine, ventilated improved pit latrine (VIP), pit latrine with slab, composting toilet and toilet not shared with any other household.



2.7.3 Hand washing practice Observance and promotion of basic hygiene are fundamental for good public health. Hand washing with soap ensures that transmission of germs is restricted, especially among children who are prone to diarrhoea and other childhood illnesses. Using a soap for washing hands, particularly after contact with excreta, can reduce diarrhoeal diseases by over 40 per cent and respiratory infections by 30 per cent. The government of India through various public awareness programmes promotes hand washing with soap which is among the most effective and inexpensive ways to prevent diarrhoeal diseases and pneumonia. Table 2.36 provides information according to social groups and wealth quintiles by residence on designated places for hand washing in households and on the availability of water and cleansing agents for washing hands. In RSOC, interviewers were instructed to observe the place where household members usually wash their hands. They looked for the availability of water supply and observed whether the household had cleansing agents near the place of hand washing. In cases where they did not see the hand washing material, it was further probed by asking about the availability of these items at home. Overall, the interviewers observed designated places for hand washing in 86 percent of households with little variation in urban and rural households (87 percent and 85 percent, respectively). There is not much variation with regard to the observed designated places for hand washing across social groups. There is a gradual rise in proportion of households where place of hand washing was observed across wealth quintiles. Among the households where the place of hand washing was observed, 90 percent have availability of water and 81 percent have availability of hand washing material like soap, detergent or ash. Significantly a higher proportion of rural households did not have water and soap, detergent or any cleansing agent as compared to urban households. The availability increases with higher wealth quintiles establishing a direct relationship between wealth of the household and use of water and soap, detergent or any cleansing agent for hand washing.



Table 2.36: Availability of hand washing facilities Percentage of households by availability of hand-wash facilities by select characteristics, RSOC, 2013-14.

Characteristic Observed

Location of Hand washing

Availability of water at hand washing place

Availability of soap, detergent or ash

(observed) Residence

Urban Rural



Total

87.4 85.4

84.4 84.5 87.5 86.2 65.4

80.0 84.2 84.8 89.2 92.0 86.0

96.1 86.7

87.4 79.4 91.8 92.7 80.6

74.1 85.4 91.9 96.5 99.1 89.8

91.4 75.3

73.6 74.0 81.8 86.7 57.6

60.4 72.5 80.9 89.0 97.5 80.7

Table 2.37 presents the state-wise data on designated places for hand washing in households and on the availability of water and cleansing agents for washing hands. Barring West Bengal (71 percent), Andhra Pradesh (71 percent) and Karnataka (66 Percent), proportion of households where the designated place of hand washing was observed is in excess of 80 percent. Of these households, water was available at place of hand washing in more than 80 percent of households in majority of states except for Chhattisgarh (65 percent), Jharkhand (67percent) and Odisha (64 percent). As regards availability of soap, detergent, ash or mud/sand at the place of hand washing, all states reported in excess of 70 percent excluding Chhattisgarh (68 percent), Tamil Nadu (66 percent), Odisha (51 percent) and West Bengal (50 percent).



Table 2.37: Hand wash facilities in households by states Percentage of households by availability of hand-wash facilities across states, RSOC, 2013-14.

State Observed

Location of Hand washing

Availability of

water at hand

washing place

Availability of soap,

detergent, ash and

mud/sand (observed)

India 86.0 89.8 80.7 North

Delhi 83.9 98.6 98.1 Haryana 96.2 97.8 90.7 Himachal Pradesh 95.6 94.5 99.5 Jammu & Kashmir 93.6 88.4 89.6 Punjab 97.7 98.9 98.0 Uttar Pradesh 92.0 95.1 85.4 Uttarakhand 93.0 90.1 92.3

Central Chhattisgarh 98.8 65.2 67.8 Madhya Pradesh 86.3 93.9 90.4

East Bihar 85.7 89.7 74.5 Jharkhand 88.4 67.0 76.4 Odisha 92.9 63.7 51.1 West Bengal 71.0 81.1 49.5

Northeast Arunachal Pradesh 98.6 92.0 94.8 Assam 81.8 81.8 94.8 Manipur 94.6 94.2 89.2 Meghalaya 82.4 87.8 87.0 Mizoram 96.9 99.6 99.6 Nagaland 98.2 97.7 95.6 Sikkim 98.1 97.3 93.1 Tripura 93.0 85.4 73.0

West Rajasthan 92.5 89.1 72.4 Goa 87.2 92.6 92.6 Gujarat 95.2 95.2 91.5 Maharashtra 90.6 96.1 94.3

South Andhra Pradesh 70.7 89.3 82.7 Karnataka 66.0 91.6 89.2 Kerala 92.7 98.0 94.6 Tamil Nadu 88.6 94.3 65.8

2.8 HOUSEHOLD POSSESSION AND WEALTH INDEX

2.8.1 Possession of household assets Possession of durable goods is another useful indicator of a household’s socio-economic well-being. The availability and use of such goods have multiple effects and implications on their living standard. For instance, access to radio/transistor or television or computer keeps the household members updated on daily events, information and educational materials which have a direct bearing on their day–to-day life. Similarly, a refrigerator prolongs food storage and keeps food fresh and hygienic. Availability of means of transportation such as bicycle, motorcycle/scooter, etc. allows greater and faster access to services away from the local area and enhances social and economic activities.



Under RSOC, information on household possessions of 27 items was collected. Table 2.38 presents the percentages of households possessing these items by place of residence. The table shows that mobile phones are possessed by 84 percent of households. The wider penetration particularly in rural areas (80 percent) is an encouraging sign. Six of 10 households have a television. Urban households are more likely to have a television (86 percent) than rural households (49 percent). Possession of a radio declined from 27 percent in 2007-08 to 5 percent in 2013-14, while ownership of a colour television has gone up from 46 percent to 58 percent. Another important indicator of a household’s socio-economic status is possession of a computer and availability of an internet connection. Close to 6 percent of households possess a computer (Desktop and Laptop taken together), and just 2 percent have access to an internet connection with notable urban-rural variations. For example, 11 percent of urban households and 2 percent of rural households possess a computer. Similarly, 5 percent of urban households have access to an internet connection, as compared with less than 1 percent of rural households. A refrigerator is available in 16 percent households (34 percent in urban areas and 8 percent in rural areas). About 3 percent of households possess an air conditioner and 8 percent a washing machine with higher percentages in urban than rural households. Around 10 percent of households possess an air cooler with 20 percent in urban areas and 5 percent in rural areas. Bicycles and motorcycles/scooters are the most common means of transportation; 53 percent of households possess a bicycle, and 29 percent, a motorcycle/scooter. Bicycle possession is more in rural areas (57 percent) than urban areas (46 percent). On the other hand, 21 percent households possess a motorcycle/scooter in rural areas against 44 percent in urban areas. Only 2 percent of households possess an animal drawn car with 2.3 percent in rural areas as compared to just 0.8 percent in urban areas. Ownership of car/jeep is much higher in urban areas (8 percent) than in rural areas (2.0 percent). Under RSOC, data in respect of households not possessing any of these durable goods was also collected to have an idea about those households who live in abject poverty and deprivation. About 1 percent of households reported not possessing any of these durable goods. As expected, percentage of such households is much higher in rural areas (1.1 percent) than urban areas (0.3 percent).



Table 2.38: Household possessions Percentage of households by possession of household durable goods, according to place of residence and de jure population, RSOC, 2013-14.

Household assets Residence

Total De jure


Mattress made of cotton/foam 67.4 46.2 53.2 55.3

Pressure cooker 75.8 34.8 48.3 49.3

Chair 83.2 65.8 71.5 72.5

Cot/Bed 83.1 79.1 80.4 82.1

Table 61.6 37.6 45.5 46.4

Electric fan 82.8 53.3 63.0 63.4

Radio/Transistor 7.3 4.0 5.1 5.3

Black and White television 3.1 2.8 2.9 3.1

Color television 82.8 46.0 58.2 58.3

Sewing machine 25.6 14.9 18.5 20.9

Mobile telephone 91.0 80.3 83.9 86.4

Landline telephone 6.4 1.7 3.3 3.1

Internet connection 4.9 0.8 2.1 2.1

Desktop computer 5.8 0.9 2.5 2.6

Laptop 7.8 1.3 3.5 3.6

Refrigerator 33.9 7.7 16.3 16.8

Air cooler 19.6 5.3 10.0 10.8

Air conditioner 6.7 0.7 2.7 2.7

Washing machine 19.2 3.1 8.4 8.7

Watch/Clock 79.8 63.1 68.6 70.4

Bicycle 46.2 56.9 53.4 56.9

Motorcycle/Scooter 43.9 21.3 28.8 30.4

Animal Drawn cart 0.8 2.3 1.8 2.2

Car/Jeep 7.9 2.1 4.0 4.2

Water pump 9.9 7.6 8.3 9.0

Thresher 0.3 1.2 0.9 1.2

Tractor 0.3 1.9 1.3 1.9

No assets 0.3 1.1 0.8 0.6

Total households 34,775 70,707 1,05,482 4,95,571



2.8.2 Wealth Index Table 2.39 presents the distribution of population by wealth quintiles according to their social group and religious affiliations. The economic inequality based on social group status is also corroborated by RSOC data. In terms of economic status, ST and SC population are at the bottom rung. This is evident from the fact that 40 percent of ST and 26 percent of SC population falls in the poorest category as compared to 16 percent for OBCs and 10 percent for Others. At the same time, the share of SC and ST population in their respective richest group is 12 percent and 8 percent respectively. The proportion of population in the richest quintile is the least among Buddhists (17 percent) followed by Hindus (20 percent) and Muslims (21 percent). Christians with 24 percent of population in the highest quintile are comparatively wealthier. About 43 percent of urban residents are in the highest wealth quintile, as compared with only 11 percent of rural residents. More than half (51 percent) of the rural population falls in the last two quintiles, as compared to 12 percent of urban population which illustrates the rural-urban inequality. This, to a large extent, explains the poor performance of rural folks on critical indicators related to education, sanitation and health as compared to their urban counterparts.

Table 2.39: Wealth Quintiles by Social Group and Religion

Percent distribution of the household population by wealth quintile, according to social-group and religion, India, RSOC, 2013-14.

State

Wealth Index Total

Total

population Lowest Second Middle Fourth Highest



Religion Hinduism Islam Christianity Sikhism Jain Buddhism No religion Others

Total

3.8

25.8

25.6 39.5 16.2

9.8 25.5

19.7 17.0 11.6

1.3 3.3

15.8 17.8 35.9 18.8

8.3

25.5

25.5 23.0 19.1 16.3 28.7

20.2 20.8 17.8

7.4 17.2 18.0 36.5 22.3 20.0

16.2 21.7

21.1 17.3 20.7 19.1 20.4

20.0 20.0 21.6 12.4 15.3 29.3 18.3 20.9 20.0

28.4 16.3

16.3 12.6 22.5 22.5

9.3

19.8 21.3 24.7 24.5

8.5 20.3 10.2 12.8 20.2

43.3 10.7

11.5

7.5 21.4 32.3 16.0

20.3 20.9 24.4 54.3 55.7 16.6 17.1

8.2 21.1

100.0 100.0

100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

1,57,750 3,37,821

95,610 53,770

2,00,943 1,41,670

3,580

3,96,380 71,635 12,802

7,876 1,233 3,607

306 1,732

4,95,571

Table 2.40 presents wealth quintiles by states. Across states, there is a large variation in the distribution of households through wealth quintiles. States like Mizoram, Delhi, Kerala, Punjab, Nagaland and Goa report almost negligible proportion of households in the poorest category, but at the same time there are states like Jharkhand (51 percent), Odisha (43 percent), Bihar (36 percent), Madhya Pradesh (34 percent) and Chhattisgarh (33 percent) wherein almost every 3rd person belongs to this category. Consequently, wide variations are also seen in the richest quintile, and how this economic inequality has impacted the state level performance on well-being of children and women will unfold in subsequent sections/chapters.



Table 2.40: Wealth Quintile

Percent distribution of the household population by wealth quintiles, according to place of residence and states, India, RSOC, 2013-14.

Residence/State Wealth Index

Lowest Second Middle Fourth Highest Total

India North







18.8

0.2 4.0 2.1

11.0 0.8

22.4 4.3

33.2 34.4

35.9 51.4 42.7 22.6

4.9

12.4 7.7 4.8 0.0 0.9 3.5

10.7

13.8 0.8

15.3 12.6

7.1 8.0 0.7 5.0

20.0

1.9 11.8

7.3 19.1

5.3 24.0 12.1

24.7 19.9

28.5 19.4 23.3 23.4

24.2 41.5 27.2 31.9

1.9 27.2 11.8 26.4

19.6

3.4 17.3 14.9

19.4 18.6

3.4 16.2

20.0

10.7 18.1 22.3 24.6

9.6 18.7 19.4

16.4 14.5

17.9 11.8 16.2 22.5

33.8 23.9 28.7 30.4 18.3 29.2 27.9 34.6

21.5

8.7 20.0 21.4

27.8 23.4

7.2 28.8

20.2

21.2 25.7 30.4 20.8 24.0 16.9 28.0

11.5 13.3

10.7

8.2 9.7

18.9

24.1 12.2 22.4 23.6 40.0 24.2 40.2 17.5

20.4 25.1 22.9 24.7

29.7 25.9 29.0 32.4

21.1

65.9 40.5 37.8 24.6 60.3 18.1 36.2

14.1 17.9

7.0 9.2 8.0

12.7

13.0 10.0 13.9

9.2 39.8 18.4 16.7 10.8

24.6 62.0 24.6 26.4

15.9 24.1 59.7 17.6

100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0

100.0 100.0 100.0 100.0



2.9 IODINE LEVELS IN COOKING SALT

Iodine deficiency disorders (IDDs) constitute the single largest cause of preventable brain damage worldwide. Majority of consequences of IDDs are invisible and irreversible but at the same time these are preventable. In India, the entire population is prone to IDD due to deficiency of iodine in the soil of the subcontinent and consequently the food derived from it. To combat the risk of IDD, salt is fortified with iodine. IDD constitutes the single largest cause of preventable brain damage worldwide leading to learning disabilities and psychomotor impairment. Children living in iodine-deficient areas on an average have lower intelligence quotient (IQ), by as much as 13.5 IQ points as compared to children living in iodine-sufficient areas. IDDs have been shown to be associated with at least six of the eight MDG. Under RSOC, the cooking salt used by the households was tested to assess whether the salt is fortified with iodine. This was done using a salt testing kit that instantly yields the iodine content in the salt. Table 2.41 depicts the percentage of households using adequately iodized salt (more than or equal to 15 PPM) by residence, social groups and wealth quintiles. Sixty seven percent of households are using adequately iodized salt with a notable rural-urban differential. About 80 percent households use adequately iodized salt in urban areas as compared to 61 percent in rural areas. When analysed by social groups, 61 percent of SC, 62 percent of ST, 66 percent of OBCs and 76 percent of Other households use adequately iodized salt. Wealth index has a more pronounced impact with regard to use of adequately iodized salt. The proportion of households using adequately iodized salt shows a gradual increase across wealth quintiles both in rural as well as urban areas. The gap between the proportion of households belonging to the poorest and the richest category in terms of using adequately iodized salt is 37 percent at the overall level, and close to 33 percent in case of urban as well as rural households.



Table 2.41: households using adequately iodized salt by selected characteristics Percentage of households using adequately iodized salt (more than or equal to 15 PPM) by selected background characteristics, according to residence, RSOC, 2013-14.


Residence Total

Urban Rural

HH using cooking

salt more than or

equal to 15 PPM

Total

number of

households

HH using

cooking salt

more than or

equal to 15

PPM

Total number

of households

HH using

cooking salt

more than or

equal to 15

PPM

Total

number of

households

Social - group

Scheduled Caste 77.5 5,571 54.9 14,808 61.1 20,378

Scheduled Tribe 70.9 2,162 60.2 9,571 62.1 11,733

Other Backward Class 78.6 13,825 59.2 28,130 65.6 41,955

Other 83.2 12,967 70.4 17,646 75.8 30,613

Do not know 84.8 250 72.2 552 76.2 802

Wealth index

Lowest 55.2 1,476 49.1 19,620 49.6 21,096

Second 62.9 3,027 57.7 18,069 58.4 21,096

Middle 73.3 5,906 63.7 15,193 66.4 21,099

Fourth 80.0 10,043 72.3 11,053 76.0 21,096

Highest 88.2 14,323 83.1 6,772 86.6 21,095

Total 79.7 34,775 61.3 70,707 67.4 1,05,482

Table 2.42 presents the state wise picture with regard to use of adequately iodized salt. Seven states namely Nagaland, Mizoram, Meghalaya, Sikkim, Manipur, Assam and Kerala reported more than 90 percent of households using appropriately iodized cooking salt. On the other hand, states like Uttar Pradesh, Madhya Pradesh, Jharkhand, Andhra Pradesh and Tamil Nadu have reported below 60 percent, with Uttar Pradesh recording the least (47.7 percent). There is a substantial urban-rural variation seen in case of Uttar Pradesh, Madhya Pradesh, Jharkhand, West Bengal, Tripura, Rajasthan and Tamil Nadu.



Table 2.42: Households using adequately iodized salt by state

Percentage of households using adequately iodized salt (more than or equal to 15 PPM) by state, according to

residence, RSOC, 2013-14.

State Residence

Total Urban Rural

India North

Delhi Haryana Himachal Pradesh Jammu & Kashmir Punjab Uttar Pradesh

Uttarakhand Central

Chhattisgarh Madhya Pradesh





79.7

82.7 91.3 85.7 93.2 90.1 74.8 93.1

80.0 74.3

78.7 76.2 93.0 89.8

88.4 94.4 94.1 96.8 98.9 99.2 98.6 86.7

80.5 84.6 88.2 82.8

62.2 75.1 93.9 68.4

61.3

78.6 83.1 88.6 81.1 86.8 39.5 78.4

65.4 50.1

60.9 49.0 84.3 66.9

80.8 91.5 96.7 96.3 99.5 99.5 94.7 58.5

58.6 80.9 73.0 75.3

50.4 57.5 86.7 46.5

67.4

82.6 86.1 88.3 84.3 88.1 47.7 83.0

68.7 56.7

62.9 54.9 85.7 74.4

82.9 92.0 95.8 96.4 99.2 99.4 95.8 66.4

64.1 83.2 80.2 78.8

54.6 64.8 90.1 57.3



CHAPTER 3 PROFILE OF EVER MARRIED WOMEN AND CHILDREN

3.1 INTRODUCTION

The focus of RSOC is on the children in India. The survey studies the preventive and curative health

care given to the children and their nutritional status. Young children are under the care of their

mother and other women in the households. The health, nutritional status and utilization of health

care services depend on the characteristics of the women in the households. This chapter provides

details of the demographic and socio-economic characteristics of ever married women (EMW) in the

reproductive ages from the surveyed households. The profile of the women will help in building the

context for studying health and nutritional status of children.

In RSOC, the criterion for a woman to be eligible for individual interview was that a woman should

be ever-married and should be in the reproductive age-group of 15-49. So in RSOC, all the EMW in

reproductive ages of 15-49 from all the surveyed households were interviewed. The chapter

discusses demographic and socio-economic profile of these women. The educational attainment,

age at marriage, fertility performance and family planning practice of these women are discussed in

detail. The chapter also includes discussion on the educational attainment and age at the time of

marriage of adolescent girls.

As RSOC is about children below age six, the discussion on the demographic profile of the children,

birth registration and pre-school attendance is also a part of this chapter.

3.2 SOCIO-ECONOMIC PROFILE OF EVER MARRIED WOMEN

Table 3.1 presents distribution of EMW in rural, urban and total areas by age-group, educational

attainment, religion, social group, occupation and wealth quintile. The proportion of women

increases from three percent in the youngest age-group of 15-19 to 15 percent in 20-24 age-group

and 21 percent in 25-29 age-group. From age 30 onwards, there is a decrease in the proportion of

women in subsequent age-groups. The same pattern is observed in both rural and urban areas. The

small proportion of ever married women aged 15-19 is an indication of increase in marriage age in

recent years.

Among all the ever-married women 40 percent do not have any education, and six percent have

gone to school but did not complete primary schooling. Another 15 and 13 percent of the women

have completed primary and middle school education respectively. All the remaining 26 percent of

the women have completed secondary schooling. Among them 12 percent have completed

Secondary School Certificate (SSC) and 14 percent have completed Higher Secondary Certificate

(HSC). These 14 percent women who have completed HSC also include women who have completed

college or university education.



Table 3.1: Socio-economic and demographic characteristics of respondents

Percent distribution of ever married women aged 15-49 by background characteristics, RSOC, 2013-14

Background characteristic Residence

Total Urban Rural

Age

15-19 1.6 3.0 2.6

20-24 13.4 16.2 15.3

25-29 21.2 20.6 20.8

30-34 18.8 17.5 18.0

35-39 17.5 15.8 16.4

40-44 13.1 12.4 12.6

45-49 14.4 14.5 14.3

Education

No Education 23.0 47.3 39.3

Below Primary 4.9 6.2 5.8

Completed Primary 14.4 15.4 15.0

Completed Middle 15.0 12.6 13.4

Completed Secondary 17.1 9.9 12.3

Completed Higher Secondary and above 25.6 8.6 14.2

Religion

Hinduism 77.6 82.1 80.6

Islam 16.2 12.5 13.7

Christianity 3.1 2.4 2.6

Sikhism 1.3 1.7 1.6

Jainism 0.4 0.2 0.3

Buddhism/Neo-Buddhism 1.0 0.6 0.7

No Religion 0.1 0.1 0.1

Other 0.4 0.4 0.4

Social-group

Scheduled Caste 16.2 20.8 19.3

Scheduled Tribe 6.1 13.2 10.9

Other Backward Classes 39.6 40.2 40.0

Other 37.3 25.0 29.1

No Response 0.7 0.8 0.8

Wealth Index

Lowest 3.6 24.7 17.7

Second 8.1 25.3 19.7

Middle 16.5 22.2 20.3

Fourth 28.5 16.8 20.7

Highest 43.3 10.9 21.6

Occupation

Cultivator 0.6 10.1 7.0

Wage labourer 7.1 16.8 13.6

Self employed 4.2 2.1 2.8

Regular salaried/Wage employee 4.8 2.2 3.1

Other 1.0 0.5 0.7

Non-working 82.3 68.4 73.0

Total 32,556 66,027 98,583



The distribution of ever married women by religion, social group and wealth quintile is much similar

to that of surveyed households by these characteristics. Among the ever married women most (81%)

belong to Hindu religion, 14 percent belong to Islam and remaining 5 percent are from all other

religions. The proportion of women from Islam is a little higher in urban areas (16%) than in rural

areas (13%). About one-fifth (19%) of the women are from scheduled castes (SCs), 11 percent are

from scheduled tribes (STs), 40 percent are from other backward classes (OBCs) and remaining 29

percent are from Other castes. The proportion of women from SC and ST is relatively higher in rural

areas and that from Other castes is higher in urban areas. Almost equal proportion of women belong

to each of the wealth quintiles. The economic status of women from urban areas is better than their

rural counterpart, as more than two-thirds (72%) of women in urban areas belong to two highest

wealth quintiles compared to 28 percent of women in rural areas.

Most of the ever married women aged 15-49 (73%) are not engaged in any work besides their own

household work. The proportion of women not engaged in any occupation is higher in urban (82%)

than rural areas (68%). Among the 27 percent of working women, most are occupied as wage

labourers (14%) or cultivators (7%).

The percent distribution of ever married women age 15-49 by social group and educational

attainment and literacy rates across the states are presented in Annexure Table 3.1a and Table 3.2a

respectively.

3.3 SCHOOL ENROLMENT OF ADOLESCENT GIRLS

In RSOC, information on the school attendance during school year 2012-13 was collected for all the

household members aged 5-24. The Head of the household or the respondent of the Household

questionnaire was asked about each household member aged 5-24, whether he/she attended

school/college during 2012-13 and the grade he/she attended during that year. Table 3.2 gives the

percent distribution of adolescent girls by the standard they were attending in 2012-13. More than

three-fourth (78%) of the adolescent girls were attending school in 2012-13. Out of the 22 percent of

the girls who were not attending school, eight percent never attended school at all and remaining 15

percent attended school sometimes but dropped out of school before the school year 2012-13.

Among the 78 percent of the girls who were attending school, 12 percent were in classes 1-4, 35

percent in classes 5-8, 17 percent in classes 9-10 and the remaining 14 percent were in classes above

the 10th standard.



Table 3.2: Current educational status of adolescent girls aged 10-19 during 2012-13

Percent distribution of adolescent girls age 10-19 by the grade they were attending during the school year

2012-13 according to selected background characteristics, RSOC, 2013-14


Never

attended

school

Did not

attend

school in

2012-13

Attending grade

Total

Number of

adolescent

girls

Primary

(1-4)

Middle

(5-8)

Secondary

(9-10)

Higher

secondary or

higher (11th

or

higher grade)

Age-group

10-14 6.4 4.1 23.8 57.9 7.6 0.3 100.0 25,187

15-19 9.4 25.9 0.5 11.0 26.0 27.3 100.0 23,959

Residence

Urban 4.6 12.4 10.0 35.8 18.2 19.0 100.0 13,971

Rural 9.1 15.6 13.3 34.7 15.9 11.3 100.0 35,175

Religion

Hinduism 7.2 13.6 12.2 35.0 17.3 14.7 100.0 38,655

Islam 11.8 20.1 14.3 33.2 13.3 7.2 100.0 8,109

Christianity 5.3 15.1 6.8 39.6 17.2 16.0 100.0 1,228

Sikhism 4.4 10.9 14.9 35.7 16.9 17.2 100.0 636

Jainism (6.5) (0.0) (22.6) (41.9) (16.5) (12.9) 100.0 31

Buddhism/Neo-Buddhism 2.8 17.1 7.7 52.6 11.3 8.4 100.0 305

Other 10.3 8.7 11.6 44.3 14.3 10.7 100.0 146

No Response (6.7) (10.0) (13.3) (40.0) (20.0) (10.0) 100.0 20

Social-group

Scheduled Caste 9.7 15.7 14.1 34.5 15.1 10.9 100.0 10,085

Scheduled Tribe 12.3 17.5 11.6 34.2 14.8 9.6 100.0 5,357

Other backward Classes 7.8 13.6 12.4 34.9 16.6 14.7 100.0 20,696

Other 4.6 14.6 11.2 35.8 18.6 15.2 100.0 12,698

No Response 6.0 17.9 21.2 37.5 8.2 9.1 100.0 309

Wealth Index

Lowest 16.4 17.6 18.1 33.9 10.2 3.8 100.0 9,801

Second 10.1 16.1 13.3 37.1 14.7 8.7 100.0 10,889

Middle 6.5 18.1 9.7 34.6 17.8 13.3 100.0 10,256

Fourth 3.3 13.3 10.4 34.8 21.2 17.0 100.0 9,712

Highest 1.8 7.3 10.1 34.2 19.6 27.0 100.0 8,487

Total 7.8 14.7 12.4 35.0 16.6 13.5 100.0 49,145

( ) Based on 25-49 unweighted cases.



The proportion of girls who never attended school as well as the proportion who did not attend

school in the year 2012-13 was much higher among girls aged 15-19 than 10-14. School attendance

dropped from 90 percent among the young girls aged 10-14, to 65 percent among the girls aged 15-

19. Most of the older girls aged 15-19 were studying in higher grades compared to younger girls.

School attendance was higher in urban areas than in rural areas, as 83 percent of the girls from

urban areas and 75 percent from the rural areas were attending school during school year 2012-13.

Relatively higher proportion of the girls from the urban areas than rural areas were attending higher

grades. Among the adolescent girls from the four social groups, relatively higher proportion of girls

from the OBCs (79%) and Other castes (81%) were enrolled than those from SC (75%) and ST (70%).

Higher economic status leads to substantial increase in school enrolment of girls. The proportion of

girls who never attended school dropped from 16 percent among girls from the lowest wealth

quintile to only 2 percent among those from the highest wealth quintile. Similarly, the proportion of

those who did not attend school in the year 2012-13 also dropped from 18 percent among the girls

aged 10-19 in the lowest wealth quintile to 7 percent among those from the highest wealth quintile.

The proportion of the girls attending grades higher than 10th standard also increased with the better

economic status.

The state-wise percent distribution of adolescent girls by the standard they were attending in 2012-

13 is presented in Annexure Table 3.3a.

3.4 MARITAL STATUS

Marriage marks an important event in an individual’s life. In case of women, it marks the beginning

of the reproductive performance. Marital status and marriage age are determined by many of the

socio-economic and cultural factors and in turn they shape many of the socio-economic factors in

the society. The age at marriage has an impact on fertility, family planning practices, maternal health

and health care as well as infant and child mortality, and child care practices. RSOC collected data on

marital status and age at first marriage for every male and female household member aged 10 and

above, in the household questionnaire. The interviewee was head of the household. From all the

interviewed ever married women aged 15-49, age at marriage was verified by asking them about age

at marriage once again. The marital status distribution of all the women, irrespective of their

interview status, by residence and age-group is presented in Table 3.3. In the age-group of 15-19

most of the women (87%) were never married, one percent was married but their gauna was yet to

be performed, and the remaining 12 percent were married and had started living with their

husband.



Table 3.3: Marital status of women

Percent distribution of women age 15-49 by marital status, according to age and residence, RSOC,

2013-14

Residence/Age

Marital status

Total

Number

of

women

Never

married

Currently

married

and gauna

performed

Widowed Divorced Separated

Not stated/

married but

gauna not

performed

Urban

15-19 91.1 8.4 0.0 0.0 0.0 0.4 100.0 6,919

20-24 40.2 58.4 0.3 0.2 0.6 0.3 100.0 7,804

25-29 10.6 87.6 0.9 0.4 0.4 0.1 100.0 8,164

30-34 2.6 94.4 1.9 0.3 0.5 0.2 100.0 6,674

35-39 1.4 93.7 3.6 0.4 0.7 0.2 100.0 6,074

40-44 1.2 90.4 7.2 0.3 0.4 0.4 100.0 4,511

45-49 0.5 88.3 10.1 0.5 0.4 0.2 100.0 4,948

15-49 23.6 72.6 2.8 0.3 0.4 0.3 100.0 45,093

Rural

15-19 85.6 12.9 0.0 0 0 1.4 100.0 17,039

20-24 25.0 73.4 0.5 0.1 0.5 0.5 100.0 15,295

25-29 4.3 94.1 0.8 0.2 0.6 0.2 100.0 15,064

30-34 1.5 96.0 1.8 0.2 0.5 0.1 100.0 12,272

35-39 0.7 95.2 3.0 0.3 0.5 0.4 100.0 11,006

40-44 0.7 91.7 6.3 0.5 0.6 0.2 100.0 8,686

45-49 0.2 89.0 9.6 0.5 0.5 0.2 100.0 10,053

15-49 21.7 74.7 2.5 0.2 0.4 0.5 100.0 89,415

Total

15-19 87.2 11.6 0.0 0.0 0.0 1.1 100.0 23,959

20-24 30.2 68.3 0.4 0.1 0.5 0.4 100.0 23,099

25-29 6.5 91.8 0.8 0.2 0.5 0.1 100.0 23,227

30-34 1.9 95.4 1.8 0.2 0.5 0.1 100.0 18,945

35-39 0.9 94.7 3.2 0.3 0.5 0.3 100.0 17,080

40-44 0.9 91.2 6.6 0.4 0.5 0.3 100.0 13,197

45-49 0.3 88.8 9.8 0.5 0.4 0.2 100.0 15,001

15-49 22.3 74.0 2.6 0.2 0.4 0.4 100.0 1,34,508

The proportion of never married women dropped rapidly from 87 percent in the age-group 15-19 to

30 percent in the age-group 20-24 and further to 7 percent in the age-group 25-29. By age 30,

almost all the women were married as in the age-group 30-34 only two percent women were never

married and 99 percent were currently married. The proportion of widowed women was almost

negligible till the age 35, thereafter their proportion increased to 3 percent in the-group 35-39, 7

percent in the age-group 40-44 and further to 10 percent in the age-group 45-49. The pattern of age-

specific marital status distribution in rural and urban areas was quite similar, only the difference was

that in younger age-groups, the proportion of never married women was higher in urban areas than

rural areas. Relatively late marriages in urban areas resulted into higher proportion of never married

women in ages till 30.



3.5 AGE AT FIRST MARRIAGE

Table 3.4 gives the percentage of women aged 15-49 who were married by specific exact ages, the

percentage who have never married, and the median age at first marriage according to current age

and residence. The percentages are based on the data on marital status of all the household

members aged 10 and above collected in the Household questionnaire.

Table 3.4: Age at first marriage

Percentage of women age 15-49 married by specific exact age and median age at first marriage, according to

residence and current age, RSOC, 2013-14

Residence/Age

Percent first married by exact age Percent

never

married/not

stated

Number

of

women

Median age

at first

marriage 15 18 20 21 25

Urban

15-19 0.5 na na na na 91.1 6,919 nc

20-24 1.8 13.4 36.6 na na 40.2 7,804 nc

25-29 2.5 17.4 41.9 54.5 81.5 10.6 8,164 19.64

30-34 3.0 21.9 47.6 60.6 84.2 2.6 6,674 19.18

35-39 5.2 27.3 52.9 66.1 86.1 1.4 6,074 18.69

40-44 5.6 29.0 57.4 70.0 88.3 1.2 4,511 18.18

45-49 7.1 33.2 60.1 73.6 90.1 0.5 4,948 17.90

20-49 3.8 22.4 47.8 63.6 85.5 11.4 38,174 19.18

25-49 4.4 24.7 50.6 63.6 85.5 4.0 30,370 18.93

Rural

15-19 1.7 na na na na 85.6 17,712 nc

20-24 4.0 25.1 55.3 na na 25.0 15,295 18.57

25-29 6.0 32.4 61.3 73.1 91.9 4.3 15,064 17.95

30-34 8.1 42.0 69.5 80.0 92.3 1.5 12,272 17.42

35-39 8.9 45.9 73.5 82.9 93.7 0.7 11,006 17.22

40-44 9.7 43.8 71.8 84.0 94.0 0.7 8,686 17.31

45-49 11.9 51.9 75.2 84.5 94.1 0.2 10,053 16.84

20-49 7.6 38.6 66.5 80.1 93.1 6.7 72,375 17.63

25-49 8.6 42.2 69.5 80.1 93.1 1.7 57,080 17.42

Total

15-19 1.4 na na na na 87.2 23,959 nc

20-24 3.2 21.1 49.0 na na 30.2 23,099 19.10

25-29 4.8 27.2 54.5 66.5 88.3 6.5 23,227 18.57

30-34 6.3 34.9 61.8 73.2 89.5 1.9 18,945 17.84

35-39 7.6 39.3 66.2 76.9 91.0 0.9 17,080 17.61

40-44 8.3 38.7 66.9 79.2 92.0 0.9 13,197 17.57

45-49 10.3 45.7 70.2 80.9 92.8 0.3 15,001 17.26

20-49 6.3 33.0 60.0 74.4 90.4 8.3 1,10,549 17.98

25-49 7.1 36.1 62.9 74.4 90.4 2.5 87,451 17.79

na = Not applicable due to censoring. nc = Omitted because less than 50 percent of the women were married for the first time before reaching the beginning of the age group.



The median age at first marriage is the age by which 50 percent of the women marry. Among

women aged 20-49, six percent of the women married before age 15, 33 percent married before

18—the legal age at marriage and 60 percent married in their teens before age 20. The median age

at marriage for women aged 20-49 is 18 years. A slow change in the median age at marriage over the

period is observed from the increase in it from 17.26 years among women aged 45-49 to 18.57

among women aged 25-29. In recent period there is relatively faster increase in it to 19.1 among

women aged 20-24. The median age at marriage among women in urban areas is higher than that

among women in rural areas and the urban–rural difference in the median age at marriage is

increasing from about one year among women aged 45-49 to about two years among those aged 25-

29.

The extent of marriage among adolescent girls aged 10-19 is presented in Table 3.5. Among the girls

aged 10-19 six percent are married and four percent have married before attaining the legal age of

marriage which is 18. Out of these, a small proportion of 0.3 percent of girls aged 10-14 are married

and obviously all of them have married before attaining the age 18. Every one in eight girls (13%)

aged 15-19 is married and eight percent of them were married by age 18. Extent of early marriage is

at higher side in rural areas. The proportion of ever married and married by age 18 do not vary much

among young women from different social groups. With better economic status there is reduction in

the proportion of women who are ever married and those married by age 18.

Table 3.5: Age at first marriage among adolescent girls aged 10-19

Percentage of adolescent girls aged 10-19 married by age 18 and percentage of ever married, by background

characteristics, RSOC, 2013-14


Percentage

married at age

below 18 years

Percentage

ever

married

Number of

adolescent

girls

Age

10-14 0.3 0.3 25,186

15-19 7.5 12.8 23,959

Residence

Urban 2.3 4.5 13,970

Rural 4.4 7.2 35,175

Social-group

Scheduled caste 4.3 7.5 10,085

Scheduled tribe 3.5 6.4 5,357

Other Backward Classes 3.7 6.0 20,696

Other 3.4 5.8 12,698

Don’t know 18.7 21.4 309

Wealth Index

Lowest 4.6 6.7 9,801

Second 4.8 7.1 10,889

Middle 4.6 8.6 10,256

Fourth 3.1 5.8 9,712

Highest 1.5 3.2 8,487

Total 3.8 6.4 49,145

Percentage of ever-married women age 15-49 who were ever-pregnant and percentage who had

their first pregnancy by age 18 across states is given in Appendix Table 3.4a.



3.6 AGE AT FIRST PREGNANCY

Data on the age at first pregnancy and first live birth was collected from all the interviewed ever

married women aged 15-49 who ever became pregnant. Table 3.6 presents the distribution of ever

married by age at first pregnancy and median age at first pregnancy by different background

characteristics of women. Among all the ever married women aged 15-49, eight percent never

became pregnant; among the 92 percent women who ever became pregnant, 2 percent became

pregnant in the age-group 10-14 and another 48 percent in the age-group 15-19. In other words,

one-half of the ever married women had their first pregnancy when they were in their teen ages.

Almost one-half of the women aged 15-19 never became pregnant. However, the proportion of

women who never became pregnant decreased by 11 percent in the age-group 20-29 and then to 4

percent beyond age 30. The proportion of women who never became pregnant was almost equal

(6–8%) for women in different categories of residence, social group or wealth index. With increase in

education, the proportion of women who never became pregnant increased from 6 percent among

women with no education to 12 percent among women with 12 or more years of education.

Median age at first pregnancy among younger women aged 20-29 (20.4) was slightly higher than

that among women aged 40-49 (19.1). Among women in urban areas, the median age at first

pregnancy was more than one year higher than that among women in rural areas. Among women

from the four social groups, the median age at first pregnancy was the lowest among those

belonging to SC (18.4) and the highest among those from Other castes (19.4). With increase in

education as well as wealth quintile there was an increase in the median age at first pregnancy.

Median age at first pregnancy among women who completed secondary (25.2) was six years higher

than that among women with no education (18.7). Similarly, median age at first pregnancy among

women belonging to the highest wealth quintile (20.8) was more than one year higher than that

among women from the lowest wealth quintile (19.5).



Table 3.6: Age at first pregnancy

Percent distribution of ever married women aged 15-49 by age at first pregnancy and median age at first

pregnancy, by background characteristics, RSOC, 2013-14


Age at first pregnancy Percenta

ge never

pregnant

Number

of

women

Median

age at first

pregnancy 10-14 15-19 20-24 25-29 30-34 34+

Age

15-19 1.9 49.9 na na na na 48.2 2,533 nc

20-29 1.7 46.3 38.0 3.5 na na 10.5 35,581 20.4

30-39 2.3 48.1 34.4 9.4 1.7 0.2 4.0 33,859 19.3

40-49 2.6 48.8 33.8 7.8 1.6 1.3 4.1 26,610 19.1

Residence

Urban 1.7 40.2 38.8 9.7 1.9 0.1 7.5 32,556 21.8

Rural 2.3 51.3 32.6 5.1 1.1 0.0 7.5 66,027 20.3

Mother's education

No Education 3.2 56.7 28.7 4.4 1.3 0.1 5.7 38,713 18.7

Below Primary 3.1 58.0 27.9 4.8 1.6 0.0 4.5 5,693 19.1

Completed Primary 2.8 52.9 31.8 4.5 1.0 0.1 7.0 14,819 19.7

Completed Middle 1.2 47.3 36.9 5.4 0.8 0.0 8.3 13,200 22.0

Completed Secondary 0.6 38.4 42.1 7.9 1.5 0.0 9.5 12,133 25.2

Completed Higher

Secondary and above 0.2 21.4 48.3 15.7 2.4 0.0 11.9 14,024 nc

Social-group

Scheduled Caste 2.6 53.1 31.2 4.7 1.1 0.1 7.3 18,986 20.1

Scheduled Tribe 2.0 47.7 33.9 6.1 1.3 0.1 8.9 10,726 20.8

Other Backward Classes 1.9 47.9 35.5 6.2 1.3 0.0 7.1 39,405 20.8

Other 2.1 43.3 36.4 8.7 1.7 0.1 7.7 28,670 21.4

No Response 4.2 63.5 24.8 2.7 0.4 0.0 4.5 796 18.6

Wealth Index

Lowest 3.4 55.5 28.4 4.4 1.2 0.1 7.2 17,458 19.5

Second 2.5 54.1 30.8 4.0 1.1 0.0 7.5 19,380 19.9

Middle 2.0 51.3 32.0 5.4 1.0 0.1 8.2 20,013 20.5

Fourth 2.1 45.5 36.9 7.1 1.3 0.0 7.1 20,409 21.0

Highest 0.9 34.0 43.7 11.6 2.1 0.1 7.6 21,323 22.7

Total 2.1 47.7 34.7 6.6 1.4 0.1 7.5 98,583 20.8

na: Not applicable.

nc: Omitted because less than 50 percent of the women were pregnant for the first time before reaching the beginning

of the age group.



The variation in the median age at marriage, first pregnancy and first live-birth by selected

background characteristics is presented in Table 3.7. It may be noted that all these medians refer to

all women including those who are never married. Hence the median age at first pregnancy

presented in this table is different from the median presented in the previous table, which refers to

ever married women. Median age at first marriage was 18.8 years. Median age at first pregnancy

(20.8) was two years higher than age at marriage (18.8) and median age at first live-birth (22.0) was

one year higher than median age at first pregnancy. In urban areas, all the three, i.e., age at

marriage, first pregnancy and first live-birth are higher than that in rural areas by about two years.

The decreasing trend in the age at marriage, first pregnancy and first live-birth with increase in the

age, in both urban and rural areas suggests an increasing trend in all the three with time period. In

both the urban and rural areas, there is substantial increase in all the three—median age at first

marriage, first pregnancy and first live-birth. The median age at first marriage among women with 12

or more years of schooling was 23.7 as compared to 17.1 among women with no education. Age at

first marriage and first pregnancy and live-birth is relatively lower among women from SC and higher

among those from other castes. Better economic status leads to delay in marriage and childbearing

as reflected in increasing trend in the age at marriage, first pregnancy and first live-birth with age in

both urban and rural areas. All the three ages—median age at first marriage, first pregnancy and first

live-birth—are almost three years higher among women from the highest wealth quintile as

compared to those from the lowest wealth quintile. Among women from different occupations,

marriage and initiation of childbearing is relatively late among those who are salaried/wage

employee and early among those who are either cultivators or wage labourers.



Table 3.7: Median age at first marriage, first pregnancy and first live birth by background characteristics

Median age at first marriage, first pregnancy and first live birth for women aged 15-49 by residence, according

to background characteristics, RSOC, 2013-14


Urban Rural Total

Median age at first Median age at first Median age at first

Marriage Pregnancy Live birth



Age 15-19 nc nc nc nc nc nc nc nc nc 20-24 20.5 nc nc 18.6 20.3 21.8 19.1 21.1 nc 25-29 19.6 20.9 21.9 18.0 19.5 20.5 18.6 19.9 21.0 30-34 19.2 20.6 21.6 17.4 19.0 20.0 17.8 19.5 20.5 35-39 18.7 20.0 21.1 17.2 18.6 19.7 17.6 19.0 20.1 40-44 18.2 19.7 20.7 17.3 19.0 20.0 17.6 19.2 20.3 45-49 17.9 19.7 20.8 16.8 18.9 19.9 17.3 19.1 20.2

Education No education 17.6 19.0 20.1 17.0 18.7 19.7 17.1 18.7 19.8 < 5 years complete 17.5 19.1 20.1 17.4 19.1 20.2 17.5 19.1 20.2 5-7 years complete 18.0 19.6 20.7 17.9 19.7 20.9 17.9 19.7 20.8 8-9 years complete 19.4 21.2 22.4 19.6 22.8 24.9 19.5 22.0 23.7 10-11 years complete 20.9 23.4 24.6 21.8 nc nc 21.4 25.2 27.8 12 or more years complete 23.4 26.5 28.7 24.2 nc nc 23.7 nc nc

Religion Hinduism 19.8 21.8 23.0 18.1 20.3 21.5 18.7 20.8 22.0 Islam 19.3 21.1 22.4 17.9 19.8 21.0 18.5 20.3 21.5 Christianity 22.5 24.4 25.7 20.8 22.5 23.6 21.5 23.3 24.5 Sikhism 21.4 23.0 24.0 20.0 21.5 22.8 20.4 21.9 23.1 Jainism 22.3 24.4 26.0 18.4 19.5 20.4 19.8 22.1 23.6 Buddhism/Neo-Buddhism 19.9 22.0 24.7 18.5 20.3 21.3 19.1 20.8 22.2 No Religion 19.4 20.2 21.2 21.3 23.8 24.8 20.3 23.0 24.0 Other 19.1 20.5 21.5 17.9 20.5 22.2 18.4 20.5 21.8

Social-group Scheduled Caste 19.5 21.2 22.5 17.7 19.7 20.8 18.0 20.1 21.3 Scheduled Tribe 19.7 21.8 23.2 18.5 20.6 21.8 18.8 20.8 22.0 Other Backward Classes 19.6 21.7 22.9 18.1 20.4 21.6 18.7 20.8 22.1 Other 20.2 22.3 23.5 18.7 20.7 21.9 19.4 21.4 22.6 No Response 17.4 19.0 20.1 16.8 18.4 19.6 17.0 18.6 19.7

Wealth index Lowest 17.8 19.5 20.6 17.5 19.5 20.7 17.5 19.5 20.7 Second 18.5 20.6 21.9 17.8 19.9 21.0 17.9 19.9 21.1 Middle 19.0 20.8 22.2 18.2 20.4 21.6 18.4 20.5 21.7 Fourth 19.5 21.3 22.5 18.9 20.8 22.2 19.2 21.0 22.3 Highest 21.0 23.0 24.1 19.9 22.2 23.6 20.6 22.7 23.9

Occupation Cultivator 17.1 19.0 20.2 16.8 18.4 19.5 16.8 18.5 19.5 Wage labourer 17.3 18.6 19.7 17.1 18.3 19.3 17.1 18.3 19.4 Self employed 18.2 19.3 20.3 17.4 18.7 19.7 17.8 18.9 20.0 Regular salaried/wage

employee 19.6 20.8 21.9 18.0 19.4 20.5 18.9 20.0 21.1

Other 18.6 19.2 20.5 17.8 20.0 21.1 18.3 19.4 20.6 Non-working 18.7 19.8 20.9 17.5 18.9 20.0 17.9 19.2 20.3

Total 19.8 21.8 23.1 18.2 20.3 21.5 18.8 20.8 22.0

nc: Not calculated because less than 50 percent of the women had a birth before reaching the beginning of the age group



3.7 TEENAGE CHILDBEARING

Teenage pregnancy is an important public health problem in India as age at marriage in most of the

states is quite low. Teenage pregnancy is a ‘high risk’ pregnancy due to its association with various

adverse maternal and foetal outcomes which result in increased mortality and morbidity of the

mother and the child. In addition to the biological disadvantage due to younger age the teenage

mothers also face risks associated with socio-economic factors like lower level of education, and

thus lesser knowledge of maternal and child health care and its utilization.

Based on the information collected from all ever married women aged 15-19 about number of live

births and current pregnancy status, Table 3.8 presents percentage of women aged 15-19 who have

had a live birth or who are pregnant with their first child, and percentage of those who have begun

childbearing, by background characteristics.

Table 3.8: Teenage pregnancy and motherhood

Percentage of women aged 15-19 who had a live birth, who were pregnant with first child and who began

childbearing by background characteristics, RSOC, 2013-14


Percentage of women Number of

women Who have had

a live birth

Pregnant with

first child

Who have begun

childbearing

Age

15 0.0 0.0 0.1 5,363

16 0.2 0.4 0.6 5,137

17 1.0 1.0 2.0 4,265

18 4.4 3.6 8.0 5,608

19 13.5 6.2 19.7 3,584

Residence

Urban 2.8 1.2 3.9 6,919

Rural 3.5 2.4 5.9 17,039

Mother's education

No education 9.6 4.1 13.7 2,241

<5 years complete 9.6 2.2 11.8 667

5 -7 years complete 5.0 2.5 7.5 3,156

8 -9 years complete 3.0 2.5 5.5 6,259

10-11 years complete 1.4 0.9 2.3 7,155

12 or more years complete 1.2 2.0 3.2 4,480

Social-group

Scheduled Caste 4.2 2.7 6.9 4,816

Scheduled Tribe 3.6 1.5 5.2 2,576

Other Backward Classes 2.7 1.8 4.5 10,099

Other 3.2 2.1 5.3 6,319

No response 11.4 3.4 14.7 149

Wealth Index

Lowest 4.1 2.0 6.2 4,127

Second 3.9 2.2 6.1 5,124

Middle 3.8 2.7 6.5 5,354

Fourth 3.0 2.3 5.3 4,861

Highest 1.4 0.9 2.3 4,493

Total 3.3 2.1 5.3 23,959



Among all the women aged 15-19, three percent have had a live-birth, additional two percent had

no live-birth but were pregnant at the time of survey. So in all 5 percent of the women had started

childbearing in their teens. Practically, not a single woman aged 15 was either already a mother or

pregnant at the time of survey. However, by age 18, eight percent had initiated childbearing and by

age 19 the proportion rose to 20 percent. Teenagers in rural areas are more likely to initiate

childbearing in their teens compared to their urban counterparts. However, the rural–urban

differentials in initiation of childbearing in teen ages are quite small. Education seems to bring

substantial reduction in teenage fertility, as only 2-3 percent of the women aged 15-19 having 10 or

more years of schooling have initiated childbearing compared to 14 percent of their counterparts

having no education. The proportion of woman aged 15-19 who have begun childbearing is higher

among women from SC (7%) than women from all other three social groups (5%). The level of

teenage pregnancy and motherhood decreases with increase in wealth index.

State-wise percentage of women aged 15-19 who have had a live birth or who are pregnant with

their first child, and percentage who have begun childbearing, by background characteristics is given

in the Annexure Table 3.5a.

3.8 CHILDREN EVER BORN AND LIVING

From all the ever married women interviewed RSOC collected data on the number of children ever

born to them and the number living at the time of survey. Table 3.9 gives the distribution of women

by the number of ever born and living children. Among the ever married women aged 15-19, 69

percent did not bear any live-birth and 70 percent did not have any living child. The proportion of

women with no live-birth decreased to 25 percent in the age-group 20-24 and to eight percent in 25-

29. About 4-5 percent of women aged 30 and above did not have any live-birth at all. The mean

number of ever born children increased from 0.4 among the women aged 15-19 to 3.5 in the age-

group 45-49. The mean number of living children increased from 0.3 in the age-group 15-19 to 3.1 in

the age-group 45-49.



Table 3.9: Children ever born and living

Percent distribution of ever married women age 15-49 by number of ever born children, mean number of ever

born children and percent distribution of ever married women by number of living children and mean number

of living children according to age, RSOC, 2013-14

Age group

Children ever born Mean number of ever

born children

Living children Mean number of living children

Number of

women 0 1 2 3 4+ Total 0 1 2 3 4+ Total

15-19 68.9 26.9 3.2 0.6 0.5 100.0 0.4 69.9 26.4 2.8 0.5 0.5 100.0 0.3 2,533

20-24 24.7 43.5 25.0 5.5 1.2 100.0 1.2 26.3 43.6 24.7 4.5 0.8 100.0 1.1 15,036

25-29 8.1 26.3 39.5 17.4 8.6 100.0 2.0 9.4 26.9 40.1 17.1 6.5 100.0 1.8 20,545

30-34 4.9 12.9 36.7 24.3 21.2 100.0 2.6 6.0 13.8 37.9 24.7 17.6 100.0 2.4 17,697

35-39 4.1 9.4 31.8 25.2 29.5 100.0 3.0 5.0 9.7 33.8 25.8 25.7 100.0 2.7 16,161

40-44 4.3 9.8 28.7 22.5 34.7 100.0 3.2 5.1 10.4 29.9 24.2 30.4 100.0 2.9 12,436

45-49 5.0 8.9 23.5 20.9 41.7 100.0 3.5 5.7 9.4 25.7 22.8 36.5 100.0 3.1 14,174

Total 10.0 19.2 30.9 18.8 21.0 100.0 2.4 11.1 19.7 32.0 19.3 17.9 100.0 2.3 98,583

Table on Percentage of ever married women aged 15-49 who ever had a live birth and mean number

of ever born and living children by state is presented in Annexure (Table 3.6a).

Among the women aged 15-49 many women in the younger ages are yet continuing childbearing,

the mean number of ever born children of them may not give correct idea of the fertility. Since most

of the women complete childbearing by age 35, the mean number of ever born children among

women older than this age can provide good idea about the completed cohort fertility. Mean

number of ever born and living children for women aged 35-49 by selected background

characteristics is presented in Table 3.10. About 93 to 96 percent of the women from each category

of residence, education, social group and wealth index have ever given a live-birth. Urban fertility is

much lower than rural fertility. The mean number of ever born children and living children among

women in urban areas (2.6 and 2.5 respectively) is much lower than those among women in rural

areas (3.5 and 3.1 respectively).

Among the four social groups, fertility of women from the other castes is lower compared to that of

women from all the remaining three social groups. With increase in education as well as economic

status there is a sharp fall in the fertility. The mean number of ever born children decreases from 3.8

among women with no education to 2.0 among with 12 or more years of education. Similarly, the

mean number of ever born children decreases from 3.9 among women in the lowest wealth quintile

to 2.5 among women in the highest wealth quintile.



Table 3.10: Children ever born and living by background characteristics

Percentage of ever married women age 35-49 who ever had a live birth and mean number of ever born and

living by background characteristics, RSOC, 2013-14


Percentage who

ever had a live

birth

Mean number of

ever born children

Mean

number of

living

children

Number of

ever married

women

Residence

Urban 95.1 2.6 2.5 14,638

Rural 95.8 3.5 3.2 28,133

Woman's education

No education 95.6 3.8 3.4 21,709

<5 years complete 95.8 3.2 2.9 2,862

5-7 years complete 95.1 2.8 2.7 5,893

8-9 years complete 95.7 2.7 2.5 4,190

10-11 years complete 95.2 2.3 2.2 4,086

12 or more years complete 95.9 2.0 2.0 4,033

Social-group

Scheduled Caste 95.3 3.5 3.2 7,881

Scheduled Tribe 93.4 3.2 2.9 4,640

Other Backward Classes 95.4 3.3 3.0 17,202

Other 96.6 2.9 2.7 12,735

No Response 94.1 3.5 3.1 314

Wealth Index

Lowest 94.2 3.9 3.5 7,441

Second 95.2 3.7 3.3 8,340

Middle 96.0 3.2 3.0 8,325

Fourth 95.9 2.9 2.7 8,648

Highest 96.1 2.5 2.4 10,017

Total 95.5 3.2 2.9 42,771

Percentage of ever married women age 35-49 who ever had a live birth and mean number of ever

born and living children by state is annexed in Appendix Table 3.7a.

3.9 BIRTH ORDER

RSOC was not planned to estimate period fertility rates like Total Fertility Rate (TFR). However, the

distribution of live-births in three years preceding the survey, to all interviewed ever married women

aged 15-49, by order of birth indirectly reflects current fertility levels in the population. A larger

proportion of higher order births indicate higher fertility in a population. Table 3.11 presents percent

distribution of live-births in three years preceding the survey by birth order, according to

background characteristics.



Table 3.11: Birth order

Percent distribution of live-births in three years preceding the survey by order of birth according to

background characteristics, RSOC, 2013-14

Background characteristic Birth order Number of live-

births 1 2 3+ Total

Mother's Age

15-19 87.3 11.1 1.5 100.0 1,539

20-29 51.1 32.8 16.1 100.0 41,225

30-39 26.7 24.7 48.6 100.0 10,867

40-49 30.6 13.0 56.5 100.0 919

Residence

Urban 53.2 31.2 15.6 100.0 16,320

Rural 44.2 29.9 26.0 100.0 38,230

Mother's education

No education 33.1 26.6 40.2 100.0 17,616

<5 years complete 37.3 29.4 33.3 100.0 2,615

5-7 years complete 44.7 34.0 21.3 100.0 8,351

8-9 years complete 50.0 33.9 16.1 100.0 8,562

10-11 years complete 57.0 32.7 10.2 100.0 7,602

12 or more years complete 65.4 28.6 5.9 100.0 9,805

Religion

Hinduism 47.8 31.2 21.0 100.0 42,653

Islam 39.7 25.8 34.5 100.0 9,074

Christianity 52.3 32.4 15.3 100.0 1,278

Sikhism 55.4 32.3 12.3 100.0 825

Jainism 80.5 13.0 6.5 100.0 119

Buddhism/Neo-Buddhism 62.6 26.1 11.3 100.0 338

No Religion 48.5 14.4 37.1 100.0 36

Other 52.7 30.3 17.0 100.0 224

Social-group

Scheduled Caste 44.1 31.0 24.9 100.0 10,976

Scheduled Tribe 45.3 28.8 25.9 100.0 6,311

Other Backward Classes 46.0 30.1 23.9 100.0 21,886

Other 51.4 30.3 18.3 100.0 14,828

No Response 33.4 35.5 31.1 100.0 550

Wealth Index

Lowest 34.0 28.1 37.9 100.0 10,977

Second 41.8 30.2 28.0 100.0 11,248

Middle 48.0 31.2 20.9 100.0 11,213

Fourth 53.9 30.9 15.2 100.0 11,092

Highest 57.7 31.0 11.3 100.0 10,020

Total 46.9 30.3 22.9 100.0 54,550


Majority (47%) of the births that occurred three years prior to the survey were first order births. The

proportion of second and third order births was 30 and 23 percent respectively. Eighty-seven

percent of the live-births to mothers aged 15-19 were of the first order and only 2 percent were of

the order three and above. On the other hand among mothers aged 40 and above 31 percent were



of order one and 57 percent were of order three and above. However, in total births the share of

births to mothers below age 20 or above age 40 was quite small. Most of the births occurred to

women aged 20-29 and among them 51 percent were of order one and 16 percent were of order

three and above. The proportion of births that are of order three or higher, is 16 percent in urban

areas and 26 percent in rural areas. The proportion of births of order three and above is relatively

higher among women from Islam religion (35%) and those from STs (26%) in comparison to their

respective counterparts from different religions (7-21%) and social groups (18-25%). With increase in

woman’s education and wealth index there is a sizeable decrease in the births that are of order

three and above. For example, 40 percent of the births to women with no education were of order

three and above compared to only six percent of the births to women having 12 or more years of

education.

Percent distribution of live-births in the three years preceding the survey by order of birth, according

to states is presented in Appendix Table 3.8a.

3.10 FAMILY PLANNING PRACTICES

Contraceptive prevalence rate and method mix are the important determinants of fertility. They also

have an impact on the reproductive health of women. RSOC collected data on the current use of

family planning and the method used from all the currently married non-pregnant respondents of

individual interview. Table 3.12 presents percent distribution of currently married women by the

family planning method they or their husband were using. The prevalence of contraceptive use

among the currently married women aged 15-49 was 58 percent. Most (88%) of the women among

the users were using modern contraceptive methods and 13 percent of the users were using

traditional methods. A small proportion of the users reported use of multiple methods. Female

sterilization was the most common method used by more than two-thirds (67%) of the users. Among

the spacing methods, the most widely used methods were condom (6%) and pills (5%).



Table 3.12: Current use of family planning Percentage of currently married women aged 15-49 using family planning by method currently using according to background characteristics


Percentage using

any family

planning method

Modern methods Traditional Methods

Using any modern method

Female sterilization

Male sterilization

IUD Pills Condom Any other modern

method*

Using any traditional

method

Lactational amenorrhoea

Periodic abstinence/Rhythm

Withdrawal Any other traditional

method

Number of

currently married women

Age 15-19 24.2 17.1 4.4 0.1 0.5 5.7 6.9 0.2 8.1 1.7 4.0 3.4 0.7 2,513 20-24 35.9 27.5 12.4 0.3 0.9 6.6 7.7 0.3 9.5 2.4 5.2 2.8 0.8 14,798 25-29 53.6 46.0 30.0 0.5 1.3 6.5 8.2 0.7 9.0 1.6 5.2 2.7 0.8 20,209 30-44 66.7 60.5 49.3 0.7 0.9 4.7 5.6 0.4 7.1 0.9 4.2 2.4 0.8 44,234 45-49 65.6 60.8 55.6 1.0 0.5 1.8 2.5 0.1 5.5 0.6 3.1 1.3 1.4 12,659

Residence

Urban 59.8 54.3 40.2 0.6 1.3 4.9 7.7 0.5 6.6 0.9 4.1 2.1 0.8 31,051 Rural 56.8 49.5 38.4 0.7 0.7 5.1 5.3 0.4 8.2 1.5 4.6 2.6 1.0 63,362

Educational status

No education 58.2 51.4 43.1 0.6 0.5 3.3 4.3 0.3 7.5 1.6 4.1 2.2 0.9 36,548 <5 years complete 67.3 59.4 46.8 0.5 0.9 9.0 2.8 0.5 9.1 1.2 5.1 3.0 1.1 5,350 5-7 years complete 61.1 54.8 43.2 0.4 0.7 6.2 4.7 0.3 7.2 1.3 4.2 2.2 0.6 14,186 8-9 years complete 56.7 48.9 34.1 0.9 1.0 7.2 6.7 0.5 8.9 1.4 5.6 2.9 0.9 12,799 10-11 years complete 56.2 51.1 36.9 0.8 1.2 5.4 7.5 0.4 6.4 0.8 3.9 2.2 0.9 11,790 12 or more years

complete 51.6 45.2 27.3 0.6 1.9 4.4 11.7 0.7 7.9 0.7 4.9 2.6 1.2 13,740

Caste

Scheduled Caste 57.6 50.5 39.8 0.9 0.5 4.5 5.1 0.5 7.9 1.6 4.3 2.4 0.9 18,137 Scheduled Tribe 54.1 48.1 39.4 0.4 0.9 4.4 3.3 0.4 6.6 1.4 3.6 1.8 0.7 10,211 OBC 56.3 51.0 40.7 0.6 1.0 3.0 6.2 0.4 6.1 1.0 3.6 1.8 0.6 37,779 Others 61.0 52.5 36.2 0.6 1.1 8.0 7.7 0.4 10.0 1.4 6.0 3.5 1.4 27,531 Do Not Know 66.5 57.4 32.7 0.3 0.5 20.7 4.1 0.0 10.6 1.4 4.3 5.0 0.3 757

Wealth Index

Lowest 51.2 44.4 34.9 0.9 0.4 5.2 3.6 0.3 7.4 1.7 3.6 2.4 0.7 16,446 Second 56.8 48.8 38.0 0.4 0.7 5.9 4.3 0.3 9.0 1.6 5.1 3.0 1.0 18,557 Middle 57.5 50.6 40.2 0.4 0.6 5.3 4.5 0.4 7.8 1.3 4.5 2.6 1.0 19,059 Fourth 60.5 54.4 42.7 0.7 1.0 4.7 6.0 0.4 7.2 0.9 4.5 2.1 0.9 19,588 Highest 61.4 55.7 38.6 0.9 1.7 4.2 11.2 0.6 7.0 0.9 4.4 2.0 1.0 20,763

Total 57.8 51.1 39.0 0.6 0.9 5.0 6.1 0.4 7.7 1.3 4.4 2.4 0.9 94,413

Other modern method includes: Injectables, Implants, Female condoms, Diaphragm or Foam/Jelly, IUD: intrauterine device



With increase in age, there is an increase in the prevalence of contraception from 24 percent among

the women aged 15-19 to 66-67 percent among the women aged 30 and above. Use of spacing

methods was more prevalent among younger women and sterilization was more common among

older women. In fact, in the age-group 45-49, 56 percent of women were sterilized, implying that

female sterilization accounted for 85 percent of the family planning users among women aged 45-

49. Among younger women below age 30, 7-8 percent reported use of condom, 6-7 percent was

using pills and 4-5 percent reported adopting periodic abstinence.

The urban-rural differentials in contraceptive use are quite small. The contraceptive use is higher

among women in urban areas than rural areas by three percentage points. Contraceptive prevalence

rate increased from 58 percent among women with no education to 67 percent among those with

less than five years of schooling, but then decreased with increase in education to 52 percent among

women with 12 or more years of education. Though with increase in education there was decrease

in the contraceptive prevalence rate, the use of IUD and condom was increasing with increase in

education. Among the women from four social groups, the contraceptive use is the lowest among

women belonging to STs (54%) and the highest among those from Other castes (61%). Use of spacing

methods—modern as well as traditional—is relatively higher among women from Other castes. With

better economic condition, there is an increase in the contraceptive use. The family planning use

increases from 51 percent among women in the lowest wealth quintile to 61 percent among those in

the highest wealth quintile.

State-wise percentages of women aged 15-49 currently using any method, any family planning

method, or any modern method according to residence has been supplemented in Annexure Table

3.9 (a).

3.11 PROFILE OF CHILDREN

Table 3.13 presents distribution of children below age six by selected demographic and socio-

economic characteristics. RSOC collected data about 1,21,987 children from 28 states and Delhi.

Among these children 70 percent were from rural areas and remaining 30 percent were from the

urban areas. The sex ratio of surveyed children was 934 female children per 1,000 male children. The

sex distribution was almost same in rural and urban areas. The distribution of children by single year

of age in both rural and urban areas shows slightly lower proportion of younger children below age

two.



Table 3.13: Profile of children

Percent distribution of children below age six by background characteristics according to residence, RSOC,

2013-14

Background characteristics Residence

Total Urban Rural

Gender Male 51.7 51.7 51.7 Female 48.3 48.3 48.3

Age (in completed years) 0 15.7 16.6 16.3 1 16.5 16.2 16.3 2 17.5 17.6 17.6 3 17.2 16.9 17.0 4 16.2 15.6 15.8 5 16.8 17.1 17.0

Social-group Scheduled Caste 16.6 21.7 20.1 Scheduled Tribe 6.2 13.7 11.5 Other Backward Classes 40.8 40.6 40.5 Other 35.4 23.0 26.8 No response 1.0 1.0 1.0

Wealth Index

Lowest 4.6 27.1 20.3 Second 9.3 25.3 20.5 Middle 17.7 22.1 20.8 Fourth 30.0 16.0 20.3 Highest 38.4 9.5 18.2

Total 100.0 100.0 100.0 Number of children aged 0-6 36,842 85,145 1,21,987

The distribution of children by social groups and wealth quintile is consistent with the distribution of

households and ever married women aged 15-49 by these characteristics, presented in Chapter 2

and 3 respectively. One-fifth (20%) of the children were from SCs, 12 percent were from STs, 41

percent belonged to OBCs and remaining 27 percent were from all other castes. Compared to urban

areas, in rural areas, there were relatively more children from the SC (22% vs 17% in urban) and ST

(14% vs 6%). There were almost equal proportions of children in each wealth quintile. The

distribution of children by wealth quintiles was very different in rural and urban areas. More than

two-thirds (68%) of urban children belong to the two highest wealth quintile compared to only 26

percent in rural areas.

The state-wise age distribution of the children aged 0-5 and sex ratios are presented in Annexure

Table 3.10 (a.)



3.12 BIRTH REGISTRATION

The Article 7 of the 1989 UN Convention on the Rights of the Child (CRC) states ‘the child shall be

registered immediately after birth and shall have the right from birth to a name, the right to acquire

a nationality and as far as possible, the right to know and be cared for by his or her parents’. Birth

registration is a permanent and official record of a child’s existence. The child who is not registered

at birth is in danger of being denied the right to an official identity, a recognized name and a

nationality. As a signatory of UN CRC, India recognizes birth registration as the first right of the child.

Registration of births is also vital for collection of data on vital statistics which has an important role

in national planning process by providing demographic base.

In India, the registration of births, deaths and still births are compulsory in all parts of the country,

under the provisions of Registration of Births and Deaths (RBD) Act, 1969. It is the duty of the head

of the household to report the birth in case of birth occurring at house, and in case of birth occurring

in a health institution, the medical officer in-charge is responsible for reporting. The normal period

of 21 days from the birth date has been prescribed for reporting, within which reporting is free of

charge, beyond which the birth can be registered with payment of the prescribed fee.

In RSOC, data on birth registration was collected in the household questionnaire. The head of the

household was asked about every child under age five in the household, whether the birth of the

child was registered, if registered whether it was registered within 21 days of the birth or later, and

whether child’s birth certificate is available. In case the birth certificate was available, interviewer

asked the respondent to show the birth certificate. Table 3.14 and Figures 3.1 and 3.2 present the

percentage of children whose birth was registered, whose birth was registered within 21 days of the

birth and who have birth certificate by selected characteristics of household and children.

Figure 3.1: Birth registration

72

62

37

61

Registered birth Registered birthwithin 21 days

Has a birthcertificate (seen)

Has a birthcertificate



The survey shows that in case of 72 percent of the children below age five, birth was registered and

for 62 percent of the children registration of the birth was done within 21 days of the birth. For 61

percent of the children birth certificate was available, though only in case of 37 percent of the

children respondent could show the birth certificate to the interviewer. The National Family Health

Survey (NFHS) conducted in 2005-06 (NFHS-3) showed that in case of 41 percent of children below

age 5, birth was registered and for 27 percent of children birth certificate was available. So, in the

last eight years since NFHS-3, there has been an increase of 31 percentage points in the extent of

birth registration and of 34 percentage points in possession of birth certificate. However,

considering a goal of 100 percent registration of births by the year 2010 by the National Population

Policy, 2000 of India, the extent of birth registration is much on the lower side.



Table 3.14: Birth registration and possession of birth certificate

Percentage of children below age five whose birth was registered, whose birth was registered within 21 days

of birth, who had a birth certificate and seen by investigator and who had a birth certificate by background


Background characteristic Registered

birth

Registered the

birth within 21

days

Has a birth

certificate

(Seen)

Has a birth

certificate

Total

number of

children

Age of the child in completed years

0 70.0 60.9 34.3 55.9 19,889 1-2 73.7 63.6 38.8 63.4 41,351 3-4 71.0 60.1 36.6 60.8 40,020

Gender

Male 71.2 61.0 36.2 60.1 52,283 Female 72.6 62.4 38.0 61.7 48,977

Residence

Urban 83.0 74.0 47.4 75.2 30,647 Rural 67.0 56.3 32.6 54.7 70,613

Mother's education

No Education 53.7 42.0 20.9 39.3 32,633 <5 years complete 75.5 61.9 39.9 61.7 4,730 5-7 years complete 76.1 65.1 40.7 64.6 14,732 8-9 years complete 79.4 69.5 46.0 70.2 14,461 10-11 years complete 83.9 75.6 48.9 75.6 13,147 12 or more years complete 86.1 78.1 50.2 79.2 16,065

Religion

Hinduism 71.8 61.7 36.2 60.5 79,115 Islam 69.1 57.6 36.8 58.6 16,723 Christianity 77.8 69.5 49.4 71.0 2,746 Sikhism 85.8 79.0 58.7 82.1 1,384 Jainism 90.8 87.4 52.6 86.2 160 Buddhism/Neo-Buddhism 90.3 82.6 44.1 74.9 673 No Religion 63.6 56.5 21.7 49.7 61 Other 73.2 63.0 38.7 63.3 398

Social-group

Scheduled Caste 67.5 58.3 36.5 56.8 20,383 Scheduled Tribe 70.6 57.9 32.2 54.4 11,653 Other Backward Classes 68.3 58.6 34.1 57.3 41,168 Other 80.7 70.3 43.6 71.9 27,071 No Response 86.4 69.4 49.6 71.8 985

Wealth Index

Lowest 57.0 44.8 22.0 41.0 20,337 Second 65.3 53.8 31.2 53.4 20,678 Middle 72.9 62.8 39.4 62.6 21,177 Fourth 79.6 71.1 45.1 70.5 20,674 Highest 85.9 77.4 48.6 78.7 18,394

Total 71.9 61.7 37.1 60.9 1,01,260



The proportion of children below age five whose birth was registered and who had birth certificate

was much higher in urban areas (83% and 75% respectively) than in rural areas (67% and 55%),

though even in urban areas one-fourth (25%) of the children did not have birth certificate. The

extent of birth registration by age does not suggest any improvement in the birth registration in

recent years. There is no sizeable difference in the registration of births of male and female children.

Both registrations of birth and possession of a birth certificate for children increased consistently

with the increase in mother’s education. Registration of birth among children whose mothers have

completed 5 years of education is 23 percent more (76% against 54%) than children of mothers who

had no education, which increases to 86 percent for those children whose mothers are educated for

12 and more years. Compared to children from the Hindu (72%) and Islam (69%) households,

children from Christian (78%), Sikh (86%), Jain (91%) and Buddhist (90%) households are more likely

to be registered. Birth registration is higher for the children from other castes (81%) compared to

those from SCs, STs and OBCs (68-71%). The proportion of children below age five whose birth was

registered and who had a birth certificate increased steadily with wealth quintile.

Figure 3.2: Birth registration and possession of birth certificate

71

73

83

67

57

65

73

80

86

72

60

62

75

55

41

53

63

71

79

61

Male

Female

Urban

Rural

Lowest

Second

Middle

Fourth

Highest

Total

Sex

Re

sid

en

ceW

eal

th In

dex

Registered birth and has a birth certificate Total registered birth



The state-level variation in the percentage of children whose birth was registered and for whom the

birth certificate was available is shown in Table 3.15. There is a large state-wise variation in the

prevalence of birth registration and possession of birth certificate. The extent of birth registration

varies from the highest of 99 percent in Goa to the lowest of 28 percent in Manipur. Similarly, the

proportion of children with birth certificate ranges from 97 percent in Goa to 18 percent in Manipur.

Along with Goa, in Tamil Nadu, Mizoram, Kerala and Gujarat also, birth registration exceeds 95

percent. On the other hand, in Manipur, Jharkhand, Uttar Pradesh and Bihar, in case of majority of

the children birth was not registered. The proportion of children with birth certificate that were seen

by the enumerators ranges from 79 percent in Tamil Nadu to 9 percent in Manipur.

Table 3.15: Birth registration and possession of birth certificate by state

Percentage of children aged 0-4 whose birth is registered, whose birth is registered within 21 days of birth,

who had a birth certificate and seen by investigator and who had a birth certificate by state, RSOC, 2013-14

States Registered the birth

Registered the birth within 21 days

Has a birth certificate (seen)

Has a birth certificate

India 71.9 61.7 37.1 60.9 North

Delhi 85.8 78.6 43.1 80.3 Haryana 86.5 81.9 56.1 80.8 Himachal Pradesh 88.7 80.8 31.8 77.9 Jammu & Kashmir 64.5 51.2 14.2 45.7 Punjab 85.5 79.9 55.2 81.3 Uttar Pradesh 39.1 30.0 10.1 27.1 Uttarakhand 79.5 66.2 23.2 57.6

Central

Chhattisgarh 60.9 48.4 23.2 39.6 Madhya Pradesh 84.5 68.8 29.9 67.4

East

Bihar 39.5 29.5 15.0 31.9 Jharkhand 34.8 24.6 13.5 24.6 Odisha 75.9 54.6 22.4 37.6 West Bengal 94.0 79.9 64.6 85.0

Northeast

Arunachal Pradesh 75.9 55.5 20.1 63.4 Assam 80.9 55.7 52.3 77.6 Manipur 27.7 15.9 9.4 17.6 Meghalaya 78.9 63.2 46.2 65.3 Mizoram 97.2 94.3 55.1 96.3 Nagaland 60.1 42.0 39.8 59.8 Sikkim 88.9 84.5 65.2 85.9 Tripura 90.3 76.5 73.5 87.5

West

Rajasthan 53.5 37.5 14.1 32.8 Goa 98.7 95.7 65.3 96.8 Gujarat 95.0 91.6 57.2 91.2 Maharashtra 92.5 86.6 47.0 80.2

South

Andhra Pradesh 64.4 52.2 34.0 55.8 Karnataka 89.5 80.5 47.7 84.2 Kerala 96.1 93.6 64.6 92.0 Tamil Nadu 97.5 93.9 78.8 93.8



39

31

27 3

ICDS run PSE Private PSE

Not attending any PSE Don't know

3.13 PRE-SCHOOL EDUCATION IN INDIA

India has a tradition of valuing the early years of a child’s life, and a rich heritage of practices for

stimulating development and inculcating sanskaras or basic values and social skills in children.

Traditionally this was done within a family. However, with changes in the family system as well as

social context in the last few decades the early childhood education outside home, prior to formal

schooling has become an essential activity.

India is a signatory to both the CRC, 1989 and Education for All (EFA) 1990. The latter has postulated

Early Childhood Care and Education (ECCE) as the very first goal to be achieved for ‘Education for

All’, since learning begins at birth. The Government of India recognizes21 the significance of ECCE,

which has been included as a constitutional provision which directs that, ‘The State shall endeavour

to provide ECCE for all children until they complete the age of six years.’ In India ECCE services are

delivered through public, private and non-governmental channels. In the public sector, Integrated

Child Development Services (ICDS) is the world’s largest programme imparting ECCE. The private

sector in an organized or unorganized form, with varied quality, is perhaps, the second largest

service provider of ECCE, and its outreach is steadily percolating even into the rural areas across the

country.

Figure 3.3: Percent distribution of children aged 3-6 by attendance in pre-school education

For all the children below aged six years, RSOC

collected data on pre-school attendance in the

household questionnaire. The head of the

household was asked about every child aged 3-

6, whether the child attends any pre-school,

and if attends the type of pre-school. Table 3.16

presents distribution of children by pre-school

activity. Nationally, 39 percent of the children

aged 3-6 were attending ICDS run pre-schools,

31 percent were attending privately run pre-

schools and in case of a small proportion (4%) of

children information was not available. Little

more than one-fourth (27%) of the children

aged 3-6 were not attending any pre-school.

With increase in age there was an increase in

the proportion of children attending pre-school. Children aged 3 and 4 were more likely to attend

ICDS run pre-school whereas children aged 5 were more likely to attend privately run pre-school.

Among the children aged three, 42 percent were attending ICDS run pre-school and 17 percent were

attending privately run pre-school, but among children aged five, 33 percent were attending ICDS

and 44 percent were privately run pre-school. A little higher proportion of female (40%) than male

(38%) children were attending ICDS run pre-schools.

21 Draft National Early Childhood Care and Education Policy, 2012; Ministry of Women and Child

Development, Government of India



Table 3.16: Pre-school education (PSE)

Percent distribution of children below age 6 by the type of PSE attended according to background



Attending PSE Number of

children

aged 3-6

ICDS run

PSE

Private

PSE

Not

attending

any PSE

Don't

know Total

Age of child in completed years

3 42.2 17.3 35.0 5.5 100.0 20,749

4 41.4 31.2 24.9 2.5 100.0 19,270

5 32.7 43.5 21.4 2.4 100.0 20,727

Gender

Male 37.5 31.7 27.4 3.5 100.0 31,443

Female 40.1 29.6 26.9 3.5 100.0 29,303

Residence

Urban 22.2 50.4 24.5 2.9 100.0 18,493

Rural 46.0 22.0 28.3 3.8 100.0 42,253

Religion

Hinduism 40.0 30.6 25.9 3.5 100.0 47,505

Islam 34.4 27.6 34.0 4.0 100.0 10,033

Christianity 35.2 38.5 25.6 0.7 100.0 1,689

Sikhism 21.9 52.8 23.3 1.9 100.0 812

Jainism 27.4 58.1 12.4 2.1 100.0 56

Buddhism/Neo-Buddhism 49.1 31.4 18.2 1.3 100.0 385

No Religion 25.5 24.8 46.6 3.2 100.0 44

Other 39.3 30.2 26.9 3.7 100.0 222

Social-group

Scheduled Caste 42.3 24.9 29.4 3.4 100.0 12,326

Scheduled Tribe 52.0 17.4 26.9 3.7 100.0 6,885

Other backward classes 35.9 31.9 28.3 4.0 100.0 24,834

Others 34.3 39.3 23.6 2.7 100.0 16,113

No response 49.3 16.9 31.7 2.0 100.0 588

Wealth Index

Lowest 51.9 8.6 34.8 4.8 100.0 12,727

Second 49.5 17.2 29.2 4.0 100.0 12,494

Middle 42.8 27.9 25.9 3.4 100.0 12,507

Fourth 30.1 42.6 24.5 2.8 100.0 12,059

Highest 16.0 61.6 20.3 2.2 100.0 10,959

Total 38.7 30.7 27.1 3.5 100.0 60,746

Children from urban areas were more likely to attend privately run pre-schools whereas rural

children were more likely to attend ICDS run pre-schools. Every second child (50%) in urban areas

was attending privately run pre-school and 22 percent were attending ICDS run pre-school, on the

contrary in rural areas 46 percent and 22 percent of the children were attending ICDS run and

privately run pre-school respectively. Relatively higher proportion of children from SC (42%) and ST

(52%) were attending ICDS run pre-school, in comparison to their counterparts from other castes

and OBC (34-36%). With increase in economic status from the lowest wealth quintile to the highest



quintile, there was an increase in the proportion of children attending pre-school. Children from the

lower wealth quintile were more likely to attend ICDS run pre-school, whereas those from the higher

wealth quintile were likely to attend privately run pre-school. The proportion of children attending

ICDS run pre-school decreased from 52 percent among the children from the lowest wealth quintile

to 16 percent among those from the highest wealth quintile. Consequently, the proportion of

children who attended privately run pre-school increased from 9 percent among the children from

the lowest wealth quintile to 62 percent among the children from the highest wealth quintile.

Figure 3.4: Children attending pre-school education

Table 3.17 shows the state-level variation in the distribution of children aged 3-6 by pre-school

attendance. There is large variation in proportion of children attending pre-school across the states

ranging from 19 percent in Nagaland to 90 percent in Tripura. In Manipur (88%), Sikkim (87%) and

Goa (89%) also a large proportion of the children aged 3-6 were attending pre-school. At the same

time, in Nagaland, Meghalaya and Uttar Pradesh majority of the children were not attending any

pre-school. The preference for ICDS run school also varies substantially from state to state. In Tripura

(69%) and Odisha (63%) a large proportion of children attend ICDS schools. Even in Chhattisgarh,

West Bengal, Bihar, Assam, Mizoram, Karnataka, Gujarat, and Maharashtra majority of the children

(50-58%) were sent to ICDS run pre-school.

Generally, the proportion of the children attending pre-school is higher in urban than rural areas.

Children from rural areas tend to attend ICDS run pre-school whereas those from urban areas tend

to attend privately run pre-schools. In rural areas of Tripura (74%), Maharashtra (74%), Odisha

(69%), Mizoram (69%), Karnataka (69%) and Gujarat (67%) two-thirds or more children were

attending ICDS run pre-schools.

42 41 33 22 46 38 40 52 50 43 30 16 39

17 31 44

50 22 32 30 9 17 28

43 62 31

3 years 4 years 5 years Urban Rural Male Female Lowest Second Middle Fourth Highest Total

Age of child Residence Sex Wealth Index

Attending Private PSE Attending ICDS run PSE



Table 3.17: Pre-school education (PSE) by State

Percentage of children aged 3-5 who were attending ICDS run PSE and any PSE by residence, according to

states, RSOC, 2013-14

States

Urban Rural Total

Attending PSE

ICDS run Any PSE ICDS run Any PSE ICDS run Any PSE

India 22.2 72.6 46.0 68.0 38.7 69.4

North

Delhi 9.1 64.7 10.7 63.9 9.1 64.7

Haryana 11.4 71.6 22.2 65.8 18.6 67.7

Himachal Pradesh 12.2 68.7 34.0 82.7 31.8 81.3

Jammu & Kashmir 12.5 70.7 21.0 58.0 18.7 61.4

Punjab 12.0 77.7 23.9 72.1 19.4 74.2

Uttar Pradesh 5.6 51.2 20.3 41.7 17.2 43.7

Uttarakhand 9.9 78.1 33.4 76.5 26.7 77.0

Central

Chhattisgarh 18.8 78.8 65.2 84.0 55.4 82.9

Madhya Pradesh 20.1 71.8 44.4 62.8 37.8 65.2

East

Bihar 31.4 56.1 51.8 60.3 49.5 59.8

Jharkhand 23.0 67.5 48.3 59.6 42.5 61.4

Odisha 36.7 75.4 68.5 79.2 63.3 78.6

West Bengal 26.2 70.5 62.0 73.3 51.1 72.5

North-East

Arunachal Pradesh 18.9 71.6 42.5 69.6 37.5 70.0

Assam 17.0 64.4 56.3 67.7 51.2 67.3

Manipur 25.0 87.8 35.8 87.9 33.0 87.9

Meghalaya 4.4 44.8 19.9 42.5 17.1 42.9

Mizoram 46.1 63.4 68.6 73.5 57.9 68.7

Nagaland 0.2 34.6 1.6 14.4 1.2 19.4

Sikkim 22.0 82.9 44.7 88.7 38.4 87.1

Tripura 47.9 93.4 74.4 89.3 68.8 90.2

West

Rajasthan 11.2 64.5 16.9 50.3 15.5 53.7

Goa 28.7 90.2 48.8 87.1 36.4 89.0

Gujarat 36.8 83.1 67.0 75.7 54.7 78.7

Maharashtra 23.2 78.5 74.3 88.2 51.4 83.9

South

Andhra Pradesh 27.8 71.8 55.4 91.0 46.0 84.4

Karnataka 34.5 80.6 69.3 89.8 57.2 86.6

Kerala 29.4 80.0 23.4 68.2 26.3 73.9

Tamil Nadu 22.9 84.8 38.8 85.2 31.3 85.0

MATERNAL HEALTHCARE


CHAPTER 4 MATERNAL HEALTHCARE

4.1 BACKGROUND

Making motherhood safe is one of the priorities of the governments at National and State level. The

government’s policy has been revolving around the fact that safe motherhood not only ensures the

safety of the pregnant woman but also the well-being of the child. The challenge in making

motherhood safe and thereby reducing maternal mortality lies majorly on making quality services

available to all prospective mothers, especially reaching out to the most vulnerable women in the

community. Though research and evidences have improved the comprehensive knowledge required

to address these issues, programmatically there are still wide fissures which are quite often not so

difficult to bridge.

The government’s focus has been on a continuum of maternal care which covers the entire pathway,

beginning from conceiving the baby to post-delivery quality care to both the mother and the child.

The critical services that the government’s maternal health programme promises to cover pertain to

not only availing the recommended number of antenatal check-ups with the desired components,

consuming adequate doses of iron supplements but also support safe delivery through trained

nurses or doctors in institutional facilities.

Outcomes of maternal care are measured through several indicators, but the most common being

maternal mortality ratio (MMR). As per the Goal 5 of the MDG framework, India is required to

reduce MMR to 109 per 100,000 live births by 2015, from an estimated MMR level of 437 in 1990.

Latest estimate of MMR published by the Office of Registrar General of India (RGI) in 2014, for the

year 2011-13 was 178 per 100,000 live births. As per the Twelfth Five Year Plan, the government

plans to bring down MMR to 100 by the year 2017. Though, in recent years, decline in maternal

mortality rate has been sharp, it would still be a challenge to achieve the MDG target by 2015.22 This

survey though does not estimate MMR, but estimates the level of several correlated indicators

measuring well-being of women.

Government of India, over the last six decades has been focusing on the issue of improving maternal

care through several nationwide programmes and aptly allocating its resources in the programmes

like Reproductive and Child Health (RCH) and promoting it through the National Rural Health Mission

(NRHM) during 2005-12 and presently under National Health Mission (NHM). The Twelfth Five Year

Plan (2012-2017) also highlighted government’s continued engagement by stating that ‘Maternal

and child health care will continue to be a major focus, especially given the inadequate progress in

reducing IMR and MMR’. As per MDG Report, 2015, India is likely to reach the figure of 140 in 2015

and is likely to miss the MDG target by 31 points.23

22 http://mospi.nic.in/Mospi_New/upload/mdg_26feb15.pdf

23 http://mospi.nic.in/Mospi_New/upload/mdg_26feb15.pdf

MATERNAL HEALTHCARE


The most recent policy document of the Ministry of Health and Family Welfare ( MoHFW), namely

Strategic Approach to Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A)

(2012-2017) enunciates the focus on expanding the continuum of maternal care by including

reproductive and adolescent care within its fold. The document mentions that all schemes and

programmes that constituted RCH-II under the NRHM have been absorbed into the new national

programme called the National Health Mission which now covers both rural and urban inhabitants.

Two of its safe motherhood schemes mainly for poor pregnant women, namely Janani Suraksha

Yojana (JSY), Janani Shishu Suraksha Karyakram (JSSK) are quite popular and have resulted in

improving institutional delivery across the country.

In addition to improving nutrition of pregnant women and lactating mothers, MoWCD through its

Integrated Child Development Services (ICDS) scheme it provides free food supplementation,

referral and counselling on nutrition and health education (NHE) services to women by Anganwadi

workers (AWWs) through more than 1.35 million Anganwadi Centres (AWCs) spread across the

country. AWWs are also mandated to facilitate antenatal care services to all pregnant women at

AWCs and also by visiting the women along with other service providers like ASHA and Auxiliary

Midwife nurses (ANM). AWWs are also to counsel and promote institutional and safe delivery

among the pregnant women.

In RSOC (2013-14) a variety of questions were asked to ever married women in the age group 15-49

who had a live birth during the three years preceding the survey. The reference cut-off date to

provide information on safe motherhood practices and use of services from service providers

including that from the AWC was ‘on or after 1st August of 2010’. The District level Household

Survey (2007-08) also collected information from ever married women aged 15-49 with a reference

period of three years preceding the survey and NFHS 2005-06 collected information from ever

married women aged 15-49, with a reference period of five years. The results on maternal health

indicators of RSOC are comparable with NFHS 2005-06 and DLHS, 2007-08.

Topics covered in this chapter are awareness and utilization of health services during prenatal, intra-

natal and postnatal period of pregnancies, especially antenatal care, delivery, and postnatal care and

role of AWC in care during pregnancy/delivery/post-delivery periods and care provided by service

providers.

Entire analysis in this chapter is based on number live births that were reported by the ever married

women age 15-49, in the three years preceding the survey. EMWs who delivered more than one live

births during the period has been counted as many times. For example, if an eligible woman gave

birth to two live births during the period, that woman has been counted twice. Thus, the number of

live births and number of EMWs are same in the analysis.

4.2 ANTENATAL CARE (ANC)

In India, the safe motherhood programme aims at providing at least four antenatal check-ups as per

the recommendations of the World Health Organization (WHO). Each ANC inter-alia includes weight

and blood pressure check, abdominal examination, immunization against tetanus, intake of 100 iron

MATERNAL HEALTHCARE


and folic acid tablets or syrup prophylaxis along with anaemia management. This also helps to

establish early contact with the women, and identifies and manages current and potential risks and

complications. For this reason; it is recommended that the pregnant women are registered with the

local health provider in the first trimester itself. This helps in counselling and establishing a delivery

plan. It is recommended that a doctor, an ANM, or other trained health professionals provide the

antenatal check-ups.24

RSOC collected information on ANCs from ever married women aged 15-49 and who had a live birth

in the three years preceding the survey on whether they registered their pregnancies and if so in

what month of pregnancy; who motivated them to register; whether -they received the Mother and

Child Protection (MCP) card and whether their pregnancies were registered in an AWC. From the

respondents who received antenatal care further questions were asked about place where ANC

received, the provider of ANC check-ups, timing of the first antenatal care visit and the total number

of visits made. In addition, the survey asked the women whether they received Tetanus Toxoid (TT)

injections, if yes, how many; whether Iron and Folic Acid (IFA) tablets or syrup were received or

purchased and whether consumed during the pregnancy. Results from each of these questions are

discussed in the subsequent sections.

4.2.1 Registration of pregnancy

The first step towards Maternal Healthcare begins with the registration of pregnancy. It is seen from

the analysis that more than four out of every five (84 percent) women had registered their

pregnancy. Table 4.1 presents the percent distribution of women who had live births in the three

years preceding the survey, by registration of pregnancy for ANC services and timing of the

registration, by place of residence. It is seen from the analysis that more than four out of every five

(84 percent) women had registered their pregnancy. Slightly higher proportion of the urban women

(87 percent) registered their pregnancies in comparison to the rural women (83 percent). This

reflects on the high level of awareness about maternal health care among the women in both rural

and urban areas. Amongst all the women aged 15-49, nearly two-third (65 percent) registered during

the first trimester of the pregnancy with more women from the urban areas (71 percent) than the

women residing in the rural areas (62 percent). It also means that close to one-third women (35

percent) were either not aware of the proper timing of registration or were not motivated about

benefits of early check-ups.

24 NFHS III Report Vol.1, 2005-06.

MATERNAL HEALTHCARE


Table 4.1: Registration of pregnancy Percent distribution of women who had live births in the three years preceding the survey, by registration of pregnancy for ANC services and timing of the registration, according to place of residence, India, RSOC, 2013-14

Registration of pregnancy and availability of MCP card Residence

Total Urban Rural

Registration of pregnancy 87.4 82.7 84.1 Number of months pregnant at the time of registration

< = 3 month 71.1 61.6 64.5 4-6 months 14.4 19.2 17.8

7 months and above 1.8 1.9 1.9 Not registered 12.6 17.3 15.9

Total 100.0 100.0 100.0 Number of women

25 16,320 38,230 54,550

4.2.2 Registration of pregnancy, timing of registration and having an MCP card

Upon registering pregnancy for ANC services, an MCP card is required to be issued to the pregnant

women. MCP Card is a joint initiative of ICDS and NRHM now known as NHM and has been

developed as a tool for families to learn, understand and follow different types of services which

should be accessed by the mother and the child for achieving continuum of care and enhancing

utilization of services from NRHM and ICDS. The card helps in recoding information on antenatal

care to post-delivery care of the mother and the child. Generally, this card should be kept with the

pregnant women. However, in some states MCP cards are also maintained by the ANMs or AWWs.

RSOC collected information on availability of MCP26 card from all women who had a live birth in the

three years preceding the survey. The woman was asked whether the MCP card was given to her at

the time of registration of pregnancy or not. In some cases cards similar to MCP card designed by the

government were also considered equivalent.27 If the respondent reported availability of such card

then she was requested to show the same. Responses were accordingly coded as ‘yes-shown’, ‘yes-

not shown’ and ‘No’.

25 For those mothers who had more than one live birth during the reference period of last three years, have been counted

as many times in the base. This was necessitated as information on antenatal, natal, postnatal etc. was collected in respect of last two live births under RSOC unlike in NFHS/DLHS where some of the indicators are based on the most recent live births. Thus in RSOC, number of women and number of births are same. 26

Enumerator carried a copy of the MCP card and the same was shown to the women respondent. 27

This was mostly seen for those who took services from private health institutions.

MATERNAL HEALTHCARE


Figure 4.1: Percentage of pregnant women having MCP cards

From Figure 4.1, it is seen that 73 percent of

the women had an MCP card, but only 34

percent could actually show the card to the

enumerator at the time of the interview.

Almost equal percentage of women from the

urban (36 percent) and the rural (34 percent)

areas reported to have received and also

could show their MCP cards.

The differentials in registration of pregnancy are linked to women’s age, education, social groups

and wealth quintile her family belongs to. As can be seen in Table 4.2, women in the higher age

brackets were less likely to get their pregnancy registered. Close to nine out of every ten women

below 24 years of age had registered their pregnancy; and close to three-forth received an MCP

card. On the other hand, amongst the women aged 30 or above, close to one-fourth had not

registered their pregnancy and one-third not received the MCP card. Among the women with no

education, close to 30 percent had not registered their pregnancy; and around 40 percent had not

received the MCP card at the time of registering their pregnancy.

Registration of pregnancy for ANC services is popular among women from all social groups. More

than four out of every five scheduled caste (SC), scheduled tribe (ST) and other backward class (OBC)

women had registered pregnancy and more than 70 percent received MCP card. However, it is

observed that the women from lowest (poorest) quintile were the most left out from registration

(close to 25 percent) and close to 40 percent had not received MCP card.

40 39 39 36 34 34

12 11 11

Urban Rural Total

Yes - not seen Yes - seen No MCP card

MATERNAL HEALTHCARE


Table 4.2: Registration of pregnancy, timing and MCP card

Among women who had live births in the three years preceding the survey, percentage who registered their pregnancy, registered in the first trimester and received of MCP card, according to background characteristics , RSOC, 2013-14

Background characteristics Registered pregnancy

for ANC

Registered pregnancy in

first trimester

Received MCP card at the time of registration of pregnancy (seen &

not seen)

Mother’s age 15-19 88.9 67.7 78.7 20-24 87.2 67.5 76.5 25-29 84.6 65.4 73.6 30-34 79.0 59.5 66.8 35-49 73.6 51.6 62.1

Mother’s education

No education 70.6 47.2 57.3 Below Primary 89.6 64.5 78.2 Completed Primary 86.2 65.9 76.4 Completed Middle 92.6 73.0 83.2 Completed Secondary 91.7 75.0 82.8 Completed Higher Secondary & Above 91.9 78.6 80.7

Social-group

Scheduled Caste 82.0 61.0 71.8 Scheduled Tribe 86.1 64.3 71.2 Other Backward Class 82.4 63.2 70.8 Other 87.1 68.7 77.6 Do not know 93.3 71.3 84.1

Wealth index

Lowest 75.9 50.2 62.0 Second 80.3 58.1 69.7 Middle 86.2 66.6 76.8 Fourth 89.5 72.3 78.9 Highest 89.1 76.2 78.2

Total 84.1 64.5 73.1

Registration in first trimester

It is always advisable to register pregnancy in the first trimester. It also helps in planning the entire

pre to natal period. Close to two-third of the women (65 percent) had registered their pregnancy in

the first trimester. However, it is seen that women from the poorer households generally do not

register their pregnancy in time. Fewer women from the poorest households (50 percent) were likely

to register their pregnancy in the first trimester than women from the richest households (76

percent). It is also seen that level of education of the women influences the timing of the

registration. More women with higher level of education registered their pregnancy in the first

trimester. Close to three-fourth of the women with eight or more years of education registered their

pregnancy in the first trimester whereas among women with ‘no education’ less than half (47

percent) had registered their pregnancy in the first trimester.

MATERNAL HEALTHCARE


Registration of pregnancy, timing and having MCP card by States

State-wise analysis on registration of pregnancy for ANC, registration in the first trimester and

receipt of MCP card has been presented in Table 4.3. There is wide variation in the level of

registration of pregnancy among the states, varying from 57 percent in Nagaland to 99 percent in

Sikkim. While in 13 states, the level of registration is more than or equal to 90 percent, in ten states

namely, Nagaland (57 percent), Uttar Pradesh (64 percent), Bihar (66 percent), Jharkhand (73

percent), Haryana (77 percent), Kerala (79 percent), Punjab (80 percent), Uttarakhand (80 percent),

Delhi (81 percent) and Jammu and Kashmir (83 percent), it was below the national average (84

percent).

Table 4.3: Antenatal care indicators by state

Among women who had a live birth in the three years preceding the survey, percentage who registered pregnancy, registered in first trimester and received MCP card, according to States, India, RSOC, 2013-14

States Registered

pregnancy for ANC Registered pregnancy

in first trimester Received MCP card at the time

of registration of pregnancy

India 84.1 64.5 73.1 North

Delhi 81.3 69.2 72.6 Haryana 76.8 57.6 66.7 Himachal Pradesh 91.9 75.3 85.8 Jammu & Kashmir 82.6 63.9 70.8 Punjab 79.6 66.7 71.0 Uttar Pradesh 64.2 48.5 53.9 Uttarakhand 80.4 67.1 71.5

Central Chhattisgarh 91.2 73.4 71.5 Madhya Pradesh 90.2 69.2 77.2

East Bihar 66.4 33.7 48.4 Jharkhand 73.0 47.3 65.4 Odisha 90.3 62.8 80.3 West Bengal 98.4 72.5 95.0

Northeast Arunachal Pradesh 84.9 46.1 76.0 Assam 95.1 62.0 92.9 Manipur 93.2 80.7 9.0 Meghalaya 85.5 59.8 65.9 Mizoram 89.4 67.5 81.9 Nagaland 56.8 49.1 40.0 Sikkim 99.2 81.1 97.5 Tripura 84.7 64.4 65.0

West Rajasthan 85.2 65.4 73.5 Goa 95.4 86.0 91.8 Gujarat 88.3 76.9 81.3 Maharashtra 92.1 75.1 77.4

South Andhra Pradesh 95.1 73.3 82.1 Karnataka 93.8 77.4 86.2 Kerala 79.3 71.1 66.3 Tamil Nadu 93.6 81.0 83.7

MATERNAL HEALTHCARE


With regards to timing of the registration too there is wide variation among the states. Registering in

the first trimester varied from 34 percent in Bihar to 86 percent in Goa. Level of registration in first

trimester is more than the national average in 18 states. In states of Nagaland, Uttar Pradesh,

Jharkhand, Arunachal Pradesh and Bihar, more than half of the women had not registered in the first

trimester. With regards to having an MCP card (seen and not seen) there are again large variations

among the states, varying from 98 percent in Sikkim to just 9 percent in Manipur.

4.2.3 Utilization of ANC service, timing of first ANC and number of check-ups taken

It is not about registering pregnancy only but the number of ANC check-ups taken and the timing of

the first check-up that are critical for health of the mother and the outcome of the pregnancy. The

World Health Organization (WHO)28 recommends that all pregnant women should have at least four

ANC check-ups/assessments by or under the supervision of a skilled attendant. These assessments

should be spaced at regular intervals throughout pregnancy, beginning as early as possible in the

first trimester. Skilled attendant are those who are trained professionally for providing medical care.

These are doctors, nurses, ANMs.

In RSOC 2013-14, a question was asked to women who had a live birth in the three years preceding

the survey whether she received any antenatal service. If responded in affirmative, further queries

were made about the time of first check-up received and the number of ANC check-ups taken during

the pregnancy. Table 4.4 presents the percentage of women who had live births in the three years

preceding the survey by receipt of ANC, number of check-up visits and timing of first check-up,

according to the place of residence of the respondent. More than four out of every five women (85

percent) received ANC during pregnancy. In the urban areas the proportion of women (90 percent)

receiving ‘any ANC’ was higher in comparison to that of the women (83 percent) residing in rural

areas. As per DLHS 2007-08, the level of ‘any ANC’ was around 75 percent. Thus, the coverage of

‘any ANC’ has increased over the years.

28 Standards of Maternal and Neonatal Care, Integrated Management of Pregnancy and Childbirth, WHO, 2006.

MATERNAL HEALTHCARE


Table 4.4: Utilization of Antenatal care service

Percent distribution of women who had a live birth in the three years preceding the survey by receipt of any ANC check-up, number of check-up received and timing of first check-up according to the place of residence, India, RSOC, 2013-14

Number and timing of check-ups Residence

Total Urban Rural

Percentage of women who received any ANC during pregnancy 90.3 83.0 85.2 Number of ANC check-ups received

None 9.5 16.7 14.5 1 3.6 8.9 7.3 2 11.1 15.3 14.1 3 16.0 18.9 18.0 4+ 58.9 39.6 45.4 Do not know 0.9 0.6 0.7 Total 100 100 100

Number of months pregnant at the time of first ANC check-up

No ANC 9.5 16.7 14.5 < = 3 months 69.7 58.5 61.8 4-6 months 17.9 21.5 20.4 7 months or after 2.2 2.7 2.5 Do not know 0.7 0.7 0.7 Total 100 100 100

Median months pregnant at first visit of antenatal check-up

3.0

3.0

3.0

Number of women 16,320 38,230 54,550

More than three out of every five women received three or more (3+) antenatal check-ups. Also,

more than two out of every five (45 percent) women received four or more (4 +) ANC check-ups. A

higher proportion of urban women (59 percent) received four or more number of ANC check-ups in

comparison to women from the rural areas (39 percent). It may be recalled from the previous

section that close to 16 percent women had not registered their pregnancy.

Close to 62 percentage of the women received their first ANC in the first trimester. Women receiving

ANC in the first trimester was more among the urban women (70 percent) in comparison to women

from the rural areas (59 percent). First check-up was delayed in a fifth of the women. Close to 20

percent of the women received first ANC check-up in the second trimester and another 3 percent

received during the seventh month or after. As per DLHS 2007-08, 45 percent women received the

first check-up in the first trimester and 26 percent received in the second trimester. Thus, the

situation on timing of the first antenatal check-up by women since 2007-08 seems to have improved.

Table 4.5 presents the percentage of women who had a live birth in the three years preceding the

survey by number of antenatal check-ups received and timing of first check-up, according to various


MATERNAL HEALTHCARE


Table 4.5: Utilization of antenatal care services Percentage of women who had a live birth in the three years preceding the survey by number of antenatal check-up received and timing of first check-up, according to various background characteristics, RSOC, 2013-14

Background characteristics

Percentage who had at least one

ANC check-up

Percentage who had 3 and more

ANC check-ups

Percentage who had 4 and more

ANC check-ups

Percentage who received first ANC check-up in first

trimester of pregnancy

Number of women

Mother’s age 15-19 92.0 68.9 49.4 64.9 1,539 20-24 88.2 67.5 48.5 64.6 20,364 25-29 85.9 63.7 45.9 63.1 20,861 30-34 79.4 57.9 41.1 56.7 8,145 35-49 74.5 48.2 32.3 49.2 3,642

Residence

Urban 90.3 74.9 58.9 69.7 16,320 Rural 83.0 58.5 39.6 58.5 38,230

Birth order

One 88.1 69.8 52.5 66.8 25,575 Two 87.7 66.5 48.2 63.4 16,502 Three and more 75.8 46.2 26.9 49.5 12,473


No education 71.8 40.3 22.4 46.7 17,616 Below Primary 88.1 64.1 40.2 54.5 2,615 Completed Primary 86.1 65.4 45.4 59.7 8,351 Completed Middle 92.0 74.1 55.5 68.0 8,562 Completed Secondary 93.6 78.8 61.1 72.2 7,602 Completed Higher Secondary & above

95.3 81.7 67.0 79.3 9,805

Social-group

Scheduled Caste 83.8 58.9 41.8 59.6 10,976 Scheduled Tribe 81.8 56.4 37.0 54.7 6,311 Other Backward Class 84.2 60.8 43.3 62.8 21,886 Other 88.8 72.9 54.4 65.1 14,828 Do not know 93.5 78.2 53.1 60.1 550

Religion

Hindu 85.5 62.9 45.6 62.1 42,658 Muslim 82.9 63.9 42.9 58.8 9,074 Christian 87.6 76.0 58.4 65.9 1,278 Sikh 87.1 60.8 40.9 66.9 825 Jain 92.7 51.6 48.9 78.9 119 Buddhist 94.6 68.6 47.1 74.7 338 Other 86.7 65.7 43.2 54.9 224 No religion 88.9 63.3 44.8 73.0 36

Wealth index

Lowest 74.7 43.7 24.5 47.0 10,977 Second 81.5 55.1 35.1 55.7 11,248 Middle 87.2 66.2 47.6 62.0 11,213 Fourth 89.5 73.3 56.8 68.8 11,092 Highest 94.0 80.1 64.4 77.0 10,020

Total 85.2 63.4 45.4 61.8 54,550

MATERNAL HEALTHCARE


As seen from the previous section, although close to 85 percent of the women received at least one

ANC check-up during pregnancy; 63 percent received three or more check-ups and 45 percent

received the recommended four or more ANCs, it is seen that there was a decline in the proportion

of pregnant women receiving check-ups, with the increase in their age. The women in the younger

age group (15-29) received relatively more number of check-ups than women of the higher age

groups. More than two-third of the women (between 68-69 percent) in the age group 15-24 had

received three or more check-ups in comparison to 48 percent in the case of the women aged 35-49.

Similarly, 49 percent of women in the age group 15-24 received four or more antenatal check-ups,

while the proportion of women in the age group 30-49 years varied between 32 to 41 percent.

Women belonging to the marginalized communities and financially weaker sections are less likely to

receive the recommended four + ANC check-ups, as it is seen that 42 percent of the women from SC

families and 37 percent of the women from the ST families received four or more ANC check-ups in

comparison to higher proportion (54 percent) of the women from Other categories. Similarly, close

to one-fourth women belonging to the poorest families received four or more check-ups, in contrast

to close to two-third of the women (64 percent) from the richest families.

4.2.4 Components of antenatal care

Tetanus Toxoid (TT) injections29

A question was asked in RSOC to women who delivered a live birth in the three years preceding the

survey whether TT injection was received during the pregnancy and if yes, number of injections

received. Those who had not received TT injection were further asked whether TT injection was

taken before that pregnancy and time of receiving that injection. Table 4.6 gives the percentage of

women who had a live birth in the three years preceding the survey, by the number of TT injections

received during pregnancy and percentage who received one TT injection during the current pregnancy

and at least one within one year prior to the pregnancy percentage, according to place of residence. Close

to nine out of every ten women (88 percent) received two doses of TT injections and another 2

percent of the women reported to have received at least one TT injection during this pregnancy and

at least one within one year prior to the current pregnancy. This means that overall 90 percent of

the women were covered under the required doses of TT injections, with 92 percent women from

the urban areas and 89 percent from the rural areas.

29 In order to correctly assess the coverage of women who are adequately immunized against tetanus, women reporting

receipt of less than two doses of TT during current pregnancy were further probed whether they had received any TT injection any time before this pregnancy. among those reporting in affirmative, women who had received any dose of TT in last one year preceding current pregnancy, such women are also included under the category of ‘adequately immunized ones’. It is pertinent to note here that under RSOC, the period for such consideration was ‘last one year of current pregnancy’ against last 3 years used in NFHS.

MATERNAL HEALTHCARE


Table 4.6: Tetanus Toxoid vaccination Percent distribution age of women who had a live birth in the three years preceding the survey, by number of TT injections received during pregnancy and percentage who received one TT injection during the current pregnancy and at least one within one year prior to the pregnancy percentage, according to place of residence, RSOC, 2013-14

TT injections received Residence

Total Urban Rural

Number of TT injection received

No TT 3.6 5.7 5.1 One 5.7 7.0 6.6

Two or more 90.7 87.3 88.3 Total 100.0 100.0 100.0

Percentage who received one TT injection during the current pregnancy and at least one within one year prior to the

pregnancy 1.5 1.5 1.5

Percentage who received either two TT injection during current pregnancy or one during current pregnancy and one

within a year prior to pregnancy 92.2 88.8 89.8

Number of women 16,320 38,230 54,550

Figure 4.2: Percentage of women who received two or more TT injections during pregnancy by wealth quintiles, as per RSOC and DLHS 2007-08

Figure 4.2 gives the comparison of proportion of women who received two or more TT injections as

per RSOC and DLHS 2007-08. It is seen that the overall situation of receiving two or more TT

injections by women has improved by 21 percentage points since DLHS 2007-08 and a similar

situation is seen across all wealth quintiles too; maximum improvement (36 percentage points) is

seen among the women from the poorest quintile.

83 86 89 91 94 88

47 55

65 75

87

67

Lowest Second Middle Fourth Highest Total

RSOC 2013-14 DLHS 2007-08

MATERNAL HEALTHCARE


Receipt and Consumption of Iron Folic Acid (IFA) tablets

As per the recommendations, a pregnant woman is required to consume 100 or more IFA tablets

during her pregnancy. In RSOC, a question was asked in the ever married women (EMW)

questionnaire whether IFA tablets/syrup were purchased or received during the pregnancy. If

answered in affirmative, she was asked about the number of tablets/syrup bottles

purchased/received. From Table 4.7 it is observed that slightly over two-third of the women (68

percent) purchased or received IFA tablets and/syrup bottles30 (irrespective of quantity or size of

tablet) during pregnancy. The proportion of the urban women (72 percent) purchasing/receiving IFA

tablets/syrup bottles was relatively higher than that of the rural women (67 percent). However, only

31 percent women received or purchased the requisite31 100 or more tablets/syrup during

pregnancy. Another 37 percent did not receive or procure adequate quantity. Thus, close to one in

every three women (32 percent) neither received nor procured IFA tablets/syrup.

Government has been supplying IFA tablets/syrups to all pregnant women from their health facilities

as part of the RCH programme. Close to half of the women aged 15-49 years (47 percent) cited

government as the main source from where they received or procured the IFA tablets/syrups. This

phenomenon was seen more in the rural areas (51 percent) than in the urban areas (39 percent);

close to a tenth (13 percent) reported to have received from private sources and around 9 percent

received/procured from other sources. More urban women (24 percent) than the rural women (8

percent) procured/received IFA from private sources.

30 Three IFA syrup bottles of 100 ml each is equivalent to 100 IFA large tablets.

31 As per the programme every pregnant women should consume 100 or more IFA tablets/equivalent syrup during pregnancy.

MATERNAL HEALTHCARE


Table 4.7: Receipt and consumption of IFA tablets Percent distribution of women who had a live birth in the three years preceding the survey by the number of IFA tablets or syrup received/purchased; of those who received/purchased IFA tablets or syrup by source from where received/purchased and the number of IFA tablets consumed, according to place of residence, RSOC, 2013-14

Receipt and consumption of IFA Residence

Total Urban Rural

Number of IFA tablets/syrup32

received or purchased* 72.1 66.9 68.4

1-59 14.5 18.9 17.6 60-89 11.5 11.0 11.1 90-99 10.0 7.9 8.5

100 or more 36.1 29.1 31.2 Neither received nor purchased IFA 27.9 33.1 31.6

Total 100.0 100.0 100.0

Source of IFA tablets/syrup*

Government source 38.7 50.8 47.2

Private source 23.9 7.6 12.5 Other sources 9.5 8.5 8.8

Neither received nor purchased IFA 27.9 33.1 31.6 Total 100.0 100.0 100.0

Number of IFA tablets/syrup consumed*

1-59 20.2 24.8 23.4 60-89 12.3 11.1 11.4 90-99 9.7 7.2 8.0

100 or more 28.8 21.4 23.6 Not received/consumed 29.0 35.6 33.6

Total 100.0 100.0 100.0

Number of women 16,320 38,230 54,550

*Any type of tablets/syrup irrespective of size/quantity.

Low procurement or receipt of iron and folic tablets/syrups significantly affected the consumption of

the requisite quantity of IFA tablets/syrup by the women in both the rural and the urban areas.

Consumption of 100 IFA tablets or equivalent quantity of syrup during pregnancy is critical for health

of the woman and the baby. Close to two-third of the women (68 percent) reported to have

consumed IFA tablet/syrup during pregnancy, with 72 percent from the urban and 67 percent from

the rural areas. But, less than one-fourth (24 percent) reported consuming the requisite quantity

(100 or more IFA tablet/syrup) during pregnancy. In terms of place of residence, 29 percent of the

women from the urban and 21 percent of the women from the rural areas reported to have

consumed the requisite quantity of IFA.

Of the women who had a live birth in three years preceding the survey, analysis of percentage of

women who received/purchased 100 or more IFA tablets, consumed 100 or more IFA tablets and

32 Syrup bottles have been converted to tablets as per the formula.

MATERNAL HEALTHCARE


received two or more TT injections during pregnancy by various background is presented in the

Table 4.8. As per the analysis, overall receipt and consumption of IFA tablet/syrup was low across all

ages of the women. Regarding receipt, proportion of women receiving 100 or more IFA tablet/syrup

declined from 33 percent for women in the age group 15-19 to 24 percent for the women in the age

group 35-49. Consumption was also low among all age groups. Proportion of women consuming 100

or more IFA tablets/syrup varied between 18 to 23 percent for women in the age group 15-49.

Relatively women from the urban areas are more likely to consume IFA than the women from the

rural areas, as 29 percent of the urban women consumed 100 or more IFA tablet/syrup in

comparison to 21 percent of the rural women. It is also seen from the table that more proportion of

women with the first and second order birth (26 percent for both birth order) consumed required

quantity of IFA than those women with higher (3 or more) birth orders (15 percent).

Level of education of the women and economic condition of the households are important drivers of

improving consumption of IFA. There is a gradual increase in consumption of IFA with increase in the

levels of education, increasing from 13 percent for women with no education to 36 percent for

women who completed higher secondary & above level of education. Similarly, an increasing trend is

seen in consumption pattern of 100 or more IFA tablets amongst the women from different wealth

quintiles, increasing from the lowest to the highest quintiles. Relatively less proportion of the

women (14 percent) from the lowest quintile consumed the requisite 100 or more tablets, in

contrast to 35 percent of the women from the richest families. There are researches and evidences

for the low consumption of IFA tablets. However, it has not been studied in this survey.

MATERNAL HEALTHCARE


Table 4.8: Antenatal care indicators

Among the women who had a live birth in three years preceding the survey, percentage of women who received/purchased 100 or more IFA tablets, consumed 100 or more IFA tablets and those who received two or more TT injections during pregnancy, according to background characteristics, RSOC, 2013-14

Background characteristics Received/purchas

ed 100 or more IFA tablets*

Consumed 100 or more IFA

tablets*

Received two or more TT injections

during pregnancy

Received one TT injection during

pregnancy and one within a year prior to

current pregnancy

Number of women

Mother’s age 15-19 33.2 22.8 91.0 1.7 1,539 20-24 33.0 24.5 89.5 1.5 20,364 25-29 31.7 24.8 89.2 1.5 20,861 30-34 28.0 20.8 86.2 1.5 8,145 35-49 24.2 17.8 80.2 1.6 3,642

Residence Urban 36.1 28.8 90.7 1.5 16,320 Rural 29.1 21.4 87.3 1.5 38,230

Birth order One 34.3 26.4 91.5 1.4 25,575 Two 34.0 25.8 88.6 1.5 16,502 Three and more 21.0 15.0 81.4 1.6 12,473

Mother’s education No education 18.9 13.3 80.6 1.5 17,616 Below Primary 30.9 19.8 87.5 1.8 2,615 Completed Primary 31.4 23.3 89.3 1.7 8,351 Completed Middle 33.7 24.7 92.4 1.4 8,562 Completed Secondary 40.3 31.7 93.4 1.6 7,602 Completed Higher Secondary & above

43.7 36.1 94.1 1.3 9,805

Social-group Scheduled Caste 29.3 21.6 87.6 1.6 10,976 Scheduled Tribe 30.5 20.6 84.2 1.9 6,311 Other Backward Class 30.3 23.6 88.1 1.3 21,886 Other 34.3 26.6 90.8 1.5 14,828 Do not know 26.7 16.2 88.7 3.2 550

Religion Hindu 31.4 23.8 88.7 1.5 42,658 Muslim 27.9 20.6 86.3 1.2 9,074 Christian 44.9 35.2 86.9 1.5 1,278 Sikh 26.5 21.1 92.7 1.5 825 Jain 48.9 43.2 97.3 0.0 119 Buddhist 38.2 31.8 88.2 3.0 338 Others 41.1 31.0 88.9 2.5 224 No religion 29.2 27.2 88.2 0.2 36

Wealth index Lowest 20.7 13.8 82.8 1.6 10,977 Second 26.9 19.5 85.6 1.6 11,248 Middle 31.3 23.5 88.8 1.6 11,213 Fourth 36.0 27.3 91.2 1.5 11,092 Highest 41.8 35.0 93.7 1.0 10,020

Total 31.2 23.6 88.3 1.5 54,550

MATERNAL HEALTHCARE


Close to 90 percent of the women had received TT injections during their pregnancy. No significant differential is seen in the receipt of TT injections amongst the women from the different social groups as the variation was between 88 to 91 percent.

Full Antenatal care

As per the requirement of safe motherhood programme under the RCH,33 full ANC includes receipt

of 3+ ANC, at least one dose of TT and consumption of 100 or more IFA tablets/three bottles of IFA

syrup during pregnancy. Table 4.9 presents analysis of percentage of women who received full ANC

according to various background characteristics.

Table 4.9: Full ANC Among the women who had a live birth in the three years preceding the survey, percentage of women who received full ANC according to various background characteristics, RSOC, 2013-14

33 Reproductive and Child Health Programme of the Government of India, http://mohfw.nic.in/ and http://nrhm.gov.in/

Background characteristics Received Full ANC # Number of women

Mother’s age 15-19 18.9 1,539 20-24 20.7 20,364 25-29 20.7 20,861 30-34 17.2 8,145 35-49 13.9 3,642

Residence Urban 25.2 16,320 Rural 17.3 38,230

Birth order One 22.5 25,575 Two 21.6 16,502 Three and more 11.3 12,473

Mother’s education No education 9.3 17,616 Below Primary 15.9 2,615 Completed Primary 19.7 8,351 Completed Middle 21.4 8,562 Completed Secondary 27.1 7,602 Completed Higher Secondary & above 32.1 9,805

Social-group Scheduled Caste 18.0 10,976 Scheduled Tribe 15.0 6,311 Other Backward Class 19.6 21,886 Other 23.2 14,828 Do not know 14.2 550

http://mohfw.nic.in/

MATERNAL HEALTHCARE


# Full ANC includes receipt of 3+ ANC, at least one dose of TT and consumption of 100 or more IFA

tablets/three bottles of IFA syrup

It is observed in Table 4.9 that the overall, the level of full ANC is low as only two out of every ten

(20 percent) women in the age group 15-49 received the full components of antenatal care. It is

however seen, that level of education is an important driver of receiving full ANC. While less than

one in every ten women (9 percent) with ‘no education’ received full ANC, on the other hand, close

to three for every 10 women (32 percent) who completed secondary or higher level of education

received full ANC. Relatively, women from the wealthier families are more likely to receive full ANC

than women from the poor families. The level of receipt of full ANC varied between 10 percent for

women from the poorest families to 31 percent for women from the richest families.

Figure 4.3: Percentage of women who received various components of antenatal care services

Figure 4.3 presents

the percentage of

women receiving

different components

of antenatal care

services. Although 84

percent women

registered their

pregnancy and 73

percent received MCP

card, only 31

percentage of the

women

received/procured IFA tablet/syrup and 24 percent consumed the recommended number. Overall 20

percentage of the women received all the required components of ANC. Quite clearly, low level of

full ANC is linked to inadequate supply as well as consumption of IFA.

Background characteristics Received Full ANC # Number of women

Religion Hindu 19.7 42,658 Muslim 17.9 9,074 Christian 31.9 1,278 Sikh 16.5 825 Jain 26.8 119 Buddhist 22.0 338 Other 25.6 224 No religion 19.8 36

Wealth index Lowest 9.5 10,977 Second 15.5 11,248 Middle 19.8 11,213 Fourth 23.3 11,092 Highest 31.3 10,020

Total 19.7 54,550

84

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MATERNAL HEALTHCARE


4.2.5 Components of ANC across states

Antenatal check-ups by states

Table 4.10 presents percentage of women who had live births in three years preceding the survey by

receipt of number of antenatal check-ups received during pregnancy and by place of residence,

according to state.

Table 4.10: Antenatal check-ups by state Among women who had a live birth in three years preceding the survey, percentage who received antenatal check-ups during pregnancy by number of check-ups and place of residence according to state, RSOC, 2013-14

State

Percentage who had at least one ANC

Percentage who had 3 or more ANC check-ups

Percentage who had 4 or more ANC check-ups

Urban Rural Total Urban Rural Total Urban Rural Total

India 90.3 83.0 85.2 74.9 58.5 63.4 58.9 39.6 45.4 North

Delhi 85.9 84.5 85.9 75.6 70.0 75.5 58.3 54.4 58.3 Haryana 81.7 80.3 80.7 52.8 45.1 47.5 33.0 21.2 24.9 Himachal Pradesh 84.4 91.1 90.5 57.3 57.8 57.8 38.4 34.5 34.8 Jammu & Kashmir 88.6 75.8 79.1 65.8 54.9 57.7 58.6 39.5 44.4 Punjab 88.9 85.2 86.5 67.6 55.7 59.8 49.2 32.9 38.6 Uttar Pradesh 74.7 58.1 61.6 52.9 34.9 38.6 39.8 25.1 28.1 Uttarakhand 89.1 74.1 78.7 68.0 45.0 52.0 50.8 26.6 34.0

Central Chhattisgarh 97.1 95.3 95.7 89.1 76.9 79.6 66.9 48.4 52.4 Madhya Pradesh 82.6 73.0 75.4 52.6 38.1 41.7 33.2 18.8 22.4

East Bihar 89.4 84.1 84.7 53.6 30.3 32.8 17.0 8.9 9.8 Jharkhand 90.5 78.0 80.7 65.6 42.4 47.3 38.3 16.7 21.3 Odisha 94.9 91.5 92.0 83.5 73.7 75.3 67.0 47.0 50.3 West Bengal 96.8 99.0 98.3 90.4 89.3 89.7 77.1 67.3 70.4

Northeast Arunachal Pradesh 92.4 81.1 83.9 88.2 69.1 73.8 72.9 48.7 54.7 Assam 95.9 92.8 93.2 83.1 72.9 74.2 52.7 36.8 38.9 Manipur 96.7 84.5 88.4 92.7 73.1 79.4 82.6 56.8 65.1 Meghalaya 89.3 85.2 86.0 77.6 68.9 70.6 63.3 43.0 46.9 Mizoram 91.0 88.6 89.9 79.8 69.6 75.2 64.0 37.1 51.8 Nagaland 53.5 15.2 25.1 30.5 9.0 14.5 18.8 6.2 9.4 Sikkim 99.2 99.5 99.4 91.6 92.4 92.2 79.9 74.6 75.8 Tripura 91.0 74.0 78.1 85.1 61.1 67.0 73.8 41.5 49.4

West Rajasthan 89.1 79.9 82.2 64.8 46.9 51.2 42.2 27.1 30.8 Goa 98.0 99.3 98.4 93.8 94.7 94.1 87.0 86.4 86.7 Gujarat 90.1 87.0 88.2 79.0 67.9 72.3 68.8 49.5 57.2 Maharashtra 91.8 92.9 92.4 73.7 72.9 73.2 55.3 49.0 51.9

South Andhra Pradesh 93.6 94.2 94.0 78.6 76.2 76.9 58.2 55.9 56.6 Karnataka 94.7 93.1 93.7 92.0 85.5 87.9 86.8 78.4 81.5 Kerala 97.1 95.4 96.2 88.9 86.8 87.8 76.8 76.2 76.5 Tamil Nadu 98.3 98.0 98.2 92.4 91.2 91.8 82.0 76.1 78.8

MATERNAL HEALTHCARE


The utilization of ANC services varied widely among the states. Women receiving at least one ANC

varied between 99 percent in Sikkim to 25 percent in Nagaland. Except for the six states, namely,

Nagaland (25 percent), Uttar Pradesh (62 percent), Madhya Pradesh (75 percent), Uttarakhand (79

percent), Jammu and Kashmir (79 percent) and Tripura (78 percent), in all other states 80 percent or

more women received at least one ANC check-up.

Among the states, proportion of women receiving three or more ANC check-ups varied between 94

percent in Goa to 15 percent in Nagaland. In seven states, 80 percent or more women received three

or more check-ups. As stated earlier, coming to women receiving four or more ANC check-ups as

recommended by the programme, nationally less than half (45 percent) of the women availed the

requisite number of check-ups. Among the states, women receiving four or more ANC check-ups

varied between 87 percent in Goa to 9 percent in Bihar and Nagaland. In fact there are only two

states, namely Goa and Karnataka where more than 80 percent women received four or more ANC

check-ups. In 17 states, levels of 4 + ANC check-ups were above the national average (45 percent).

Iron and Folic Tablets and Full ANC by states

Table 4.11 presents state wise percentage of women who received or purchased 100 or more IFA

tablets/syrup; percentage of women who consumed 100 or more IFA tablets/syrup and percentage of

women who received two or more TT injections during pregnancy. Percentage of women receiving or

purchasing IFA tablets/syrup varied widely from 73 percent in Goa to 5 percent in Nagaland. In only

eight states, 50 percent or more women purchased/received IFA. Likewise, proportion of women

consuming 100 or more IFA tablets/syrup was low among the states and it varied from 61 percent in

Goa to 4 percent in Nagaland and Uttar Pradesh. In 16 states, the level of consumption was more

than the national average (24 percent). Goa (61 percent women) closely followed by Kerala (59

percent) and also Sikkim (59 percent) were relatively among the better performing states. At the

other end of the spectrum are Bihar and Uttar Pradesh where consumption of recommended doses

of IFA tablets/syrup by the women was below 5 percent.

With regards to receiving the recommended two doses or more of TT injections during pregnancy,

almost all states had done well. Percentage of women aged 15-49 taking two TT injections or more

during pregnancy varied from 69 percent in Nagaland to 97 percent in Andhra Pradesh. In 15 states,

percent of women taking two or more TT injections were more than the national average (88

percent). In 12 states, namely, Himachal Pradesh, Jharkhand, Chhattisgarh, Karnataka, Tamil Nadu,

West Bengal, Sikkim, Odisha, Punjab, Goa, Andhra Pradesh and Kerala more than 90 percent of the

women reported receiving at least two or more doses of TT during pregnancy.

MATERNAL HEALTHCARE


Table 4.11: Antenatal care indicators by state

Among the women who had a live birth in the three years preceding the survey, percentage who

received/purchased 100 or more IFA tablets/syrup, consumed 100 or more IFA tablets/syrup and received two

or more TT injections during pregnancy, according to states, RSOC, 2013-14

States

Percentage who received/purchased

100 or more IFA tablets/syrup

Percentage who

consumed 100 or more

IFA tablets/syrup

Percentage who received two or

more TT injection during

pregnancy

Percentage who received Full

ANC

India 31.2 23.6 88.3 19.7 North


Central Chhattisgarh 36.0 22.1 92.2 18.8 Madhya Pradesh 30.3 19.6 88.9 12.1

East Bihar 16.7 14.0 88.6 9.6 Jharkhand 15.2 10.3 90.6 6.9 Odisha 44.8 28.9 95.8 24.6 West Bengal 34.4 22.5 96.0 21.2

Northeast Arunachal Pradesh 52.6 27.7 77.5 23.3 Assam 54.7 27.7 90.2 25.2 Manipur 32.2 27.5 90.0 27.0 Meghalaya 40.6 25.2 73.7 22.2 Mizoram 55.3 52.0 83.8 42.7 Nagaland 5.1 3.7 68.6 3.6 Sikkim 65.9 58.8 94.6 55.7 Tripura 36.7 24.6 89.8 23.1

West Rajasthan 17.5 11.6 82.6 8.6 Goa 72.7 61.0 95.1 58.9 Gujarat 37.4 31.2 87.6 25.7 Maharashtra 36.1 28.7 89.9 24.4

South Andhra Pradesh 52.7 47.0 97.1 38.2 Karnataka 41.3 34.1 93.2 32.4 Kerala 66.0 59.3 95.1 53.6 Tamil Nadu 47.3 37.7 96.4 35.2

MATERNAL HEALTHCARE


While close to three-fifth (59 percent) of the women from Goa received full ANC, in contrast, three

percentage of the women from Uttar Pradesh received the full components of ANC. In states like

Uttar Pradesh, Nagaland, Jharkhand and Rajasthan, less than 10 percentage of the women received

full ANC. In 13 states, level of full ANC was above the national average (20 percent).

4.2.6 Place of ANC and service provider

The place of antenatal check-ups and the type of service provider are in a sense indicative of the

quality of ANC service received by the women. In RSOC, women who had a live birth in the three

years preceding the survey were asked about the place of receiving ANC check-ups and the type of

healthcare provider who did the check-ups. As women might have received services from more than

one provider, results would not add up to 100 percent. The results are presented in Table 4.12.

Government-run health facilities appear to be preferred places of receiving ANC check-ups, both in

rural and the urban areas. Overall, 43 percent of the women had taken check-ups at government run

health facilities. Little more than one out of every five women (22 percent) reported receiving ANC

from AWCs and 38 percent reported receiving ANC check-ups from private health facilities. More

women (50 percent) from the urban areas accessed private health facilities than women from the

rural areas (33 percent) for ANC services.

MATERNAL HEALTHCARE


Table 4.12: Place of antenatal check-ups and type of service provider Percentage of women who had a live birth in the three years preceding the survey by place where antenatal check-up taken and type of ANC providers, according to residence, RSOC, 2013-14

Place of ANC and ANC provider

Residence

Total Urban Rural

Place of antenatal check up Anganwadi centre 10.6 27.4 22.4

Government health facilities 44.6 42.7 43.3 Private health facilities 49.7 33.1 38.1

Mobile clinic 0.6 0.5 0.5 Home 1.5 3.0 2.6 Other 1.2 1.6 1.5

Don’t know/can’t say 0.4 0.2 0.3

ANC provider Doctor 71.8 51.5 57.6

Auxiliary Nurse Midwife (ANM) 19.7 35.2 30.5 Lady Health Visitor(LHV)/nurse 14.8 17.4 16.7

Other health professional 2.2 3.0 2.8 Trained Birth Attendant (TBA) 0.5 1.0 0.9

Any skilled provider34

89.0 82.1 84.2 Other 0.9 0.8 0.8

Number of women 16,320 38,230 54,550

Nationally, close to three for every five women (58 percent) reported that a doctor provided ANC

services. Overall, 84 percent of the ANC check-ups were provided by a skilled health provider. The

urban and rural differential as per Table 4.12 indicates that more women living in the urban areas

(72 percent) received ANC services from a doctor than their counterparts in the rural areas (52

percent). Close to one-third women (31 percent) reported receiving services from an ANM whereas

less than a fifth (17 percent) reported receiving ANC services from an LHV/nurse of a health facility.

A substantial proportion of women living in rural areas reported receiving services from an ANM (35

percent) and LHV/Nurse (17 percent).

34 A skilled provider is doctor, ANM, nurses or other health professional

MATERNAL HEALTHCARE


Visit by health functionaries during pregnancy

One of the job responsibilities of an AWW, ASHA and the ANM is to make routine home visitations to

all pregnant woman and lactating mothers who reside within the jurisdictional boundaries of their

operational area. The AWW and ASHA are required to make allotted home visits every day. The

home visitations by the healthcare workers are necessary to provide individual and family

counselling on issues of diet, rest, use of iodized salt as part of ANC. These visitations are also used

for counselling on issues of birth planning and safe/institutional delivery.35

In RSOC 2013-14, eligible respondents were asked whether any AWW/ASHA/ANM or doctor visited

their home during period of pregnancy. Enumerators read out the options of service providers so

that the women could respond if they were visited by more than one provider. Table 4.13 presents

the percentage of women who had a live birth in the last three years preceding the survey, visited by

AWW, ASHA, ANM or/and doctor at home during pregnancy, according to various background

characteristics. Close to a third (35 percent) women reported that an AWW visited them during

pregnancy; a little less than a third (32 percent) reported she was visited by an ASHA. Fourteen

percent of the women reported visitations by an ANM and around three percent women reported a

visit by a doctor during her pregnancy period.

Table 4.13: Visit by health functionaries at home during pregnancy Among women who had a live birth in the last three years preceding the survey, percentage who were visited by AWW, ANM, ASHA and doctor at home during pregnancy, according to selected background characteristics, RSOC, 2013-14

Background Characteristic

Type of health functionary Number of Women AWW ASHA ANM Doctor

Mothers age

15-19 35.2 38.9 13.0 1.8 1,539 20-24 36.6 32.8 15.4 2.6 20,364 25-29 34.9 30.8 13.8 3.1 20,861 30-34 31.2 28.6 11.3 2.6 8,145 35-49 32.2 32.7 12.1 3.1 3,642

Social-group Scheduled Caste 36.1 33.3 14.3 2.3 10,976 Scheduled Tribe 42.5 37.4 13.8 2.6 6,311 Other Backward Class 33.6 29.4 14.3 3.2 21,886 Other 32.5 30.6 13.0 2.6 14,828 Do Not Know 30.3 42.9 11.1 2.7 550


Total 34.8 31.6 13.9 2.8 54,550

35Letter from MWCD on Role Clarity and Delineation of Roles for Frontline Health Workers, No. 9-1/2012-CD—I (Part), 2013

MATERNAL HEALTHCARE


4.3 NATAL CARE

The emphasis of the government on timely provision of emergency obstetric and essential obstetric

care and newborn care are the key strategies for natal care. The Twelfth Five Year Plan 2012-17 of

the government envisages to reduce maternal mortality to one per 1000 live births by the end of the

Twelfth Plan. Government is promoting institution based natal care by implementing conditional

cash transfer scheme namely Janani Suraksha Yojna (JSY). Government also implemented Janani

Shishu Suraksha Karykram (JSSK) under the aegis of the NRHM to reduce maternal and infant

mortality.

In RSOC, several questions were asked to eligible respondents on natal care focusing upon whether

she and her family members were advised or counselled to opt for institutional delivery, the place of

delivery, type of provider assisting the delivery. In case the woman opted for institutional delivery,

she was asked about the duration of her stay in the health facility post-delivery. She was also asked

about her awareness of the JSY and JSSK schemes and whether she availed any benefits from these

national flagship schemes.

4.3.1 Place of delivery

The choice of a place of delivery is very crucial in determining the quality of care available to the

mother and her child immediately after birth. In RSOC, mothers who had a live birth in the last three

years preceding the survey were asked about the place of delivery. Table 4.14 presents the percent

distribution of births in the three years preceding the survey by place of delivery and according to

various background characteristics.

MATERNAL HEALTHCARE


Table 4.14: Place of delivery Percent distribution of live births in the three years preceding the survey, by place of delivery and according to selected characteristics, RSOC, 2013-14


Place of delivery

Institutional delivery

Number of live births

Government hospital/

health centre

Private hospital/

clinic/nursing home

Home Other Total

Mother’s age 15-19 57.5 24.4 17.9 0.2 100.0 81.9 1,539 20-24 52.0 30.3 17.3 0.4 100.0 82.3 20,364 25-29 47.3 31.4 21.0 0.3 100.0 78.7 20,861 30-34 42.6 31.5 25.6 0.4 100.0 74.0 8,145 35-49 43.0 25.4 30.7 0.9 100.0 68.4 3,642

Birth order One 48.8 37.7 13.2 0.3 100.0 86.4 25,575 Two 50.0 29.8 19.9 0.3 100.0 79.8 16,502 Three and more 45.3 16.3 37.9 0.5 100.0 61.6 12,473

Residence Urban 42.6 45.9 11.2 0.3 100.0 88.5 16,320 Rural 50.8 23.8 25.0 0.4 100.0 74.6 38,230

Number of ANC visits No ANC 38.1 14.7 46.4 0.7 100.0 52.9 7,918 1-3 51.5 23.9 24.2 0.3 100.0 75.5 21,505 4+ 48.8 41.1 9.8 0.3 100.0 89.9 24,742 Do not know 49.6 27.8 22.0 0.7 100.0 77.3 386

Mother’s education No education 47.3 15.4 36.8 0.5 100.0 62.6 17,616 Below Primary 56.1 15.9 27.4 0.5 100.0 72.1 2,615 Completed Primary 54.7 24.7 20.1 0.4 100.0 79.5 8,351 Completed Middle 57.4 26.7 15.6 0.4 100.0 84.0 8,562 Completed Secondary 47.6 43.6 8.7 0.2 100.0 91.1 7,602 Completed Higher Secondary& above

35.5 59.1 5.2 0.2 100.0

94.6 9,805

Social-group Scheduled Caste 55.2 20.8 23.5 0.5 100.0 76.0 10,976 Scheduled Tribe 52.8 17.3 29.7 0.3 100.0 70.1 6,311 Other Backward Class 46.3 32.9 20.4 0.4 100.0 79.2 21,886 Other 44.4 39.8 15.5 0.3 100.0 84.2 14,828 Do not know 44.5 19.8 35.4 0.3 100.0 64.3 550

Wealth index Lowest 51.5 9.3 38.5 0.7 100.0 60.8 10,977 Second 54.8 16.8 28.0 0.3 100.0 71.7 11,248 Middle 54.0 27.1 18.5 0.3 100.0 81.1 11,213 Fourth 46.8 41.5 11.4 0.3 100.0 88.3 11,092 Highest 32.9 60.1 6.7 0.3 100.0 93.0 10,020

Total 48.3 30.4 20.9 0.4 100.0 78.7 54,550

MATERNAL HEALTHCARE


Overall, more than three-fourth (79 percent) deliveries were in a health institution (covering both

government and private). Thus, according to the findings of RSOC one-fifth of births occurred at

home in contrast to about half of deliveries taking place at home as per DLHS 2007-08.The births in

health institutions show utilization of government hospital/health centres was close to half (48

percent) and another one-third (30 percent) availed facilities of privately-run hospitals, clinics or

nursing homes. Women from urban areas are more likely to deliver in a health institution than their

counterparts in the rural areas. Three-fourth of the births in the rural areas and 89 percent of the

births in the urban areas were delivered in a health facility. It is also seen that there is a gradual

decrease in proportion of deliveries in health institutions with the increase in age of the mother.

While eight among every ten births to mothers in the age group 15-29 years were in a health facility,

in comparison, close to seven out of every ten births to mothers in the age group 30-49 years were

institutional delivery.

MATERNAL HEALTHCARE


Figure 4.4: Percentage of births in a health institution as per RSOC 2013-14 and DLHS 2007-08

Figure 4.4 presents comparison of institutional

delivery as per RSOC 2013-14 and DLHS 2007-08.

As per Figure 4.4 institutional delivery in both

rural and urban areas have significantly

improved; increasing by 37 percentage points in

rural areas and 19 percentage points in the

urban areas.

Figure 4.5: Institutional delivery among different social groups, as per RSOC 2013-14 and DLHS 2007-08

Figure 4.5 presents

comparison of institutional

delivery among different

social groups as per RSOC

and DLHS 2007-08. It is

observed that more

institutional deliveries

occurred in 2013-14 since

the DLHS held in 2007-08, to mothers from the vulnerable groups like SC and ST.

Figure 4.6 presents percentage of institutional delivery among different wealth quintile groups, as

per RSOC 2013-14 and DLHS 2007-08.

Figure 4.6: Percentage of institutional delivery among different wealth quintile groups, as per RSOC 2013-14 and DLHS 2007-08

Improvement vis-a-vis 2007-08

in proportion of births being

delivered in health institutions

is seen in 20013-14 across all

wealth quintile groups, as per

the Figure 4.6. However,

significant improvement is

seen among the mothers from

families in the lower quintiles.

In the first three quintiles, (Q1 to Q3) improvement is more than 40 percentage points with respect

to that in 2007-08 and in the fourth quintile, improvement is little more than 30 percentage points.

Differential between poorest and richest is still very large.

75

38

89

70

RSOC 2013-14

DLHS 2007-08

Urban Rural

42 33

48 59

76 70 79 84

Scheduled Caste Scheduled Tribe Other BackwardClass

Other

DLHS 2007-08 RSOC 2013-04

61 72

81 88 93

19 29

42

58 80

Lowest Second Middle Fourth Highest

RSOC DLHS 2007-08

MATERNAL HEALTHCARE


4.3.2 Assistance during delivery and safe delivery36

The RCH programme under NRHM emphasized for safe deliveries conducted by a trained/skilled

birth attendant or a health professional, even if delivered at home. Obstetric care from a trained

provider during delivery is recognized as critical for the reduction of maternal and neonatal mortality

as well as morbidity. In RSOC, 2013-14 a question was asked about who assisted in delivery, to all

eligible respondents.

Among the live births in the three years preceding the survey, type of assistance during delivery, is

presented in Table 4.15. Assistance by a doctor is seen in more than half of the births (55 percent),

in another 27 percent births LHV/nurse or an ANM assisted during delivery. Little less than a tenth (8

percent) deliveries were assisted by traditional birth attendants and similar proportion (9 percent)

was assisted by friends and relatives. Overall, close to four-fifth of the deliveries (81 percent) were

conducted by a doctor or a skilled provider. However, percentage of deliveries (71 percent) assisted

by a doctor or any trained provider was relatively lower among mother in the age group of 35-49

years in comparison to the younger mothers (more than 80 percent) in the age group of 15-29 years.

As per DLHS 2007-08, close to half of the deliveries were safe. This clearly reflects that there is an

overall improvement in the situation of safe delivery in the country. It is noted from Table 4.15 that

around 11 percent of the home deliveries were attended by a doctor or other skilled health

providers.

Safe deliveries or deliveries assisted by skilled health providers (doctors, nurses, LHVs and ANM) in

2013-14 were more likely in the urban areas (90 percent) than in the rural areas (77 percent). As per

DLHS 2007-08, safe delivery among the urban women was 76 percent and 43 percent among the

rural women.

Level of education of the mother and economic condition of the household significantly affect the

place of delivery as well as the person who assisted in the delivery. While 66 percent of births to

mothers with no education delivered in a health institution or were assisted by a trained health

provider, close to 96 percent of births to mothers who completed higher secondary or above level of

education were delivered by a skilled health provider. In fact, a majority (76 percent) of the births to

mothers were assisted by a doctor during delivery. Similarly, in comparison to 64 percent births in

the household from the lowest wealth quintile, 95 percent of births in the household from the

highest quintile were assisted by a skilled health provider. Among religious groups more births from

the Sikh (86 percent), Buddhist (91 percent), and Hindu (83 percent) households were reported to

have received assistance of a skilled health provider than births in the Muslim community (73

percent).

36 Safe delivery means delivery conducted by doctors, nurses, LHVs and ANM.

MATERNAL HEALTHCARE


Table 4.15: Type of assistance during delivery by background characteristics Among the live births in the three years preceding the survey, percent distribution of births, delivered by different heath providers and delivered by a skilled health provider according to selected characteristics, RSOC, 2013-14

Background Characteristics

Percentage of births delivered by Delivered by a

skilled health

provider37

Number of births Doctor

ANM/Midwife/LHV/Nu

rse

Trained birth

attendant

Friends/ Relatives/

Family members

Other No one

Mother’s age 15-19 53.1 30.9 4.6 7.8 2.6 0.9 84.1 1,539 20-24 56.5 28.1 6.5 7.1 1.6 0.3 84.5 20,364 25-29 55.6 25.5 8.1 8.7 1.6 0.5 81.1 20,861 30-34 52.1 24.5 9.2 11.3 2.1 0.7 76.6 8,145 35-49 45.6 25.5 10.8 14.9 2.2 1.1 71.0 3,642

Birth order 1 63.9 24.4 5.3 5.2 1.0 0.3 88.3 25,575 2 55.3 26.7 7.6 8.2 1.7 0.4 82.1 16,502 3+ 34.7 30.4 12.9 17.3 3.5 1.1 65.1 12,473

Residence Urban 70.1 20.1 4.7 3.9 0.9 0.3 90.2 16,320 Rural 48.1 29.2 9.0 11.0 2.1 0.6 77.2 38,230

Number of ANC visits No ANC 30.1 26.0 14.8 24.0 3.6 1.5 56.1 7,918 1-3 47.3 31.2 9.8 9.2 2.0 0.6 78.5 21,505 4+ 68.9 22.5 3.7 3.7 0.9 0.2 91.4 24,742 Do not know 57.0 21.9 7.0 11.7 2.0 0.3 78.9 386

Mother’s education No education 37.5 28.4 13.4 16.7 2.9 1.0 65.9 17,616 Below Primary 45.6 29.5 11.4 10.2 2.5 0.7 75.1 2,615 Completed Primary 54.0 28.3 7.2 8.3 1.8 0.4 82.3 8,351 Completed Middle 55.1 31.1 5.8 6.0 1.7 0.3 86.2 8,562 Completed Secondary 70.1 22.7 3.5 3.1 0.5 0.2 92.7 7,602 Completed Higher Secondary & above

76.1 19.5 2.0 1.9 0.5 0.1 95.5 9,805

Social-group Scheduled Caste 48.2 30.6 8.7 9.9 2.0 0.5 78.8 10,976 Scheduled Tribe 47.8 24.9 9.4 14.2 2.0 1.6 72.7 6,311 Other Backward Class 53.7 27.9 7.9 8.3 1.8 0.4 81.6 21,886 Other 63.8 22.2 6.1 6.6 1.1 0.2 86.1 14,828 Do not know 50.0 18.9 9.5 11.9 8.4 1.4 68.8 550

Wealth index Lowest 32.2 31.9 14.0 17.8 2.8 1.3 64.1 10,977 Second 45.5 29.1 9.9 12.3 2.6 0.6 74.6 11,248 Middle 55.9 27.6 6.7 7.5 1.8 0.4 83.5 11,213 Fourth 66.6 23.4 4.7 4.0 1.0 0.3 90.0 11,092 Highest 74.8 19.7 2.9 2.2 0.4 0.0 94.5 10,020

Place of delivery Institutional 67.7 32.3 0.0 0.0 0.0 0.0 100 42,951 Home 6.2 4.4 36.8 41.9 8.3 2.4 10.6 11,391 Other 17.1 23.5 11.2 32.6 6.8 8.8 40.6 208

Total 54.6 26.5 7.7 8.9 1.8 0.5 81.1 54,550

37 Doctors, nurses, LHVs and ANM are considered as skilled providers.

MATERNAL HEALTHCARE


Deliveries assisted by skilled health providers were found to be inversely proportional to the birth

order. Mothers delivering for the third or more times were less likely to receive assistance of skilled

health provider than the mothers delivering for the first or second time. Close to 65 percent of births

to mothers delivering for the third or more time were assisted by an unskilled health provider

whereas more than 80 percent of the births to mothers delivering for first or second time, were

assisted by a skilled health provider.

Figure 4.7 presents percentage of births delivered by unskilled persons according to age of mother.

It is observed that deliveries by un-skilled health providers are common among mothers of an older

age. A significant proportion of births (between 23-28 percent) to mothers in the age group 30-49

were delivered by TBAs,38 friends, relatives and others. In one-fifth of the births to mothers in age

group (30-49), the deliveries were assisted by TBAs and another one-fourth births were delivered by

other unskilled providers.

Figure 4.7: Percentage of non-institutional births delivered by unskilled persons according to age of mother

Institutional delivery and safe delivery by states

Table 4.16 presents state wise percentage of institutional deliveries and those assisted by a skilled

health provider. Proportion of institutional delivery varied from cent percent in Goa to 19 percent in

Nagaland. In 14 states, level of institutional delivery is more than the national average (79 percent).

In 13 states more than 81 percent of the deliveries were assisted by skilled health providers. In

almost all states except Nagaland, level of institutional delivery was above 55 percent which was the

national average of institutional delivery, as per DLHS 2007-08.

38 TBA: Trained birth attendant

5 7 8 9 11

8 7 9 11

15

3 2 2 2 2

15 15 19

23 28

15-19 20-24 25-29 30-34 35-49

Trained birth attendant Friends/Relatives/Family members

Other Unsafe delivery

MATERNAL HEALTHCARE


Table 4.16: Institutional and safe delivery

Among the live births in the three years preceding the survey, percentage delivered in a health institution, percentage delivered by skilled health providers, according to states, RSOC 2013-14

States Institutional

delivery Delivered by a skilled

health provider

India 78.7 81.1

North Delhi 83.4 85.5 Haryana 76.4 78.6 Himachal Pradesh 68.7 71.6 Jammu & Kashmir 72.9 74.9 Punjab 80.4 85.4 Uttar Pradesh 62.1 65.1 Uttarakhand 68.5 69.8

Central Chhattisgarh 56.1 64.2 Madhya Pradesh 78.1 79.0

East Bihar 65.3 68.4 Jharkhand 56.6 61.0 Odisha 81.3 83.7 West Bengal 76.3 78.9

North East Arunachal Pradesh 63.7 65.4 Assam 74.2 74.9 Manipur 68.5 73.5 Meghalaya 66.5 68.6 Mizoram 94.1 96.0 Nagaland 18.6 20.5 Sikkim 86.6 87.8 Tripura 79.5 80.4

West Rajasthan 82.7 85.8 Goa 99.5 99.6 Gujarat 87.9 89.6 Maharashtra 90.3 93.0

South Andhra Pradesh 91.1 93.3 Karnataka 92.0 92.6 Kerala 99.4 99.5 Tamil Nadu 99.3 99.5

In all southern states, most deliveries (more than 90 percent) were assisted by skilled health

providers.

MATERNAL HEALTHCARE


4.3.3 Advice/counselling on place of delivery

The health workers/providers as part of their job responsibilities are required to provide advisory

and counselling services to the pregnant woman and her family on issues of birth preparedness

which mainly includes information on the choice of place of delivery and care of newborn and the

mother. As part of birth preparedness the health care workers impresses upon the pregnant woman

and her family to opt for institutional delivery. Survey collected information from eligible ever

married women who had a live birth in three years preceding the survey, in a health institution,

about who advised them to take this decision. Since, more than one person could have motivated

the women to deliver in a health institution, the total responses would not add up to cent percent in

Table 4.17 which presents advice or counselling received from health providers for institutional

delivery according to various background characteristics. Such information would be of critical

importance in building health related communication strategy.

Overall, family/relatives are seen to be the major advisor/counsellor for delivering in health

institutions. A small proportion was advised by ASHA, followed by AWW and ANM, in that order.

Overall, in 56 percent of the institutional births, family/relatives counselled the mother to deliver in

a health facility. This is more or less true of all age groups of mother. More mothers living in the

urban areas (64 percent) reported to have been motivated by their relatives and friends than the

mothers living in the rural areas (52 percent). In around one-fourth (23 percent) of the births,

mother reported to have been influenced by ASHA, a village level worker; other counsellors were

AWW (in 16 percent cases) and ANM (in 12 percent cases).

Among the rural mothers and in the poorest families delivering in a health facility, ASHA seems to be

a prime advisor (31 percent in rural areas; 42 percent amongst the poorest families). ASHA is also

seen to have advised significant proportion of mothers (delivering in a health facility) with no

education (35 percent) and mothers with below primary level education (36 percent); mothers

belonging to ST (32 percent) and SC families (29 percent).

MATERNAL HEALTHCARE


Table 4.17: Persons advised/counselled for Institutional deliveries Among the live birth in the three years preceding the survey, percentage of institutional births, whose mothers were advised or counselled to deliver in a health facility, according to background characteristics, India, RSOC, 2013-14

Background Characteristics

Advice/counselling received from heath providers to deliver at a health facility Number of

institutional births AWW ANM ASHA

Any other health

professional

Family/ Relatives/

Other

Self/ No one

Mothers Age

15-19 17.0 15.2 27.0 13.1 58.5 9.9 1,261 20-24 17.8 13.8 23.3 7.7 56.3 13.2 16,752 25-29 15.5 11.7 22.1 7.1 55.8 14.9 16,416 30-34 15.1 10.5 22.3 5.7 57.3 15.5 6,031 35-49 17.4 11.3 26.4 6.6 51.4 14.9 2,492

Birth order One 15.9 12.6 19.4 8.0 57.4 15.2 22,104 Two 17.1 12.7 22.8 7.2 54.9 14.7 13,165 Three and more 17.3 11.3 33.7 5.6 54.1 10.4 7,683


Number of ANC visits No ANC 14.2 7.0 30.4 3.8 54.4 11.4 4,186 1-3 18.4 11.6 29.6 6.7 54.9 10.7 16,232 4+ 15.6 14.1 16.9 8.4 57.2 17.1 22,235 Do not know 11.3 7.0 15.0 6.1 52.5 24.3 298

Mother education No education 20.6 12.7 34.7 5.7 52.1 9.1 11,030 Below Primary 21.2 15.2 36.2 9.0 53.5 7.1 1,885 Completed Primary 18.4 13.8 25.3 8.7 53.5 13.0 6,638 Completed Middle 15.2 12.9 23.1 8.2 58.4 12.4 7,195 Completed Secondary 15.7 13.5 15.4 7.3 57.3 17.6 6,928 Completed Higher Secondary& above

11.0 9.4 10.4 7.2 60.2 21.3 9,275

Social-group Scheduled Caste 18.5 14.0 29.1 7.4 53.3 11.5 8,343 Scheduled Tribe 27.5 16.5 31.7 6.5 45.2 13.6 4,422 Other Backward Class 15.1 12.1 22.0 6.0 56.2 14.9 17,342 Other 13.4 10.4 17.2 9.2 61.2 15.3 12,491 Do not know 13.2 12.1 24.0 12.5 62.8 9.5 354

Wealth index Lowest 22.2 13.0 41.9 5.7 45.0 7.8 6,674 Second 20.1 14.4 34.2 6.4 50.4 10.4 8,061 Middle 18.4 15.3 24.0 7.5 55.2 13.2 9,099 Fourth 14.6 13.3 14.1 7.9 59.7 17.0 9,796 Highest 9.6 6.6 8.1 8.5 65.8 20.0 9,320

Place of delivery Government hospital/health centre

21.2 14.9 33.0 6.4 51.4 9.9 26,369

Private hospital/clinic/nursing home

9.1 8.5 7.1 8.7 63.3 21.1 16,582

Total 16.5 12.4 23.0 7.3 56.0 14.2 42,951

MATERNAL HEALTHCARE


AWWs also counselled significant proportion of mothers for delivering in a health institution. In little

more than one-fifth of the births, mothers from the poor families (lowest 22 percent) and second

quintile (20 percent) counselled for institutional delivery. However, in relatively less proportion

births, mothers reported that ANM had counselled them for institutional delivery.

4.3.4 Type of delivery

In RSOC, 2013-14 information was collected from eligible EMW on type of delivery as per normal,

caesarean and others39 for live births in the three years preceding the survey. Table 4.18 presents

percent distribution of births by type of delivery and according to selected characteristics. At the

national level, more than four out of every five deliveries (83 percent) were normal while a little less

than one out of every five births (16 percent) were delivered by caesarean section. As per NFHS

2005-06, close to 9 percent of births were delivered by caesarean section. Clearly, since 2005-06,

there has been an increase in the proportion of deliveries by caesarean section.

A higher proportion of mothers (86 percent) residing in the rural areas reported normal delivery in

comparison to mothers (75 percent) living in urban areas. Relatively higher proportion of the

mothers (21 percent) delivering for the first time (birth order one) delivered by caesarean section

than those who were delivering for second or more times. Both, the level of education of the mother

and the economic condition of the household are inversely proportional to the proportion of births

delivered by normal delivery. More proportion of mothers with higher level of education underwent

caesarean section than mothers with lower level of education. In a third of the births (31 percent),

mother who completed higher secondary or above level of education delivered by caesarean section

in contrast to 7 percent births delivered by caesarean section to mothers with no education.

Similarly, in five percent of the births from households in the lowest wealth quintile, mothers

reported undergoing caesarean section in comparison to 30 percent mothers from households with

the highest wealth index.

39 Others would include assisted, forceps methods etc.

MATERNAL HEALTHCARE


Table 4.18: Type of delivery Percent distribution of births in the three years preceding the survey by type of delivery, according to selected background characteristics, RSOC, 2013-14

Background characteristics Type of delivery Number of

births Normal Caesarean Other methods Total

Mother’s age

15-19 84.7 13.4 1.9 100.0 1,539

20-24 83.3 16.0 0.7 100.0 20,364

25-29 82.2 17.4 0.5 100.0 20,861

30-34 82.3 17.2 0.5 100.0 8,145

35-49 86.2 13.3 0.5 100.0 3,642

Birth order

One 77.9 21.4 0.7 100.0 25,575

Two 82.1 17.2 0.6 100.0 16,502

Three and more 94.3 5.3 0.4 100.0 12,473

Residence

Urban 74.8 24.7 0.4 100.0 16,320

Rural 86.4 12.9 0.7 100.0 38,230

Mother's education

No education 92.3 7.1 0.6 100.0 17,616

Below Primary 88.8 10.2 1.0 100.0 2,615

Completed Primary 84.3 14.9 0.8 100.0 8,351

Completed Middle 83.6 15.8 0.6 100.0 8,562

Completed Secondary 75.9 23.5 0.7 100.0 7,602

Completed Higher Secondary &

above 68.4 31.2 0.4

100.0 9,805

Social-group

Scheduled Caste 85.9 13.6 0.5 100.0 10,976

Scheduled Tribe 91.6 8.1 0.3 100.0 6,311

Other Backward Class 82.0 17.4 0.6 100.0 21,886

Other 78.5 20.7 0.8 100.0 14,828

Do not know 82.6 15.6 1.9 100.0 550

Wealth index

Lowest 94.2 5.2 0.6 100.0 10,977

Second 89.5 9.8 0.6 100.0 11,248

Middle 83.0 16.1 0.9 100.0 11,213

Fourth 76.7 22.8 0.5 100.0 11,092

Highest 70.1 29.5 0.4 100.0 10,020

Place of delivery

Government hospital/Health

centre 87.5 11.7 0.7

100.0 26,369

Private hospital/Clinic/Nursing

home 64.2 35.4 0.4

100.0 16,582

At home 99.4 0.0 0.6 100.0 11,391

Other 97.8 0.0 2.2 100.0 208

Total 83.0 16.4 0.6 100.0 54,550

MATERNAL HEALTHCARE


Figure 4.8 presents state wise percentage of live birth in the last three years preceding the survey,

by type of delivery. It is observed that more than one-fourth of the births in the states of Andhra

Pradesh (37 percent), Tamil Nadu (33 percent), Goa (32 percent), Kerala (28 percent), Punjab (26

percent) and Jammu & Kashmir (26 percent) were delivered by caesarean section. States having

higher proportion of institutional delivery seem to have higher proportion of caesarean section.

Figure 4.8: Percentage of women by type of delivery,40

state wise, RSOC, 2013-14

4.3.5 Duration of stay at health facility in case of institutional delivery

The first 48 hours after delivery, vital for detecting any complications and its immediate

management is critical for survival of both the mother and the child. Therefore as per the

programme of the government, mothers are advised to stay up to 48 hours after delivery in the

healthcare facility if the delivery is normal.

On an average, in around three-fifth (58 percent) of the institutional deliveries, mothers stayed in

the facility for 48 hours or more, in another 21 percent, stay was less than 12 hours; in around 6

percent stay was between 12-23 hours and in close to 16 percent, stay in the facility was between

24-47 hours. However, in deliveries by C-section, in 93 percentage of the births, mothers stayed in

the health institution for 48 hours or more. Mothers living in urban areas stayed longer in the health

facility after delivery than mothers from the rural areas. Staying in the facility for 48 hours or more

after delivery among urban mothers was close to 70 percent, in comparison to 52 percent for

mothers from the rural areas. Quite clearly in around two-fifth of births, stay of the mother in the

health facility was less than the recommended number of hours and thus such mothers were

exposed to the risk of mortality and morbidity.

40 C-Section = Caesarean section

37 33 32

28 26 26 23 22 20 20 17 16 16 15 15 14 14 13 11 11 10 9 9 8 8 6 5 5 2 1

63 67 68

72 73 73 75 77 80 80 83 83 84 84 85 86 85 86 89 88 89 90 91 91 92 92 95 95 98 99

An

dh

ra P

rad

esh

Tam

il N

adu

Go

a

Ke

rala

Pu

nja

b

Jam

mu

& K

ash

mir

We

st B

en

gal

Kar

nat

aka

Man

ipu

r

Sikk

im

Mah

aras

htr

a

Ind

ia

De

lhi

Him

ach

al P

rad

esh

Utt

arak

han

d

Gu

jara

t

Trip

ura

Har

yan

a

Od

ish

a

Ass

am

Ch

hat

tisg

arh

Raj

asth

an

Jhar

khan

d

Mad

hya

Pra

des

h

Utt

ar P

rad

esh

Bih

ar

Miz

ora

m

Me

ghal

aya

Aru

nac

hal

Pra

de

sh

Nag

alan

d

C-Section Delivery Normal Delivery

MATERNAL HEALTHCARE


Table 4.19: Duration of stay at health facility (for institutional births) Among the live birth in the three years preceding the survey, percent distribution of births delivered in a health facility by duration of stay of the mother and according to selected background characteristics, RSOC, 2013-14


Percentage of births for which

mother stayed at the health

facility after delivery (in hours)

Do

not

know

Total

Number of

Institutional

births <12 12-23 24-47

48 or

more

Mother’s age

15-19 24.1 8.7 16.3 50.7 0.2 100.0 1,261

20-24 19.7 5.7 16.2 58.0 0.4 100.0 16,752

25-29 20.5 5.2 14.8 59.0 0.5 100.0 16,416

30-34 21.0 5.0 15.7 57.5 0.8 100.0 6,031

35-49 24.6 5.7 15.4 53.3 0.9 100.0 2,492

Residence

Urban 11.7 3.7 13.9 70.2 0.4 100.0 14,446

Rural 25.1 6.4 16.4 51.5 0.5 100.0 28,505


No education 32.3 7.6 17.7 41.7 0.8 100.0 11,030

Below primary 31.5 7.7 16.3 44.1 0.4 100.0 1,885

Completed primary 19.6 6.1 17.3 56.5 0.5 100.0 6,638

Completed middle 19.3 5.9 16.0 58.4 0.4 100.0 7,195

Completed secondary 12.8 4.1 14.4 68.4 0.3 100.0 6,928

Completed higher secondary &

above 12.1 3.0 12.1 72.3 0.4

100.0 9,275

Social-group

Scheduled Caste 25.4 6.1 14.0 54.1 0.4 100.0 8,343

Scheduled Tribe 17.0 7.5 19.8 55.1 0.6 100.0 4,422

Other Backwards Class 22.0 4.9 13.8 58.8 0.6 100.0 17,342

Other 16.8 5.4 17.3 60.1 0.4 100.0 12,491

Do not know 23.1 4.5 19.6 52.6 0.2 100.0 354

Wealth index

Lowest 32.9 9.4 17.8 39.1 0.8 100.0 6,674

Second 27.9 7.1 15.9 48.5 0.5 100.0 8,061

Middle 20.4 5.4 16.7 57.1 0.5 100.0 9,099

Fourth 14.2 4.1 14.3 67.1 0.4 100.0 9,796

Highest 12.6 3.1 13.9 70.1 0.3 100.0 9,320

Place of delivery

Government hospital/health centre 25.5 6.7 16.0 51.2 0.6 100.0 26,369

Private hospital/clinic/nursing home 12.9 3.6 14.8 68.3 0.3 100.0 16,582

Type of delivery

Normal 25.6 6.3 19.1 48.5 0.5 100.0 33,724

Caesarean 1.9 2.4 2.1 93.3 0.3 100.0 8,968

Other 21.2 16.7 20.3 40.9 0.9 100.0 260

Total 20.6 5.5 15.5 57.8 0.5 100.0 42,951

MATERNAL HEALTHCARE


The duration of stay in the health facility after delivery shows a strong relationship with women’s

education, the type of delivery, place of delivery and the economic status of the household she

belonged to. As seen from Table 4.19, proportion of mothers staying for 48 hours or more after

delivery gradually increases with increase in the level of education. Little less than three-fourth (72

percent) of the births, mothers who completed higher secondary or above stayed for 48 hours and

more in the health facility in comparison to the mothers with no education (42 percent).

Women delivering in a government run health facility are more likely to leave health facility earlier

than those delivering in a private facility. In around a fourth of the institutional deliveries (26

percent), mothers delivering in a government hospital/health centre stayed for less than 12 hours

after delivery, in comparison to 13 percent of the mothers delivering in a private healthcare facility.

More mothers delivering in private institutions (68 percent) stayed for two or more days in the

facility after delivery in comparison to the mothers delivering in government health facilities (51

percent). Another trend that is emerging from the analysis is that mothers from poor households

leave health facilities earlier than those from the rich families. In significant proportion of

institutional deliveries, mothers from households in the highest wealth quintile (71 percent) stayed

for 48 and more hours in the health facilities in comparison to mothers from the households

belonging to the lowest wealth quintile (39 percent).

4.3.6 Stay in a health facility after delivery by states

Table 4.20 presents state wise duration of stay in the health facility after delivery. Proportion of

mothers delivering in a health facility (government and private) and staying in the health facility for

48 or more hours after delivery varied significantly among the states. Goa has the highest

percentage of the institutional births (95 percent) and Nagaland has the lowest percentage (7

percent) whose mothers stayed in the facility for 48 hours or more. In 19 states, proportion of

institutional deliveries where mothers stayed for 48 or more hours after delivery was less than that

of the national average (58 percent). In significant proportion of deliveries in facilities, mothers in

many states, stayed for less than 12 hours in the facility. In more than two-fifth of the institutional

deliveries, mothers stayed for less than 12 hours in the health facility in states of Bihar (69 percent),

Arunachal Pradesh (54 percent), Uttar Pradesh (50 percent), Nagaland (48 percent), Assam (42

percent) and Odisha (40 percent).

MATERNAL HEALTHCARE


Table 4.20: Duration of stay at health facility after institutional delivery by states Among the live birth in the three years preceding the survey and delivered in a health facility, percentage whose mothers stayed in the health facility for less than 12 hours and for 48 hours or more, , according to state, RSOC, 2013-14

State

Percentage of institutional births whose mothers stayed at health facility after delivery

For less than 12 hours For 48 or more hours

India 20.6 57.8

North

Delhi 9.3 69.1 Haryana 34.2 33.8 Himachal Pradesh 10.3 55.7 Jammu & Kashmir 13.2 57.8 Punjab 21.5 53.3 Uttar Pradesh 49.6 26.0 Uttarakhand 17.4 51.1

Central Chhattisgarh 21.2 56.8 Madhya Pradesh 5.4 72.2

East Bihar 69.1 8.6 Jharkhand 22.6 39.3 Odisha 40.0 23.6 West Bengal 27.9 46.0

Northeast Arunachal Pradesh 53.8 10.1 Assam 42.3 25.4 Manipur 28.1 39.3 Meghalaya 18.8 25.7 Mizoram 18.1 14.4 Nagaland 47.5 6.8 Sikkim 11.0 52.6 Tripura 2.7 53.4

West Rajasthan 15.4 67.3 Goa 1.5 94.9 Gujarat 11.4 51.0 Maharashtra 3.7 80.9

South Andhra Pradesh 3.2 80.7 Karnataka 3.9 79.0 Kerala 2.0 92.9 Tamil Nadu 1.1 94.4

In terms of postnatal care, in Goa, Tamil Nadu and Kerala, over 90 percent of the women reported

that they stayed in the health facility for 48 hours or more after delivery.

MATERNAL HEALTHCARE


4.3.7 Awareness and utilization of JSY and JSSK schemes

Janani Suraksha Yojna (JSY), launched in 2005 under the then National Rural Health Mission (NRHM)

is a conditional cash transfer scheme promoting safe motherhood intervention. It is implemented

with the objective of reducing maternal and neonatal mortality by promoting institutional delivery

among poor and vulnerable pregnant women. The scheme is being implemented in all states and

Union Territories (UTs).

Government of India also launched the Janani Shishu Suraksha Karyakaram (JSSK) in 2011 to provide

completely free and cashless services to pregnant women to deliver in an institution including

caesarean section delivery and cost of hospitalization of sick new born (up to 30 days after birth) in

government health institutions in both rural and urban areas. The scheme is implemented in all

states and UTs. It is to be noted that a pregnant women can access benefits of either or both

schemes.

In RSOC, women who had a live birth in the three years preceding the survey were asked about their

awareness about each of these schemes (JSY and JSSK). In addition the women were also asked

whether they availed assistance provided under the two schemes: (1) availed benefits of JSY (2)

availed benefits of JSSK (3) availed benefits from JSY and JSSK and (4) not availed any benefit from

any of the schemes.

Findings from the survey are presented in Table 4.21 showing the level of awareness and utilization

of JSY and JSSK among the women who had a live birth in the three years preceding the survey by

various background characteristics. In seven out of every ten women (71 percent) were aware about

JSY; 43 percent of the women were aware of JSSK. Cumulatively in close to three-fourth of the

women (74 percent) were aware about either JSY or JSSK and 40 percent were aware about both the

schemes. Though awareness about JSY is more than that of JSSK, yet more effective steps are

required to further enhance awareness about JSY, considering that the scheme has been under

implementation since 2005. Additionally, level of awareness about JSY was moderate among the

women from the SC (75 percent) and the ST (70 percent) families, though the scheme has special

provisions for such women under the scheme.

MATERNAL HEALTHCARE


Table 4.21: Awareness and benefits from JSY and JSSK Among women who had a live birth in the three years preceding the survey, percentage aware about JSY and JSSK and out of those who were aware about the scheme, percentage who received benefits under these schemes, according to selected characteristics of women, RSOC, 2013-14


Percentage of women aware about Out of those who were aware about the

scheme, percentage availed benefits

JSY JSSK Either JSY or JSSK

Both JSY and JSSK

Number of women

JSY JSSK Either JSY or JSSK

Both JSY and JSSK

Number of women

aware of JSY or JSSK

Mother's age 15-19 74.1 42.3 77.1 39.2 1,539 49.0 17.7 57.2 9.5 1,187 20-24 72.5 44.7 75.8 41.5 20,364 50.8 16.1 58.2 8.7 15,438 25-29 70.4 42.8 73.8 39.4 20,861 46.5 13.6 52.6 7.4 15,393 30-34 68.4 40.1 71.5 37.0 8,145 44.4 10.2 48.2 6.4 5,824 35-39 68.9 38.4 72.3 35.0 3,642 43.3 10.9 47.2 7.1 2,632

Residence Urban 62.9 43.4 67.0 39.4 16,320 36.6 13.6 43.6 6.5 10,928 Rural 74.3 42.6 77.3 39.6 38,230 51.8 14.2 57.7 8.3 29,546

Mother's education No education 70.8 35.2 73.8 32.2 17,616 50.4 11.7 54.8 7.2 12,992 Below Primary 77.1 42.2 79.8 39.5 2,615 51.4 15.4 57.4 9.4 2,086 Completed Primary 71.9 44.2 75.9 40.2 8,351 52.4 15.3 58.9 8.8 6,337 Completed Middle 74.9 45.9 77.3 43.5 8,562 52.5 14.6 59.3 7.8 6,619 Completed Secondary

68.4 48.4 72.4 44.4 7,602 43.3 17.1 52.7 7.7 5,506

Completed Higher Secondary & above 67.0 48.5 70.7 44.8 9,805 36.1 14.0 42.4 7.7 6,934

Social - Group Scheduled Caste 74.8 43.9 77.7 41.0 10,976 54.5 15.2 60.1 9.6 8,523 Scheduled Tribe 69.7 42.1 72.3 39.5 6,311 54.7 16.1 62.4 8.4 4,561 OBC 72.4 42.7 75.8 39.2 21,886 47.7 12.8 53.1 7.3 16,598 Other 65.8 42.3 69.7 38.4 14,828 39.4 14.2 46.7 7.0 10,331 No Response 82.7 51.7 83.7 50.7 550 38.8 12.6 45.8 5.6 460

Wealth Quintile Lowest 73.3 34.7 75.9 32.0 10,977 54.3 11.6 58.8 7.1 8,336 Second 72.5 41.0 75.6 37.9 11,248 53.9 14.0 59.9 8.0 8,499 Middle 73.2 45.8 76.3 42.8 11,213 52.6 17.4 60.0 9.9 8,551 Fourth 69.1 46.2 73.1 42.2 11,092 42.9 15.6 50.6 7.9 8,106 Highest 65.9 46.8 69.7 42.9 10,020 31.9 11.0 37.1 5.8 6,983

Place of delivery Government Hospital

81.3 49.2 84.0 46.5 26,369 71.8 18.7 78.9 11.6 22,148

Private Hospital 60.0 41.0 64.5 36.5 16,582 20.1 11.0 27.1 4.0 10,694 Home 62.8 30.9 65.7 27.9 11,391 16.1 4.7 18.7 2.1 7,489 Other 66.9 35.9 68.4 34.3 208 30.1 9.9 34.9 5.1 142

Total 70.9 42.8 74.2 39.5 54,550 47.7 14.0 53.9 7.8 40,474

MATERNAL HEALTHCARE


With regards to utilization of the benefits of both JSY and JSSK, it is below the awareness level.

Overall in little more than half of the births (54 percent) mothers availed benefits from either JSY or

JSSK scheme. Utilization of benefits from both the schemes was higher among mothers from the ST,

the SC families than those from OBC and Other category families. Close to 60 percentage of the

women from the lowest and the second lowest quintiles availed assistance from either JSY or JSSK. It

is also observed that more women (80 percent) delivering in a government-run health facility availed

benefits from either of the schemes than those women (27 percent) delivering in a private hospital.

Less than a tenth of the women (8 percent) availed benefits of both schemes.

Awareness about JSY and JSSK by states

Figure 4.9 presents state wise the awareness level about JSY and JSSK schemes. In 15 states, level of

awareness is lower than that of the national average.

Figure 4.9: Level of awareness about JSY and JSSK scheme among the mothers, statewise

4.3.8 Availing benefits of JSY and JSSK by states

Statewise percentage of mothers who availed benefits under JSY or/and JSSK scheme has been

presented in Table 4.22. While the overall utilization of JSY was 48 percent, however, in around 54

percent, women either availed JSY or JSSK benefits. In states namely Mizoram (86 percent) and

Odisha (78 percent) more than three-fourth of the women reported to have availed benefits from

either of the schemes. More than sixty percent of the women from Assam (72 percent), Rajasthan

(69 percent), Tamil Nadu (69 percent), Madhya Pradesh (66 percent), Meghalaya (65 percent,

Tripura (61 percent) and Karnataka (65 percent) availed either JSY or JSSK benefits.

Among the two schemes on safe motherhood, awareness as well as utilization of benefits from the

JSY were more than JSSK. In five states namely Mizoram (86 percent), Odisha (78 percent), Assam

(71 percent), Rajasthan (64 percent) and Madhya Pradesh (66 percent) more than two-third of the

women reported to have availed assistance under JSY. However, level of utilization of JSY benefits is

69

57 53 50 50 50 49 49 48 48 47 47 46

40 40 40 38 37 37 35 35 34 34 33 29 27 26 26 25 17

Ass

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MATERNAL HEALTHCARE


below the national average (48 percent) in 16 states. Moreover, in 18 states, less than half of the

women availed benefits of JSY.

On the other hand, utilization of JSSK scheme is low. Overall in around 14 percent women availed

benefits of JSSK. In 16 states, level of utilization is less than the national average. It varied from less

than one percent in Chhattisgarh to 32 percent in Tamil Nadu. It appears that the scheme is

relatively more popular among the women from the southern states—Tamil Nadu (32 percent),

Andhra Pradesh (23 percent), Karnataka (13 percent) and Kerala (17 percent). There could be many

reasons for the low utilization of this scheme. This survey did not look for the reasons of low

utilization as it was beyond the scope of this survey.

Table 4.22: Utilization of benefits of JSY and JSSK Percentage of women who had a live birth in the last three years preceding the survey, availing benefits of JSY and/or JSSK schemes according to states, RSOC, 2013-14

State

Percentage of women availing benefits under

JSY


JSSK


either JSY or JSSK

Percentage of women availing benefits under both JSY and

JSSK

India 47.7 14.0 53.9 7.8 North






MATERNAL HEALTHCARE


State


JSY


JSSK


either JSY or JSSK

Percentage of women availing benefits under both JSY and

JSSK


4.4 POSTNATAL CARE

The days and weeks following the delivery—the postnatal period—is a critical phase in the lives of

the mother and her child. The quality of care provided at this period and close monitoring of health

of the mother and the child for early detection of danger signs significantly contributes to their well-

being and also survival. Along with prenatal care, quality postnatal care reduces chances of mortality

substantially.

In RSOC 2013-14, several questions on postnatal care (PNC) were asked to the eligible women. As

per the reproductive health policy of the government, basic health service providers like ANM, AWW

and ASHA should visit all the mothers at home after their delivery/discharge from the health facility.

A question EMW was asked to eligible whether AWW, ANM or ASHA visited them at home, after

delivery or discharge from the hospital/health centre within one week of delivery. In addition,

questions were asked, about the time of first PNC, number of check-ups received by the mother and

the newborn within 10 days of delivery and the place of check-ups.

4.4.1 Visit by health care providers after delivery/discharge41 from health facility

After delivery or discharge from health facility, the visitation by a health provider at home has not

been very significant in number in the three years preceding the survey. Overall only about half of

the mothers (51 percent) reported to have been visited by a health care provider

(AWW/ASHA/ANM) within one week of delivery or discharge. among women who had live births in

the three years preceding the survey, percentage of women who were visited either by an AWW,

ANM or ASHA after delivery or after discharge from hospital/health centre within one week of

delivery is presented in Table 4.23. The Table shows that women’s education level and economic

condition of the household are directly related to visitation by the basic health care providers.

Proportion of women visited by a health care provider after discharge from the health facility or

after home delivery gradually increases with the increase in the level of education.

41 In this section for the purpose of computation of visitation by health providers (a) for mothers who delivered at home

visitation after delivery, and (b) those mothers who delivered in a health facility, visitation after discharge from the facility

has been considered.

MATERNAL HEALTHCARE


Table 4.23: Visit by health care providers after delivery/discharge from health facility Among women who had live births in the three years preceding the survey, percentage who were visited by either AWW, ANM or ASHA after delivery or after discharge from hospital/health centre within one week of delivery, according to selected background characteristics, RSOC, 2013-14.

Background characteristic Mothers visited by

AWW, ANM or ASHA after delivery

Number of births

Mother’s age

15-19 49.2 1,539 20-24 53.2 20,364 25-29 51.9 20,861 30-34 46.7 8,145 35-49 43.9 3,642

Mother’s education No education 37.7 17,616 Below Primary 50.5 2,615 Completed Primary 52.4 8,351 Completed Middle 54.1 8,562 Completed Secondary 63.9 7,602 Completed Higher Secondary & above 61.3 9,805

Social-group Scheduled Caste 49.0 10,976 Scheduled Tribe 53.5 6,311 Other Backward Class 53.5 21,886 Other 48.3 14,828 Do Not Know 37.6 550

Wealth index Lowest 40.9 10,977 Second 47.9 11,248 Middle 53.9 11,213 Fourth 59.3 11,092 Highest 53.2 10,020

Total 51.0 54,550

Visitation by heath care providers increases from 38 percent, in case of mothers with no education

to 61 percent for the mothers who completed higher secondary or above level of education.

Similarly, proportion of women receiving visits from basic health providers increased with the

increase in the wealth index of the households. It increased from 41 percent for the poorest

households to 53 percent for women from the households with highest wealth index.

MATERNAL HEALTHCARE


4.4.2 Visit by health care providers after delivery/discharge from health facility by states

Figure 4.10 presents state wise percentage of women who reported to have been visited by a health

care provider within seven days of delivery or discharge from a health facility. It varies from 97

percent in Tamil Nadu to 4 percent in Nagaland.

Figure 4.10: Percentage of women visited by a health care provider within seven days of delivery or discharge from a health facility after delivery, by states from RSOC, 2013-14

It is seen that in all southern states, more than eight for every 10 women were visited within seven

days of delivery or discharge from the health facility. It may be noted that institutional delivery was

very high in these states. In Tamil Nadu, Goa and Kerala, almost all women were visited at home

after delivery, within seven days of delivery. One can perhaps conclude that institutional or safe

delivery also improves postnatal care. A matter of concern is that in the states where maternal and

neonatal mortality is high, visitations by health care workers are low. This is especially seen in

Rajasthan (17 percent), Uttar Pradesh (19 percent), Jharkhand (27 percent) and Bihar (30 percent).

4 13 17 19 20 20 22 24 24 25 27 29 29 30 34 37

51 51 53 54 55 61 64 68 83 84 85

96 96 97

Nag

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Raj

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MATERNAL HEALTHCARE


4.4.3 Timing and number of Postnatal check-ups (PNC)42 received by mother

Timing of Postnatal check-ups

The postnatal check-up by a healthcare provider is critical for both the mother and her child. A

question was asked in RSOC 2013-14 in the EMW questionnaire, about timing of the first postnatal

care check-up after discharge from the health facility in case of institutional delivery and home

delivery.43 In addition, a question was asked about the number of postnatal check-ups received by

the women at the health facility as well as at home during the first 10 days of delivery. Table 4.24

presents percentage distribution of women by timing of receiving of first postnatal check-up after

discharge in case of institutional delivery or after delivery if delivered at home, within the 10 days.

As per the Table below, overall, little less than half of the women (48 percent) received postnatal

check-up within 10 days of delivery/discharge and another 6 percent received PNC after the

stipulated period. In other word, 46 percent of the women never received any PNC (neither within

10 days nor after from discharge/delivery). More women from rural areas never received any PNC.

More than half of the women (52 percent) from the rural areas and about a third of the women (32

percent) from the urban areas did not receive any PNC after delivery/discharge.

Postnatal check-ups are also linked with the birth order of the women. Women with higher birth

order are less probable to receive any PNC than the women with lower birth order. For example, 62

percent of the women delivering for the first time (birth order one) received PNC, in comparison to

than those 54 percent women delivering for second time (birth order 2) or 37 percent women

delivering for third time or more. Proportion of women receiving postnatal check-up within 10 days

of delivery or discharge from the health facility improves with increase in the level of education of

the women. It improves from 32 percent for women with ‘no education’ to 65 percent for women

who completed higher secondary or above. It is also seen that women from richer families are more

probable to get a PNC within ten days than the women from the poor families.

42 This is about postnatal check-ups after discharge from the health facility, in case of institutional delivery and about postnatal check-ups after home delivery.

43 One should be careful in comparing this result from RSOC with that of NFHS or DLHS as questions in RSOC were

different.

MATERNAL HEALTHCARE


Table 4.24: Timing of first postnatal check-up Among women who had live births in the three years preceding the survey, percent distribution of women by timing of receiving first postnatal check-up within the 10 days of delivery, at home or discharge from the health facility, according to selected characteristics, RSOC, 2013-14


Time within which first postnatal check-up received

No postnatal check up

Total Number of

women Within 48 hours

2nd to 10th day

After 10th day

Mother’s age 15-19 33.6 7.3 6.2 53.0 100.0 1,539 20-24 41.3 7.7 6.2 44.7 100.0 20,364 25-29 40.4 9.2 6.0 44.5 100.0 20,861 30-34 35.4 8.6 6.9 49.1 100.0 8,145 35-49 31.9 8.1 8.2 51.8 100.0 3,642

Birth order 1 46.6 9.1 6.2 38.1 100.0 25,575 2 39.9 7.8 6.5 45.7 100.0 16,502 3+ 23.2 7.8 6.5 62.5 100.0 12,473

Residence Urban 51.1 8.8 7.6 32.4 100.0 16,320 Rural 34.2 8.2 5.8 51.8 100.0 38,230

Number of ANC visits No ANC 19.7 5.8 4.4 70.1 100.0 7,918 1-3 33.1 8.5 6.3 52.1 100.0 21,505 4+ 50.9 9.1 7.1 32.9 100.0 24,742 Do not know 39.0 9.0 7.5 44.5 100.0 386

Mother’s education No education 23.8 8.0 5.4 62.8 100.0 17,616 Below Primary 27.8 8.2 6.4 57.5 100.0 2,615 Completed Primary 39.6 8.5 6.7 45.2 100.0 8,351 Completed Middle 42.2 7.8 6.5 43.5 100.0 8,562 Completed Secondary 54.1 8.3 6.0 31.5 100.0 7,602 Completed Higher Secondary 55.6 9.8 8.0 26.7 100.0 9,805

Social-group Scheduled Caste 35.3 7.8 5.2 51.7 100.0 10,976 Scheduled Tribe 36.6 9.1 6.9 47.5 100.0 6,311 Other Backward Class 43.3 7.5 5.5 43.7 100.0 21,886 Other 38.0 10.0 8.3 43.7 100.0 14,828 Do Not Know 20.7 6.3 5.9 67.1 100.0 550

Wealth index Lowest 23.0 7.0 5.6 64.5 100.0 10,977 Second 32.2 7.8 4.6 55.4 100.0 11,248 Middle 41.9 7.8 5.8 44.5 100.0 11,213 Fourth 51.2 8.6 6.8 33.5 100.0 11,092 Highest 48.8 11.2 9.3 30.6 100.0 10,020

Place of delivery Government hospital/health centre 40.5 7.8 6.4 45.2 100.0 26,369 Private hospital/clinic/nursing home 55.6 10.4 7.1 26.9 100.0 16,582 Home 13.0 6.8 5.2 75.1 100.0 11,391 Other 18.0 14.2 5.6 62.3 100.0 208

Total 39.2 8.4 6.4 46.0 100.0 54,550

MATERNAL HEALTHCARE


Close to two-third of the women (65 percent) from the poorest families did not receive any PNC.

Receiving PNC within 10 days is seen to be linked to the place of delivery too. Such women who

delivered at home are less likely to receive PNC within 10 days (20 percent women who delivered at

home received PNC within 10 days) than the women who delivered in a facility. While about a half of

the women (48 percent) who delivered in a government-run health facility received PNC within 10

days, close to two-third (66 percent) of the women who delivered in a private health facility received

the check-ups within 10 days.

Number of PNC check-ups during first 10 days:

An analysis of percentage of women who never received any PNC and percent distribution of women

who received PNC within the first 10 days of delivery or discharge from health facility by number of

postnatal check-ups has been presented in Table 2.25. According to Table, of those women who

received any PNC within first 10 days, 30 percent received just one check-up, 27 percent received

two check-ups and 40 percent received three or more check-ups.

Table 4.25: Number of postnatal check-ups received by women during first 10 days after delivery/discharge from facility Among women who had live births in the three years preceding the survey, percentage who never received any postnatal check-up and percent distribution of women who received PNC within first 10 days of delivery/discharge from health facility, by number of postnatal check-ups and according to selected characteristics, India RSOC, 2013-14


Percentage of women

not received any PNC

Number of

women

Out of the women who received PNC within first 10 days

Number of

women who

received any PNC

Number of postnatal check-up received

One Two Three

or more

Missing

Mother’s age 15-19 53.0 1,539 31.5 25.7 41.2 1.6 629 20-24 44.7 20,364 29.8 26.0 41.3 3.0 9,988 25-29 44.5 20,861 30.3 26.9 39.2 3.6 10,338 30-34 49.1 8,145 30.0 26.7 39.4 3.9 3,584 35-49 51.8 3,642 35.0 27.1 35.2 2.7 1,459

Birth order

One 38.1 25,575 28.2 26.6 41.9 3.3 14,252 Two 45.7 16,502 30.4 26.7 39.6 3.3 7,876 Three and more 62.5 12,473 38.5 26.0 32.5 3.0 3,869

Residence

Urban 32.4 16,320 28.5 27.8 40.7 3.0 9,784 Rural 51.8 38,230 31.5 25.7 39.3 3.4 16,214

Number of ANC visits

No ANC 70.1 7,918 40.0 24.1 33.0 2.9 2,018 1-3 52.1 21,505 32.2 27.6 37.8 2.4 8,950 4+ 32.9 24,742 28.1 26.1 41.9 3.9 14,843 Do not know 44.5 386 20.8 33.8 45.0 0.4 185

MATERNAL HEALTHCARE



Percentage of women

not received any PNC

Number of

women

Out of the women who received PNC within first 10 days

Number of

women who

received any PNC

Number of postnatal check-up received

One Two Three

or more

Missing

Mother’s education No education 62.8 17,616 37.3 26.1 34.8 1.8 5,598 Below Primary 57.5 2,615 36.4 25.0 36.7 1.8 943 Completed Primary 45.2 8,351 30.7 26.0 39.9 3.4 4,018 Completed Middle 43.5 8,562 30.2 25.4 40.7 3.7 4,282 Completed Secondary 31.5 7,602 27.2 27.3 41.8 3.8 4,746 Completed Higher Secondary &

above 26.7 9,805 25.7 27.6 42.7 4.1 6,409

Social-group Scheduled Caste 51.7 10,976 30.4 26.9 37.4 5.4 4,732 Scheduled Tribe 47.5 6,311 30.9 25.6 40.7 2.8 2,881 OBC 43.7 21,886 28.4 26.1 42.2 3.4 11,122 Others 43.7 14,828 32.7 27.3 37.9 2.0 7,114 Do not know 67.1 550 55.1 26.0 19.0 0.0 149

Wealth index

Lowest 64.5 10,977 36.2 27.2 34.3 2.3 3,285 Second 55.4 11,248 32.8 26.2 37.3 3.7 4,497 Middle 44.5 11,213 30.4 26.3 39.3 4.0 5,569 Fourth 33.5 11,092 26.8 27.0 42.9 3.4 6,631 Highest 30.6 10,020 29.2 26.1 41.9 2.8 6,014

Place of delivery Government hospital/health centre 45.2 26,369 24.4 28.0 43.2 4.5 12,741 Private hospital/clinic/nursing home 26.9 16,582 29.2 26.5 41.7 2.6 10,939 Home 75.1 11,391 68.9 18.1 13.0 0.0 2,250 Other 62.3 208 66.3 25.8 7.9 0.0 67

Total 46.0 54,550 30.4 26.5 39.8 3.3 25,997

As stated in the previous sections, education level of the women, place of stay (rural/urban) and

economic condition of the family were the drivers for receiving postnatal check-ups within 10 days

of delivery. Women who delivered in a health facility (public or private), are more likely to receive

more number of PNCs than those delivered at home. Only 13 percent of the women who delivered

at home received three or more PNC check-ups. Similarly 43 percentage of the women who

delivered in a government health facility and 42 percentage of the women delivering in a private

health facility received three or more postnatal check-ups within 10 days of delivery. Differential in

receiving PNC check-ups is seen among different wealth quintile groups. While 34 percent of women

from the lowest wealth quintile group received 3 or more PNC check-ups within first 10 days of the

delivery/discharge from health facility, in case of highest wealth quintile group, more than two-fifth

(42 percent) of the women received the same.

MATERNAL HEALTHCARE


4.4.4 Timing and number of postnatal check-ups received by newborn within the first 10 days of

birth

Timing of PNC44

The maternal and child health programme recommends for the first PNC to be provided to newborn

within few hours of birth. A question was asked to eligible women about timing of the first check-up

received by the newborn after discharge from the health facility in case of institutional delivery or

after birth in case of home delivery. In addition, a question was asked about the number of check-

ups received during first 10 days of birth or discharge from the facility after birth.

Figure 4.11: Percentage of newborn receiving first postnatal check-up within 10 days of birth at home or discharge from health facility after birth

It is seen from Figure 4.11 that 44

percentage of the newborn

received first check-up within 10

days of birth (home delivery) or

discharge from health facility after

birth and another 16 percent

received after the stipulated

period. Two out of every five

newborn did not receive any PNC.

Such a phenomenon contributes

to increased risk of early neonatal

and neonatal mortality.

The percent distribution of births that received first check-up within 10 days, by the time of receiving

the check-up according to various background characteristics of the mother is given in Table 4.26.

Education level, age, place of residence of the mother and the place of delivery are the main drivers

for the newborn to get the first check-up within 24 hours of birth. Babies born to the mothers with

secondary or higher level of education (more than 40 percent) are more likely to receive the first

check-up within 24 hours than the babies born to mothers with primary or below primary level of

education (ranging from 25-36 percent).

44 One should be careful in comparing this result from RSOC with that of NFHS or DLHS as the questions asked to women are different.

Within 24 hours, 34%

2nd to 10th day, 10%

After 10th day, 16%

No postnatal check up,

40%

MATERNAL HEALTHCARE


Table 4.26: Timing of first postnatal check-up to newborn Among the live births in the three years preceding the survey, percent distribution of births receiving first check-up within 10 days after birth at home or discharge from health facility after birth by timing of first check-up according to selected characteristics, RSOC, 2013-14


Time within which the newborn received first check-up after birth at home or after discharge from the health

facility after birth Number of births

Within 24 hours

2nd

to 10th

day

After 10th

day

No postnatal check up

Mother’s age 15-19 28.7 9.8 15.4 46.1 1,539 20-24 35.9 9.9 16.0 38.2 20,364 25-29 34.6 10.4 15.9 39.1 20,861 30-34 29.2 10.4 17.0 43.4 8,145 35-49 27.6 9.8 17.1 45.5 3,642

Birth order 1 38.5 10.9 17.9 32.7 25,575 2 34.6 9.9 16.3 39.2 16,502 3+ 22.6 8.9 12.5 56.0 12,473

Residence Urban 39.8 11.4 21.4 27.3 16,320 Rural 31.0 9.6 14.0 45.5 38,230

Number of ANC visits No ANC 18.9 7.0 7.9 66.2 7,918 1-3 31.7 9.3 13.6 45.4 21,505 4+ 40.0 11.9 21.0 27.1 24,742 Do not know 33.6 12.2 19.8 34.4 386

Mother’s education No education 24.5 8.7 10.3 56.5 17,616 Below Primary 25.5 10.7 14.1 49.6 2,615 Completed Primary 35.6 10.5 15.7 38.1 8,351 Completed Middle 35.0 9.9 17.9 37.3 8,562 Completed Secondary 43.7 11.0 20.0 25.3 7,602 Completed Higher Secondary and

above 41.7 11.8 23.2 23.3 9,805

Social-group Scheduled Caste 31.2 9.0 14.0 45.8 10,976 Scheduled Tribe 34.0 11.0 15.4 39.7 6,311 Other Backward Class 35.8 9.3 16.2 38.7 21,886 Other 32.6 11.9 18.3 37.2 14,828 Do Not Know 18.8 10.5 12.5 58.2 550


Place of delivery Government hospital/health centre 34.9 9.6 17.3 38.2 26,369 Private hospital/clinic/nursing home 46.0 12.1 20.0 21.9 16,582 Home 13.0 8.5 8.3 70.2 11,391 Other 18.5 13.5 6.3 61.7 208

Total 33.6 10.1 16.2 40.0 54,550

MATERNAL HEALTHCARE


As in the case of the women receiving any PNC check-ups, babies born at home are less probable (13

percent) to receive a check-up within 24 hours than those born in a health facility (35 percent and 46

percent for babies born in a government and a private health facility respectively).

Number of postnatal check-ups received by newborn

Out of the women who had live births in the three years preceding the survey, Table 4.27 presents

the percentage of newborn who received any check-up within first 10 days after birth/discharge and

percent distribution of births that received the check-up within first 10 days by number of check-ups

received, according to background characteristics of the women.

Table 4.27: Number of postnatal check-ups received by newborn within first 10 days after birth Out of the women who had live births in the three years preceding the survey, percentage of the newborn who received any check-ups within 10 days of birth/discharge and percentage distribution of newborn by number of check-up received within first 10 days of birth according to selected characteristics, RSOC, 2013-14


Received any

checkups after birth

Number of

newborn

New born baby who received any checkups after birth / discharge, within

10 days Number of

newborn who received any

PNC Number of check-up received

One Two Three or

more Missing

Mother's age 15-19 53.9 1,539 34.4 25.6 35.7 4.3 593 20-24 61.8 20,364 32.7 24.8 39.5 3.0 9,321 25-29 60.9 20,861 33.0 25.0 38.7 3.4 9,388 30-34 56.6 8,145 34.4 25.9 36.1 3.6 3,227 35-49 54.6 3,642 39.2 25.7 32.7 2.4 1,361

Birth order 1 67.3 25,575 30.9 25.9 39.9 3.4 12,628 2 60.8 16,502 32.7 25.1 38.7 3.5 7,337 3+ 44.0 12,473 43.1 22.6 31.9 2.4 3,924

Residence Urban 72.6 16,320 31.6 26.3 39.1 3.1 8,370 Rural 54.6 38,230 34.4 24.4 37.8 3.4 15,520

Mother's education No education 43.5 17,616 38.0 25.4 35.1 1.6 5,850 Below primary 50.3 2,615 38.4 24.1 34.5 2.9 948 Completed primary 61.8 8,351 35.1 23.8 37.9 3.1 3,854 Completed middle 62.8 8,562 32.6 24.4 39.1 3.9 3,842 Completed secondary 74.7 7,602 29.9 26.8 39.5 3.8 4,157 Completed higher

secondary & above 76.7 9,805 29.6 25.0 41.1 4.3 5,239

Social-group

Scheduled Caste 54.2 10,976 33.7 24.9 36.7 4.7 4,415 Scheduled Tribe 60.4 6,311 33.3 23.4 40.3 2.9 2,835 OBC 61.3 21,886 31.0 25.6 39.8 3.5 9,878 Others 62.8 14,828 36.4 25.2 36.4 2.1 6,600 Do not know 41.8 550 55.2 21.6 23.2 0.0 161

MATERNAL HEALTHCARE



Received any

checkups after birth

Number of

newborn

New born baby who received any checkups after birth / discharge, within

10 days Number of

newborn who received any

PNC Number of check-up received

One Two Three or

more Missing

Wealth index

Lowest 42.2 10,977 37.6 26.8 33.4 2.2 3,410 Second 51.2 11,248 36.6 24.3 35.4 3.7 4,419 Middle 62.5 11,213 32.7 24.4 38.8 4.1 5,142 Fourth 71.9 11,092 30.4 24.1 42.3 3.2 5,884 Highest 73.5 10,020 32.1 26.4 38.7 2.8 5,035

Place of delivery Government hospital /

health centre 61.8 26,369 27.2 26.3 42.1 4.5 11,742

Private hospital / clinic / nursing home

78.1 16,582 31.8 25.5 40.2 2.6 9,631

Home 29.8 11,391 69.1 17.9 13.0 0.0 2,451 Other 38.3 208 66.6 24.3 9.1 0.0 66

Total 59.9 54,550 33.4 25.1 38.2 3.2 23,890

As seen from the analysis close to 60 percent of the newborn received a check-up (within and after

10 days of delivery) and out of the babies that received check-ups, 33 percent received one check-

up, 25 percent received two check-ups and 38 percent received three and more check-ups within

first 10 days of birth. It may also be noted that among the newborn delivered in the government

health facilities, close to a fourth (27 percent) received only one check-up; another 26 percent

received two check-ups and 42 percent received three or more check-ups within 10 days. Babies

born in a private facility (78 percent) are more likely to receive a check-up. Around 32 percent babies

born in private health facilities received one check-up, 26 percent received two check-ups and

around 40 percent received three or more check-ups within 10 days. However, babies born at home

70 percent did not receive any check-ups within 10 days.

4.4.5 Postnatal care indicators by states

State wise information on the five critical indicators of postnatal care of mother and the newborn

has been provided in Table 4.28. Proportion of women receiving a visit within one week after

delivery by any health care provider (AWW, ANM or ASHA) varied across the states, from 13 percent

in Delhi to 97 percent in Tamil Nadu. States like Tamil Nadu (97 percent), Goa (96 percent), Kerala

(96 percent), Karnataka (85 percent), Andhra Pradesh (84 percent) and Maharashtra (83 percent)

have relatively performed better in terms of home visits by healthcare workers. In 13 states, more

than 50 percent of women received a visit by a health care worker. On the other hand, in 10 states,

about a fourth or less proportion of women received a postnatal visit by health workers within a

week of delivery. With regards to postnatal check-ups to women within 48 hours of delivery,

proportion of women receiving a check-up varies from 4 percent in Manipur to 95 percent in Goa. In

seven states, 60 or more percentage of the women received postnatal check-ups. In Goa, Tamil

MATERNAL HEALTHCARE


Nadu, Kerala, Andhra Pradesh, Karnataka, Maharashtra and Madhya Pradesh, more than 60 percent

of the women reported to have received PNC within 48 hours of delivery. There are at least 20 states

where proportion of women who received PNC within 48 hours was less or equal to 40 percent.

Table 4.28: Postnatal care indicators by states Percentage of women who had live births in three years preceding the survey, by different postnatal services received and according to states, RSOC, 2013-14

State

Percentage of women visited

within one week by AWW, ANM or ASHA after

delivery

Percentage of women who received PNC

within 48 hours of delivery

Percentage of women whose

newborn received check-ups within 24

hours of delivery

Percentage of women received at least 3 check-

ups during first 10 days of delivery*

Percentage of women whose

newborn received at least 3 check-

ups during first 10 days of delivery*

India 51.0 39.3 33.6 39.8 38.2 North

Delhi 13.4 7.8 8.8 27.0 26.2 Haryana 28.5 23.5 24.0 33.1 27.6 Himachal Pradesh 23.5 13.1 14.4 24.4 19.7 Jammu & Kashmir 21.6 10.3 12.0 38.7 30.8 Punjab 20.3 15.6 16.5 22.8 27.7 Uttar Pradesh 19.1 12.1 11.5 12.7 13.5 Uttarakhand 23.8 12.2 11.7 25.2 21.8

Central Chhattisgarh 60.7 45.9 45.5 37.6 38.1 Madhya Pradesh 64.1 60.3 53.5 55.4 58.5

East Bihar 30.1 6.4 9.4 14.1 11.6 Jharkhand 26.5 12.7 13.0 17.9 17.0 Odisha 53.9 10.5 12.6 25.3 23.4 West Bengal 24.8 9.1 9.9 16.0 15.6

Northeast Arunachal Pradesh 37.4 12.8 11.7 30.0 25.6 Assam 51.4 7.0 6.7 9.0 11.0 Manipur 52.8 3.5 3.5 29.1 11.2 Meghalaya 29.4 19.0 18.6 19.0 22.8 Mizoram 20.0 8.1 9.4 16.1 12.2 Nagaland 3.6 5.6 5.2 3.1 3.8 Sikkim 55.2 10.7 32.2 59.7 59.2 Tripura 34.2 15.9 17.8 35.9 34.2

West Rajasthan 17.2 9.5 9.9 22.3 28.8 Goa 96.1 95.0 36.7 55.8 52.0 Gujarat 68.0 47.5 49.4 29.0 30.0 Maharashtra 83.1 77.1 65.2 42.5 44.2

South Andhra Pradesh 84.2 77.9 77.9 52.2 49.7 Karnataka 85.4 75.6 52.2 50.0 46.9 Kerala 95.7 94.0 55.0 54.1 53.5 Tamil Nadu 96.7 94.7 58.7 43.5 40.2

*calculated out of those who received any PNC

MATERNAL HEALTHCARE


In six states more than half of the women’s babies got a check-up within 24 hours of birth. In three

states, Andhra Pradesh (78 percent), Maharashtra (65 percent) and Tamil Nadu (59 percent) 60

percent and more of women’s newborn got a check-up within 24 hours. In 20 states, proportion of

women whose newborn receiving a check-up within 24 hours was less than equal to 40 percent.

Regarding women whose baby got three check-ups within 10 days of births, in four states more than

50 percent of the women’s babies got three check-ups within 10 days.

4.5 ROLE OF AWC IN PRENATAL, NATAL AND POSTNATAL CARE

The healthcare workers namely ASHA, ANM and AWW are the basic providers and facilitators of

healthcare services as they form the first level of interface between government

programmes/schemes and the targeted beneficiaries. Among the field level workers, the role of the

AWW and her centre, Anganwadi Centre (AWC), is the hub for providing critical services of

improving nutrition, immunization, maternal health care, nutrition and health education for children

below six years, pregnant women, lactating mothers and adolescent girls.

Questions were asked in the EMW questionnaire to eligible women on the role of AWW in

counselling for registration of their pregnancy; whether pregnancy was registered at an AWC and

whether ANC services were provided at the AWC. Women were also asked whether they received

counselling to deliver in a health institution. Table 4.29 presents the percentage of the eligible

women who registered their pregnancies at an AWC; received counselling from the AWW to register

their pregnancies; received ANC at the AWC; visited at home by AWW during pregnancy and

percentage of women who received counselling from an AWW to deliver at a health facility.

Among all the women who had a live birth in the three years preceding this survey, 70 percent

registered their pregnancy in an AWC with relatively younger women aged (15-24) (74 percent) than

the older women, 25-49 years (58-70 percent). Overall, close to 30 percentage of the women

reported that they were advised by AWW to register their pregnancy. However, a small proportion

of the women (22 percent) ultimately received ANC services from the AWCs. This means about two-

third (68 percent) of the women who had registered dropped out and did not receive services from

AWC. Drop out was more in case of women living in urban areas and women from economically

better off families. There could be various reasons for drop out, socio-cultural and economic

conditions along with the quality of care aspired by the client. Research and more evidence would

be critical to determine the causes of the drop out from the system.

Around a third (35 percent) of the women were visited at home by AWW during pregnancy, more

visitations were seen in rural areas (39 percent) than at homes of urban women (26 percent).

Counselling to women by AWW has been poor both with regards to registration of pregnancy (30

percent) and also for delivering in a health facility (11 percent).

MATERNAL HEALTHCARE


Table 4.29: Role of AWC in Maternal Health Among women who had live births in the three years preceding the survey, percentage who registered their pregnancy at the AWC, received advice/counselling by AWW to register their pregnancy, received ANC check-ups during pregnancy at the AWC, visited at home by at least once by AWW during pregnancy and received advise/counselling by AWW to deliver at a health facility, according to selected characteristics, RSOC, 2013-14


Women registered

their pregnancy at the AWC

Women received

advise/counselling by AWW to register

their pregnancy

Women received

ANC check-ups during pregnancy at the AWC

Women visited at home at

least once by AWW

during pregnancy

Women received

advise/counselling by AWW to

deliver at a health facility

Number of women

Mothers Age 15-19 74.4 30.0 23.2 35.2 13.9 1,539 20-24 74.2 32.6 23.0 36.6 14.7 20,364 25-29 69.5 29.2 22.2 34.9 12.2 20,861 30-34 62.4 26.6 20.8 31.2 11.2 8,145 35-49 57.7 27.3 23.1 32.2 11.9 3,642


Social-group Scheduled Caste 69.6 30.9 24.3 36.1 14.0 10,976 Scheduled Tribe 77.8 45.2 36.5 42.5 19.3 6,311 OBC 69.5 29.1 23.0 33.6 11.9 21,886 Others 65.9 24.5 14.3 32.5 11.3 14,828 Do Not Know 71.7 20.4 13.8 30.3 8.5 550

Wealth Index Lowest 67.7 36.6 32.4 33.5 13.5 10,977 Second 69.3 32.4 26.4 36.7 14.4 11,248 Middle 72.8 33.4 22.4 39.7 14.9 11,213 Fourth 73.3 27.7 17.5 36.2 12.9 11,092 Highest 63.9 18.7 12.3 27.2 8.9 10,020

Total 69.5 30.0 22.4 34.8 13.0 54,550

About 32 percent of women from the poorest families received ANC services at AWCs. Among the

different social groups, high proportion of the women from the ST families availed benefits from

AWCs and services of an AWW. Around 77 percentage of the women from the ST families registered

their pregnancy; 37 percent received ANC check-ups in AWC; 43 percent reported to have been

visited at home by an AWW pregnancy and around a fifth received counselling from AWW for

delivering in a health facility. Better utilization of AWW and AWC services are seen among the

women from the rural areas. Similarly, 72 percent of the women living in rural areas registered their

pregnancy; 27 percent received ANC check-ups in AWC; 39 percent were visited by AWW during

pregnancy and 15 percent women reported to have been counselled to deliver in a health facility.

Better use of services in rural areas and among women from the tribal families can be attributed to

better spread of AWCs in rural and tribal areas and convergence of services at these AWCs.

MATERNAL HEALTHCARE


4.5.1 Role of AWW in maternal health by states

The state wise percentage of mothers who received selected maternal care services from AWWs is

presented in Table 4.30.

Table 4.30: Role of AWC in maternal health by states Among the live births in the three years preceding the survey, percentage of women who registered their pregnancy at the AWC; received ANC check-ups during pregnancy; visited at home by at least once by AWW during pregnancy; and received advise/counseling by AWW to deliver at a health facility according to selected characteristics, RSOC, 2013-14.

States

Women registered their pregnancy at the AWC

Women received ANC check-ups during pregnancy at the AWC

Women visited at home at least once by AWW during pregnancy

Women received advise/counselling by AWW to deliver at a health facility

India 69.5 22.4 34.8 13.0 North







MATERNAL HEALTHCARE


Overall, it is seen in most states, a significant proportion of women (in 20 states, more 50 percent

women registered pregnancy) registered their pregnancy in an AWC. While overall, about 70 percent

of the women registered their pregnancy at AWC, in states of Goa, Andhra Pradesh, Tamil Nadu,

Karnataka, Chhattisgarh and Maharashtra more than 90 percent of the women had registered at

AWCs. Proportion of women registering their pregnancy in AWCs varies between 21 percent in Delhi

to 94 in Goa. There were at least 17 states where registration of ANC in AWCs was lower than the

national average (70 percent).

However, proportion of women ultimately receiving ANC check-ups at AWCs was much lower (22

percent) than those who registered. It varied between less than one percent in Manipur and

Nagaland to close to 56 percent in Chhattisgarh). Other states where relatively higher proportion of

women received ANC services from AWC are Rajasthan (45 percent), Odisha (43 percent), Jharkhand

(41 percent) and Madhya Pradesh (39 percent). In 24 states, not even 30 percent of the women

received ANC check-ups at AWCs. In Delhi, Jammu and Kashmir, West Bengal, Manipur, Meghalaya,

Nagaland, Sikkim and Kerala, less than a tenth of the women received ANC check-ups in AWCs.

Home visits by AWW at least once during pregnancy varied from one percent in Nagaland to 73

percent in Manipur. In four states, namely Tamil Nadu, Odisha, Kerala and Manipur more than 50

percent women reported that they were visited at home by an AWW, during their pregnancy.

Conclusion

It is seen that overall, situation of maternal health of women has improved as compared to results of

the survey conducted in 2005-06 and also in 2007-08. However, the situation significantly differs

among the states, in almost all indicators.

More than four out of every five (84 percent) women registered their pregnancy with health

facilities and Anganwadi centres reflecting greater awareness about maternal health care among

women. More than three-fourth (79 percent) women delivered in a health facility (both government

and private). One-fifth of deliveries took place at home in contrast to about half of deliveries taking

place at home as per DLHS 2007-08.

CHILD HEALTH CARE


CHAPTER 5 CHILD HEALTH CARE

India has the largest population of children below six in the world. As per Census 2011, there were

113 million children below age five accounting for 9.3 percent of the total population in the country.

Although, during the last couple of decades, there has been a reduction in infant and child mortality

in India, still the current level of under-five mortality (49 per 1,000 live-births, Sample Registration

System 2013) and infant mortality rate (40 per 1,000 live births, SRS, 2013) is on the high side. The

Government of India is committed to the Millennium Development Goal of reduction in infant and

child mortality rates. The child health programme under the National Health Mission (NHM) of

Ministry of Health and Family Welfare integrates interventions that improve child survival, and

addresses factors contributing to infant and under-five mortality. Neonatal health, nutrition,

management of common childhood illnesses, and immunization are the main thrust areas of the

child health programme.

The Integrated Child Development Scheme (ICDS) of Ministry of Women and Child Development is

also committed to the development of children. The programme under ICDS covers children below

age six. The scheme provides health and nutrition services to children and pregnant and lactating

women and pre-school education to the children with the aim of breaking the vicious cycle of

malnutrition, morbidity, reduced learning capacity and mortality among children. This chapter on

child health care will help in the assessment of the health care children receive.

The chapter presents findings of RSOC 2013-14 related to the preventive and curative health care

given to young children below age five. It also looks into the role of Anganwadi Centres (AWCs) of

ICDS in providing child health care. The specific topics included in the chapter are: (1) childhood

immunization, (2) prevalence of common childhood diseases, i.e., diarrhoea, fever and acute

respiratory infections (ARI) and treatment given during illness, and (3) role of AWCs of ICDS in

providing child health care in terms of immunization and treatment.

5.1 IMMUNIZATION

Universal immunization is one of the key interventions for protection of children from life

threatening conditions, which are preventable. The Immunization programme in India is a major

public health intervention in the country. Under the Universal Immunization Programme (UIP),

Government of India is providing scheduled vaccination to prevent seven vaccine preventable

diseases as follows:

Bacillus Calmette Guerin (BCG): one dose at birth (up to one year if not given earlier).

DPT (Diphtheria, Pertussis and Tetanus Toxoid): five doses; three primary doses at 6,10,14

weeks and two booster doses one at 16-24 months and another at age five.

Oral Polio Vaccine (OPV): five doses; zero dose at birth, three primary doses at 6, 10 and 14

weeks and one booster dose at 16-24 months of age.

Hepatitis B vaccine: four doses; zero dose within 24 hours of birth and three doses at 6, 10

and 14 weeks of age.

Measles: two doses; first dose at 9-12 months and second dose at 16-24 months of age.

CHILD HEALTH CARE


In all the Government health institutions vaccination is available free of cost. It is also provided in

private clinics and hospitals. In rural areas ANM45 provides immunization at AWCs, where ASHA and

Anganwadi worker (AWW) provide support in planning and implementation of immunization

sessions. At the time of registration of the pregnancy, pregnant women are given the Mother and

Child Protection (MCP) card to track the stages of pregnancy, antenatal care (ANC) services, nutrition

and vaccinations required by the mother and the child. The MCP card is the best source of data on

child immunization.

In RSOC all eligible women with children aged 0-35 months were interviewed and were asked

whether they have an MCP or immunization card. All those having a card, were asked to show it. In

case the mothers were able to produce the card, all the vaccines recorded on the card were copied.

Alternatively, the mother was asked whether the child was given each of the vaccine mentioned

above. All the children who received pentavalent vaccine were considered to have received both

DPT and hepatitis vaccines. Additionally, data on the receipt of second dose of measles and the two

booster doses of DPT vaccine was collected for children aged 36-71 months. By the time of

completion of the first year of life, the child is supposed to have received all vaccines, i.e., 1) BCG, 2)

three injections of DPT, 3) polio at birth and next three doses of polio, 4) measles and 5) Hepatitis B

at birth and next three doses. So the tabulation of primary immunization is restricted to children

aged 12-23 months.

RSOC asked mothers whether they had a vaccination card. If a card was available, the interviewer

was instructed to copy the day, month, and year that each vaccination was received. For

vaccinations not recorded on the card, the mother’s report that the vaccination was or was not

given was recorded. If the mother could not show a vaccination card, she was asked whether the

child had received any vaccinations. If any vaccinations had been received, the mother was asked

whether the child had received a vaccination against each of the following (1) tuberculosis (BCG), (2)

DPT, (3) polio, (4) measles and (5) hepatitis. For DPT and polio, information was obtained on the

number of doses of the vaccine given to the child. Table 5.1 gives the percentage of children aged

12-23 months who received a specific vaccine according to the source of reporting, i.e., from card,

from mother’s report and either from card or from the mother’s report. In 7,551 (42 percent) cases

out of 17,791 children, the MCP/immunization card for the child was available and the mother could

show it to the interviewer. For one percent of children the card was blank with not a single record of

vaccine, indicating that one percent of the children did not receive any vaccine.

The comparison of the immunization coverage indicated on the cards and reported by the mother

shows higher coverage of each of the vaccine among the children having the card. The record on the

cards shows that 96 percent of the children received BCG, 89 percent received three doses of DPT,

85 percent of the children received three doses of polio and the same percentage received measles

vaccine. However, the mother’s report shows much lower coverage of each vaccine. The mother’s

report shows that 88 percent of the children received BCG, 64 percent received three doses of DPT,

45Auxiliary Nursing Midwife

CHILD HEALTH CARE


65 percent received three doses of polio and 75 percent were given the measles vaccine. For

complete protection from the six childhood diseases, it is essential to have all the six vaccines—BCG,

three injections of DPT, three doses of polio and measles. The coverage of full immunization was 58

percent according to mother’s report compared to 76 percent by card’s record. The record on

immunization card showed that one percent of children did not receive any vaccine. On the

contrary, the mother’s report showed that 11 percent of the children did not get any immunization.

CHILD HEALTH CARE


Table 5.1: Vaccinations by source of information

Percentage of children aged 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report)

Figure 5.1: Percentage of children aged 12-23 months received vaccines, RSOC, 2013-14

91 89 84

75

63

90 83

74

58 66

53

34

79

BCG DPT 1 DPT 2 DPT 3 Polio 0 Polio 1 Polio 2 Polio 3 Hepatitis0

Hepatitis1

Hepatitis2

Hepatitis3

Measles

Source of information BCG DPT Polio Hepatitis B

Measles Full

immunization*

No immunizati

on

Number of children

aged 12-23 months 1 2 3 0 1 2 3 0 1 2 3

Vaccinated at any time before the survey

Immunisation Card Mother's Report Either Source

95.7 87.8 91.1

96.4 84.2 89.4

93.9 76.9 84.1

88.9 64.4 74.8

77.2 52.2 62.8

95.4 86.1 90.0

92.6 76.6 83.4

85.2 64.8 73.5

48.5 64.4 57.6

89.7 48.9 66.2

85.3 29.7 53.3

80.0 0.9

34.4

84.6 74.6 78.9

75.5 57.7 65.3

1.3 10.6

6.6

7,551 10,240 17,791

* Full Immunization includes 1 dose of BCG, 3 doses of OPV, 3 doses of DPT and one dose of measles

CHILD HEALTH CARE


Combining both records, RSOC shows that among children aged 12-23 months, a large proportion

received BCG (91 percent), first injection of DPT (89 percent) and first dose of polio (90 percent).

However, subsequently, there were dropouts in the vaccination and ultimately, only about three-

fourth of the children received third injection of DPT (75 percent) and third dose of polio (74

percent) and 79 percent of the children received measles vaccine. Two in every three children (66%)

received first dose of hepatitis vaccine, however subsequently only one-third (34%) of children could

complete the schedule of three doses. The dropouts in vaccinations were quite high. From the first

to third dose of DPT, Polio and hepatitis the dropout rates (estimated as ratio of the difference

between the percentage of children who received first and third dose and percentage of children

who received first dose, and expressed in percentage) were 16 percent, 18 percent and 48 percent

respectively. About two in every three children (65 percent) aged 12-23 months received complete

schedule of the vaccination, i.e., they got complete protection from six diseases. At the same time

seven percent of the children did not receive a single vaccine. So among all the children aged 12-23

months, 65 percent received full immunization, seven percent received no immunization and

remaining 28 percent received only partial immunization.

Figure 5.2: Percentage of children aged 12-23 months received vaccines, RSOC, 2013-14

(Status of Full Immunization)

The previous nation-wide survey—NFHS-3—also provided levels of immunization. The comparison of

immunization coverage from NFHS-3 and RSOC suggests improvement in the coverage of BCG, DPT

and measles. The extent of full immunization comprising of BCG, three doses of DPT and polio and

measles, has increased by more than 20 percentage points from 44 percent in 2005-06 to 65 percent

in 2013-14.

Survey Year BCG DPT Polio

Measles All None 1 2 3 1 2 3

NFHS-3 (2005-06) 78.1 76.0 66.7 55.3 93.1 88.8 78.2 58.8 43.5 5.1 RSOC (2013-14) 91.1 89.4 84.1 74.8 90.0 83.4 73.5 78.9 65.3 6.6

6.6

28.1

65.3

No immunization

Partial immunization

Full immunization

CHILD HEALTH CARE


The percentage of children who received specific vaccines by selected household and child

characteristics is presented in Table 5.2. The coverage of each vaccine was higher in urban areas

than in rural areas and the coverage of full vaccination in urban areas was ten percentage points

higher in urban areas (72 percent) than in rural areas (62 percent). Both male and female children

were equally likely to receive immunization. Children of birth order three or higher were less likely to

receive each type of vaccine compared to first or second born children. Eleven percent of the

children of birth order three or more did not receive a single vaccine and 57 percent of them

received full immunization compared to 67-68 percent of the first or second order children receiving

full immunization. Educated mothers were more likely to immunize their children compared to their

lesser educated peers. The proportion of children with no immunization decreased from 13 percent

among children with mothers having no education to less than one percent among children whose

mothers had completed Higher Secondary or had higher education. The extent of full immunization

was 82 percent among children whose mothers completed Higher Secondary or had higher

education, whereas only 49 percent of the children with mothers having no education received full

immunization.

CHILD HEALTH CARE


Table 5.2: Vaccinations by background characteristics

Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or mother's report), and percentage

with an immunization card seen by the interviewer, by background characteristics

Characteristics BCG

DPT Polio

Measles Full

immunization* Partial

immunization No

immunization

Hepatitis B Percentage with an immunization card

Number of

children aged 12-

23 months

1 2 3 0 1 2 3 0 1 2 3 Seen Seen/Not

Seen

Sex of the Child

Male 91.3 89.4 84.1 74.3 63.2 90.0 83.3 73.0 79.4 65.0 28.4 6.6 58.7 66.2 53.1 33.8 41.5 84.4 9,388 Female 90.9 89.4 84.1 75.3 62.4 90.0 83.4 73.9 78.3 65.6 27.6 6.7 56.4 66.3 53.5 35.2 43.5 84.2 8,403

Birth order

1 92.4 91.2 86.2 77.4 67.5 91.8 85.7 76.1 81.9 68.3 26.2 5.4 60.7 67.6 53.4 36.1 43.6 87.2 8,802 2 92.2 90.4 85.1 76.5 63.5 90.8 84.1 75.2 79.8 66.8 27.5 5.8 58.2 68.5 56.7 36.6 45.0 84.8 5,090 3+ 86.8 84.2 78.0 66.7 51.4 85.1 77.2 65.3 70.7 56.5 32.9 10.5 50.0 60.1 48.6 28.0 36.4 77.0 3,899

Residence

Urban 94.0 92.3 87.7 80.7 70.5 92.9 88.2 79.5 83.1 72.0 23.5 4.5 63.7 69.2 55.4 35.8 43.1 87.8 5,415 Rural 89.9 88.1 82.6 72.2 59.5 88.8 81.3 70.8 77.0 62.4 30.0 7.6 55.0 64.9 52.4 33.8 42.2 82.8 12,376

Mother education

No Education 83.6 80.0 73.2 60.2 49.9 81.6 72.3 59.5 65.6 48.7 37.9 13.4 49.6 54.6 42.4 24.3 32.7 74.3 5,623 Below Primary 91.6 92.1 86.8 77.3 58.5 91.2 87.1 73.7 81.0 66.2 28.2 5.5 50.5 70.7 60.1 42.9 53.4 87.5 867 Completed Primary 93.3 92.0 85.5 76.0 65.4 92.3 85.1 74.2 80.4 66.7 28.9 4.4 57.3 69.4 55.7 38.2 47.1 87.3 2,744 Completed Middle 92.1 90.8 86.2 76.3 64.0 91.0 83.7 74.5 82.0 66.4 28.0 5.6 56.9 70.2 58.8 38.8 48.7 88.2 2,864 Completed Secondary 95.7 95.3 92.0 85.8 73.3 95.2 91.1 84.2 88.3 77.8 19.3 2.8 65.3 72.6 59.3 40.9 46.3 90.0 2,409 Completed Higher Secondary

and above 97.9 97.1 93.4 88.7 75.3 97.7 93.9 87.9 89.9 82.1 16.9 1.0 68.6 74.2 59.0 37.9 44.0 90.6 3,284

Religion

Hindu 91.7 90.1 84.9 75.7 63.3 90.6 84.0 74.6 79.6 66.2 27.7 6.1 58.1 66.7 53.2 35.0 42.9 84.6 13,987 Islam 87.0 85.0 79.3 69.9 58.6 86.3 79.7 68.2 73.1 60.2 29.9 9.9 53.4 62.5 52.0 31.3 40.4 82.0 2,895 Christian 93.8 91.6 85.0 72.8 68.8 93.1 83.0 67.3 81.8 62.4 32.8 4.8 61.5 61.1 47.6 31.5 38.1 80.6 370 Sikh 97.8 95.0 93.4 86.1 70.6 95.1 93.4 87.1 87.5 81.9 16.2 1.9 65.3 83.2 75.7 43.3 48.7 91.6 269 Jain (100.0) (92.0) (92.0) (84.0) (84.0) (100.0) (88.0) (80.0) (92.0) (80.0) (20.0) (0.0) (68.0) (72.0) (60.0) (24.0) (36.0) (84.0) 43

Buddhist 94.9 93.8 85.5 80.5 73.4 93.0 85.1 69.3 93.2 68.8 26.2 5.0 72.5 76.0 59.4 42.5 51.1 94.1 126 No Religion * * * * * * * * * * * * * * * * * * 07 Other 90.8 88.2 83.5 72.9 49.9 87.5 73.9 68.3 77.4 57.5 35.1 7.4 56.1 69.0 55.8 30.3 36.8 89.3 94

Social Group

Scheduled Caste 88.4 87.3 82.2 72.0 60.0 87.4 80.8 69.8 76.7 61.6 29.6 8.8 51.1 66.2 54.5 38.0 46.8 83.5 3,611 Scheduled Tribe 90.4 86.6 78.6 65.0 55.9 87.9 76.7 63.7 75.4 55.7 36.9 7.4 56.4 58.9 44.3 27.9 36.0 79.3 2,015 OBC 90.6 89.0 83.8 74.9 63.8 90.0 83.6 73.8 77.5 65.4 27.5 7.1 59.0 64.7 50.8 31.7 39.9 82.9 7,136 Others 94.2 92.8 88.2 80.5 66.7 92.9 87.6 79.6 83.8 71.6 24.3 4.1 61.7 71.2 59.1 37.7 44.6 88.9 4,879 Do Not Know

93.3 89.8 85.4 82.2 54.3 89.2 83.9 74.9 83.1 73.2 20.1 6.7 34.9 77.4 73.9 62.3 72.5 87.7 149

CHILD HEALTH CARE


Characteristics BCG

DPT Polio

Measles Full

immunization* Partial

immunization No

immunization

Hepatitis B Percentage with an immunization card

Number of

children aged 12-

23 months

1 2 3 0 1 2 3 0 1 2 3 Seen Seen/Not

Seen

Number of ANC visits

No ANC 72.9 68.8 62.1 49.5 36.4 69.8 61.5 49.8 55.4 39.6 36.6 23.8 39.2 41.4 30.8 14.5 20.6 63.5 2,576 1 86.0 85.3 80.8 69.2 52.0 86.0 78.9 67.4 68.8 54.9 36.1 9.0 43.6 54.1 46.7 31.5 46.1 78.4 1,233 2 93.0 91.0 83.7 72.4 59.4 91.8 82.2 70.0 78.1 60.0 35.6 4.4 60.2 64.1 49.4 28.7 37.9 85.0 2,401 3 92.3 91.2 85.8 76.9 64.6 92.1 85.8 74.7 81.0 66.8 28.4 4.8 59.6 68.9 54.3 33.0 43.1 88.0 3,367 4+ 96.7 95.4 91.1 83.5 73.3 95.8 90.3 82.4 87.2 76.0 21.8 2.2 64.2 75.6 62.4 43.7 50.0 90.0 8,136 Do not know 86.7 85.9 78.8 73.1 45.7 81.3 77.9 69.8 69.7 60.5 27.2 12.4 44.2 45.3 22.9 13.7 24.0 86.9 77

Place of delivery

Government hospital/Health centre

94.1 91.9 86.8 77.6 68.7 92.4 85.4 75.7 81.7 67.5 28.4 4.1 60.0 68.5 56.0 37.5 46.1 88.0 8,657

Private hospital/Clinic/Nursing home

94.4 93.8 88.8 81.6 70.2 94.5 89.0 80.8 84.8 73.7 22.7 3.6 63.2 71.5 56.8 37.6 43.7 87.8 5,518

At home 79.0 77.0 70.8 58.0 37.3 77.8 69.9 57.2 63.2 47.6 35.3 17.2 43.5 52.6 41.5 22.3 31.2 69.9 3,552 Other 75.0 68.7 62.5 47.4 47.9 68.7 63.4 46.5 36.2 28.9 46.0 25.0 39.6 56.0 46.1 19.6 51.3 69.9 63

Wealth Index

Lowest 84.2 81.3 75.1 62.4 49.8 82.7 73.4 60.6 66.5 50.6 36.7 12.6 46.6 55.2 44.6 28.0 37.0 75.6 3,533 Second 88.8 86.1 80.1 69.8 59.0 86.5 78.8 68.4 74.8 59.3 31.9 8.8 52.7 62.3 51.0 32.4 41.9 81.7 3,647 Middle 92.4 90.8 84.8 75.3 63.4 91.4 84.6 73.8 81.2 66.0 28.6 5.4 59.4 67.4 53.5 35.3 43.1 85.7 3,815 Fourth 94.0 93.0 88.5 80.1 68.9 93.4 87.8 78.7 83.8 71.6 24.3 4.1 63.2 70.8 55.1 36.0 43.9 88.0 3,443 Highest 96.6 96.3 92.8 87.2 73.8 96.5 92.9 86.7 88.5 80.0 18.0 2.0 66.8 76.1 62.9 40.8 46.5 90.9 3,352

Total 91.1 89.4 84.1 74.8 62.8 90.0 83.4 73.5 78.9 65.3 28.1 6.6 57.6 66.2 53.3 34.4 42.4 84.3 17,791

( ) Based on 25-49 unweighted cases. *Based Percentages are not shown, based on fewer than 25 unweighted cases.

CHILD HEALTH CARE


Figure 5.3: Percentage of children aged 12-23 months who are fully immunized and percentage received no immunization by selected characteristics, RSOC, 2013-14

Among the four social groups, the vaccination coverage was the lowest among children from the STs

and the highest among those from other castes. The proportion of fully immunized children was 16

percentage points higher among children from other castes (72 percent) compared to those from

STs (56 percent). Better economic status led to a substantial improvement in immunization

coverage. With increase in wealth quintile there was a decrease in the proportion of children with no

immunization and increase in the extent of full immunization. From the lowest wealth quintile (51

percent) to the second lowest quintile (59 percent), there was an increase of 8 percentage points in

the coverage of full immunization.

The immunization coverage is also tabulated by number of ANC visits and place of delivery. The ANC

visits give a chance to health functionaries to advise expecting mothers about child health care.

Similarly, in case of institutional delivery, health functionaries get an opportunity to advise women

about the importance of immunization. Children whose mothers avail ANC and too frequently are

more particular about utilization of health care for their children. The antenatal visits led to

substantial improvement in immunization coverage. Almost one-quarter (24 percent) of children

whose mother received no ANC did not get a single vaccine compared to nine percent of those

whose mother received ANC only once and two percent of those whose mother received ANC for

four or more times. Similarly, the coverage of full immunization increased from 40 percent among

the children whose mother did not receive any ANC to 55 percent among those whose mother

received ANC only once and 76 percent among those whose mother received ANC for four or more

times. Immunization coverage was much higher among those children who were born in health

institutions compared to those born at home. More than two-thirds of the children born in the

health institution (68 percent of those born in government health institutions and 74 percent of

65 66 68 67 57

72 62

49

66 67 66 78 82

7 7 5 6 11 5 8 13

6 4 6 3 1

Mal

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ale 1 2

3+

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Sex of Child Birth Order Residence Mother's education

Full immunization* No immunization

CHILD HEALTH CARE


those born in private health institutions) received full immunization compared to 48 percent of

children born at home.

The doses of polio and hepatitis B given at birth and the three doses of hepatitis B are not included

in full immunization. The coverage of these vaccines was lower than the six vaccines included in full

immunization. The proportion of the children who received polio and hepatitis B at birth was 63

percent and 58 percent respectively. The differentials in the coverage of these vaccines across

different characteristics are similar to those in the coverage of six vaccines included in full

immunization. A higher coverage of these vaccines among the children born at health institutions

was expected. However, it may be noted that the coverage of these vaccines was not very high even

among the children born at either government health institutions or private health institutions. Two-

thirds of children received the first dose of hepatitis B and only one-third received the subsequent

three doses of the vaccine. Even among children whose mothers completed Higher Secondary or

have higher educations (38%), or those from the highest wealth quintile (41%), less than half

received three doses of hepatitis B.

For all the children who received at least one vaccine, RSOC collected data on the place where child

received vaccination. If the child received vaccination from more than one source, the place from

where the child had received most of the vaccinations was recorded. Table 5.3 presents the

distribution of children who received at least one vaccine, by place where a child received most of

the vaccination. RSOC shows that in India AWCs are the major providers of child immunization.

Almost half (49 percent) of the children got immunized in AWCs, 35 percent were immunized in

government health facilities and 12 percent received immunization in private health institutions. The

utilization of AWCs for immunization was much higher in rural areas (60 percent), among ST children

(63 percent) and those from the lowest wealth quintile (70 percent). AWC and government health

facility were the two major places for immunization, together providing immunization to 85 percent

of children in India. Only in urban areas (25 percent) and in the highest wealth quintile (31 percent) a

sizeable proportion of children got immunized in private health facility.

CHILD HEALTH CARE


Table 5.3: Place of immunization

Percent distribution of children aged 12-23 months who received any vaccine by place of immunization,

according to background characteristics

Characteristics

Place of Immunization Number of children aged 12-23 months

who received at least one vaccine

Anganwadi Centre

Govt. hospital/health

institution

Pvt Hospital/clinic/nursing home

Home Other


Social Group Scheduled Caste 55.0 36.3 5.5 1.1 2.0 3,294 Scheduled Tribe 63.1 27.7 6.3 1.3 1.7 1,866 OBC 52.4 29.6 13.3 2.3 2.4 6,631 Other 36.3 44.7 16.0 1.4 1.7 4,678 No Response 20.6 68.8 9.2 0.7 0.7 141

Wealth Index Lowest 69.7 23.1 2.1 2.9 2.3 3,086 Second 59.6 33.0 3.0 1.8 2.5 3,325 Middle 53.3 36.5 7.1 1.2 1.9 3,610 Fourth 39.0 42.5 15.4 1.3 1.8 3,300 Highest 25.8 40.5 30.7 1.3 1.7 3,286

Total 49.3 35.3 11.7 1.7 2.0 16,609

Table 5.4 presents the variation in the percentage of children receiving full immunization, partial

immunization and no immunization across the states. The coverage of full immunization ranged

from 33 percent in Nagaland to 92 percent in Goa. In three states of Nagaland (33 percent),

Meghalaya (45 percent) and Uttar Pradesh (47 percent) less than half of children received full

immunization.

CHILD HEALTH CARE


Table 5.4: Vaccinations by state

Percentage of children aged 12-23 months by status of immunization and percentage with an immunization

card seen by the interviewer, by state

State Full

Immunization Partial

immunization No

Immunization

Percentage with an immunization card*

Seen by interviewer

Seen/Not Seen by interviewer

India 65.3 28.1 6.6 42.4 84.3 North


Central

Chhattisgarh 67.2 31.1 1.7 47.9 78.9 Madhya Pradesh 53.5 37.1 9.3 38.8 82.0

East

Bihar 60.4 28.1 11.6 39.7 77.2 Jharkhand 64.9 24.1 11.0 33.7 81.6 Odisha 62.0 30.0 8.0 64.5 85.8 West Bengal 75.2 22.2 2.6 79.8 97.0

Northeast

Arunachal Pradesh 50.5 40.6 9.0 13.1 80.0 Assam 55.3 38.2 6.5 29.5 93.9 Manipur 55.2 36.0 8.8 39.8 72.4 Meghalaya 44.6 37.9 17.5 24.9 80.5 Mizoram 68.6 26.8 4.6 3.1 92.2 Nagaland 33.2 27.4 39.4 1.6 49.7 Sikkim 77.8 21.6 0.6 66.1 97.9 Tripura 59.2 28.9 11.9 33.8 84.5

West

Rajasthan 60.7 31.1 8.2 33.4 78.0 `Goa 91.9 7.8 0.3 54.9 96.6 Gujarat 56.2 37.6 6.2 31.3 85.7 Maharashtra 77.4 21.2 1.4 39.6 86.5

South

Andhra Pradesh 74.1 23.6 2.3 37.5 86.7 Karnataka 79.4 18.1 2.4 46.6 92.7 Kerala 83.0 16.8 0.2 52.4 95.5 Tamil Nadu 76.3 22.3 1.4 39.9 80.9

* Percentage with an immunization card by state are presented for children aged 0-35 months

CHILD HEALTH CARE


Figure 5.4: Percentage of children aged 12-23 months who received full immunization by state, RSOC, 2013-14

After completion of the schedule of eight doses of six vaccines, BCG, three doses of DPT, three doses

of polio and one dose of measles, children need to be given two booster doses of DPT, one at the

age of 16-24 months and a second at age five and a second dose of measles at age 16-24 months.

RSOC collected data about the first booster of DPT and measles for children aged below three years

of age and about the second booster of DPT and booster of measles for children aged 3-6 years.

Table 5.5 presents coverage of the booster doses among children in urban, rural and total areas.

Table 5.5: Receipt of booster dose of DPT and 2nd

dose of Measles

Percentage of children aged 24-35 months who received 1st dose of DPT and 2nddose of measles and

percentage of children aged 60-71 months who received 2nd booster dose of DPT and 2nddose of measles, by

residence.

Residence

24-35 months 60-71 months

DPT Booster-1

Measles-2 Number of

children age 24-35 months

DPT Booster-2

Measles-2 Number of

children age 60-71 months

Urban 42.4 29.2 5,679 17.9 80.5 5,202 Rural 31.2 25.8 12,923 9.4 67.7 12,051 Total 34.6 26.9 18,602 11.9 71.5 17,253

It is already reported in Table 5.1 that 75 percent of the children aged 12-23 months received three

doses of DPT. However, only 35 percent of the children aged 24-35 months received first booster of

DPT and subsequently only 12 percent of the children aged 60-71 months received second booster

of DPT. The coverage of booster doses of DPT was substantially lower than the three doses of DPT

given in the first year of life. The coverage of first dose of measles was 79 percent among the

children aged 12-23 months. Compared to this level, the coverage of the second dose of measles

among children aged 24-35 months was only 27 percent. However, its coverage among children

aged 60-71 months was much higher at 72 percent. In other words, a majority of children received

the second dose of measles but not at 16-24 months as required, but later.

33 45 47 51 54 55 55 56 59 59 60 61 62 65 65 67 69 69 70 71 74 75 76 77 78 79 79 80 83

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Him

ach

al P

rad

esh

Ke

rala

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a

CHILD HEALTH CARE


The differentials in coverage of both the booster doses of DPT and the second dose of measles by

urban/rural areas are similar to the differentials in the coverage of other vaccines, and full

immunization. The coverage of both the booster doses of DPT was almost 10 percentage points

higher in urban areas than in rural areas. However, even in urban areas less than half (42%) of

children aged 24-35 months received the first booster and only 18 percent of the children aged 60-

71 months received the second booster of DPT.

5.2 CHILDHOOD DISEASES

Pneumonia and the Diarrhoeal diseases are major causes of child mortality in India. Malaria and

fever due to various infections also contribute to morbidity and mortality among young children.

Fever is a major manifestation of malaria and other acute infections among children. Considering the

fact that the leading causes of death beyond the neonatal period are diarrhoea and pneumonia,

Ministry of Health and Family welfare, Government of India, has given priority attention to the

management of these two illnesses. Availability of ORS and Zinc is ensured at all sub-centres and

with all frontline workers. Use of Zinc is actively promoted along with use of ORS in the case of

diarrhoea in children. Use of recommended antibiotics (based on national guidelines) in children

aged two months to five years with non-severe pneumonia is ensured through frontline workers

(ASHA, ANM) and at all levels of health facilities. Timely and prompt referral of children with fast

breathing and/or lower chest in-drawing to higher level facilities is emphasized.

RSOC collected data on three different childhood morbidities for all children aged 0-6, i.e., below 72

months of age. Mothers were asked during 15 days prior to the survey whether the child (1) suffered

from diarrhoea, (2) had symptoms of ARI and (3) had fever. For each of these diseases details of

medical treatment given were asked. The following sections discuss details of prevalence of these

diseases and the pattern of medical treatment given in case of episodes of the diseases.

5.2.1 Diarrhoea

As mentioned previously, Diarrhoea is one of the major causes of mortality among children beyond

the neonatal period. In most cases of diarrhoea, death is caused by dehydration due to loss of water

and electrolytes. Dehydration from diarrhoea can be prevented by giving extra fluids at home, or it

can be treated simply, effectively and cheaply in all age-groups except for the most severe cases.

Treatment is by an adequate glucose-electrolyte solution called Oral Rehydration Salts (ORS)

solution. In order to control diarrhoeal diseases, Government of India has adopted the WHO

guidelines on diarrhoea management. India introduced the low osmolarity ORS, as recommended by

WHO for the management of diarrhoea. Zinc has been approved as an adjunct to ORS for the

management of diarrhoea. Addition of Zinc can cause a reduction in the number and severity of

episodes and the duration of diarrhoea.

RSOC collected information from the interviewed ever married women with children below age six,

whether a child had diarrhoea during 15 days prior to survey. For all the children who had diarrhoea,

information was collected on whether medical treatment/advice had been sought, place of

treatment, whether ORS was given to the child, source of ORS and whether child was given

CHILD HEALTH CARE


antibiotics. The proportion of children who had diarrhoea in the 15 days prior to the survey and the

proportion of children who received treatment by source of treatment are presented in Table 5.6.

Though data was collected for all the children below age six, for the purpose of comparability with

other surveys, data is presented for children below age five. The prevalence of diarrhoea during 15

days prior to the survey was estimated at 6.5 per 100 children aged 0-59 months. The prevalence of

diarrhoea which was 7.4 percent among children below six months of age increased to 10.2 among

children aged 6-11 months. After age one year, prevalence of diarrhoea showed a decreasing trend

with the child’s age. The prevalence was the highest in the age range of 6-11 months, the age mainly

when children are introduced to food other than breast-milk. Both male and female children are

equally likely to suffer from diarrhoea. Except by age, the diarrhoea prevalence did not show any

consistent variation either by residence, mother’s education, religion, social group or wealth

quintile.

More than three-quarters (78 percent) of children suffering from diarrhoea were treated. A higher

proportion (82-84 percent) of young children aged 6-23 months received medical attention

compared to children in other age-groups. In each category of children either by gender, religion,

social group, mother’s education or wealth quintile about 75 percent of the children having

diarrhoea received treatment. Children with diarrhoea were taken to multiple places for treatment.

Among all the facilities, private health facility was the major place for treatment, as 62 percent of

the children having diarrhoea were taken to a private health facility. About a quarter (23 percent) of

children was taken to a government health facility, 11 percent were taken to an AWC and for 10

percent of the children treatment was sought from medical shopkeepers. Utilization of private

health facility was relatively higher in urban areas (69%) than in rural areas (58%), whereas use of

AWC was higher in rural areas (13%) compared to urban areas (5%).

Younger children suffering from diarrhoea were likely to be taken to a private hospital whereas older

children were more frequently taken to AWCs. Almost two-thirds (65 percent) of children aged 0-36

months, compared to 53 percent aged 36-71 months, were taken to private hospital for diarrhoea

treatment and eight percent of children aged 0-35 months compared to 17 percent aged 36-59

months were treated in AWCs. There was not much difference in the utilization of public and private

health facility for treating male and female children having diarrhoea. A relatively higher proportion

of children with mothers having no education or from ST were taken to AWCs for treatment of

diarrhoea. With an increase in mother’s education there was an increase in the utilization of private

health facilities. For example, 70 percent of the children with mothers educated for 12 or more years

were taken to a private health facility compared to 59 percent of the children with mothers having

no education. Use of private health facilities increased with better economic condition; use of AWCs

and government health facilities decreased. Three-quarters of children from the highest wealth

quintile were treated in a private health facility and 24 percent in either an AWC or a government

health facility, compared to 54 percent and 41 percent respectively from the lowest wealth quintile.

CHILD HEALTH CARE


Table 5.6: Prevalence of diarrhoea, treatment sought and place of treatment

Percentage of children aged 0-5 years who had diarrhoea in 15 days preceding the survey, percentage of children with diarrhoea who received treatment and percent

distribution of those who received treatment by place of treatment, according to background characteristics

Characteristics

Percentage of children who had diarrhoea in the last 15

days preceding survey

Number of children aged 0-5

years

Percentage of children who had diarrhoea

and received treatment


years with diarrhoea

Place of treatment Number of

children who

sought treatment

Anganwadi Centre

Govt. Hospital/ Health Centre

Pvt Hospital/ Clinic/

Nursing Home

Any Medicine

Shop

Traditional Practitioner

ASHA Other

Age of Child (in months)

<6 7.4 9,281 75.3 688 4.6 21.8 62.4 9.8 1.8 0.5 4.0 518 06-11 10.2 8,489 83.8 868 10.0 19.1 69.8 6.1 1.2 1.6 3.2 727 12-23 8.8 17,791 82.0 1,573 7.0 22.6 64.6 10.6 1.8 0.7 2.7 1,290 24-35 5.7 18,602 76.8 1,067 10.6 24.3 62.9 9.8 2.0 2.0 3.0 820 36-47 4.9 18,993 71.4 933 15.7 25.0 54.7 10.9 2.6 1.5 3.1 666 48-59 4.4 19,449 74.6 864 19.1 25.3 51.1 12.2 3.7 2.7 3.1 645 0-35 7.7 54,163 80.0 4,196 8.1 22.1 65.0 9.3 1.7 1.2 3.1 3,355 36-59 4.7 38,442 72.9 1,798 17.4 25.2 52.9 11.5 3.1 2.1 3.1 1,311

Sex of the Child

Male 6.5 48,453 79.8 3,171 10.4 21.6 61.8 10.4 1.5 1.2 3.1 2,529 Female 6.4 44,151 75.7 2,822 11.2 24.6 61.3 9.4 2.8 1.8 3.1 2,137

Residence

Urban 6.3 28,232 76.4 1,788 5.3 20.0 69.2 6.8 1.7 0.3 2.8 1,366 Rural 6.5 64,372 78.5 4,205 13.0 24.2 58.4 11.2 2.3 1.9 3.2 3,300

Mother education

No Education 5.9 31,443 76.6 1,849 13.1 20.1 58.8 15.3 1.5 1.5 2.6 1,416 Below Primary 6.1 4,573 86.7 277 10.2 27.5 56.4 8.4 2.3 1.8 5.2 240 Completed Primary 7.5 14,298 77.4 1,076 9.0 26.6 58.5 8.6 2.2 0.9 3.3 833 Completed Middle 6.8 13,978 77.4 949 10.7 26.3 58.3 7.9 1.2 2.0 3.7 735 Completed Secondary 6.7 12,720 79.2 854 9.1 23.0 67.1 6.1 2.4 1.1 2.3 677 Completed Higher

Secondary and above 6.3 15,592 77.4 988 9.9 19.8 69.9 7.2 3.7 1.7 3.4 765

CHILD HEALTH CARE


Characteristics

Percentage of children who had diarrhoea in the last 15

days preceding survey


years

Percentage of children who had diarrhoea

and received treatment


years with diarrhoea

Place of treatment Number of

children who

sought treatment

Anganwadi Centre

Govt. Hospital/ Health Centre

Pvt Hospital/ Clinic/

Nursing Home

Any Medicine

Shop

Traditional Practitioner

ASHA Other

Religion

Hindu 6.6 72,487 77.3 4,769 10.9 23.3 61.1 9.6 2.2 1.6 3.4 3,685 Muslim 6.0 15,269 81.0 919 6.3 19.8 65.6 12.4 1.0 0.6 2.6 744 Christian 5.7 2,339 75.3 134 23.1 24.8 52.7 9.0 5.2 4.0 1.3 101 Sikh 3.7 1,342 76.2 50 (14.0) (20.9) (67.4) (9.3) (4.7) (0.0) (2.3) 38 Jain 12.6 163 * 21 * * * * * * * 19 Buddhist 9.9 573 88.8 57 17.3 50.1 47.2 0.7 3.0 3.0 0.0 50 No religion 8.7 55 * 5 * * * * * * * 4 Other 10.7 372 (73.9) 40 (5.9) (41.2) (41.2) (14.7) (0.0) (0.0) (0.0) 25

Social Group

Scheduled Caste 6.7 18,733 78.9 1,246 8.3 27.6 55.5 11.5 1.6 1.1 4.9 983 Scheduled Tribe 6.3 10,641 73.0 671 17.4 29.4 52.7 8.6 1.8 1.7 2.1 490 OBC 7.0 37,251 77.3 2,601 10.4 18.7 65.6 10.3 1.6 0.9 2.0 2,009 Others 5.7 25,061 79.8 1,434 10.7 23.9 63.8 8.6 3.7 2.6 3.6 1,144 Do Not Know 4.5 919 (86.7) 41 (5.1) (30.8) (48.7) (10.3) (0.0) (0.0) (10.3) 39

Wealth Index

Lowest 6.8 18,922 77.2 1,279 14.5 26.1 54.1 12.5 0.8 1.3 3.7 988 Second 6.2 18,918 79.1 1,182 12.1 24.4 56.6 10.6 1.7 1.4 3.1 935 Middle 6.6 19,139 78.8 1,254 12.6 22.8 60.1 11.2 2.1 2.1 2.6 989 Fourth 6.9 18,756 76.6 1,298 7.6 22.5 66.2 6.8 3.8 1.3 3.5 994 Highest 5.8 16,870 77.6 980 5.9 18.0 73.3 8.2 2.2 1.2 2.5 760

Total 6.5 92,604 77.9 5,993 10.7 23.0 61.6 9.9 2.1 1.5 3.1 4,666

CHILD HEALTH CARE


Table 5.7 provides the percentage of children with diarrhoea who were treated with antibiotics,

home available fluids, ORS, and ORS plus zinc; and source of ORS, by selected characteristics.

Children with diarrhoea were given multiple therapies. Among the children with diarrhoea, 47

percent were given antibiotics. Generally antibiotics is not prescribed for diarrhoea among children,

still a large proportion of the children received this treatment. About 25 percent of the children were

given home available fluids like plain water, rice water, dal water, butter milk etc., 39 percent were

given ORS and 13 percent were given ORS as well as zinc. The main source of ORS was private

facilities. For 47 percent of children who were given ORS, the treatment was obtained from a private

health facility and 15 percent purchased it from the market. For more than one-fifth (22 percent) of

children ORS was obtained from government health facilities. The three primary health workers,

Anganwadi workers in AWCs (17 percent), ANMs (7 percent) and ASHAs (5 percent) were also

reported as sources of ORS.

A slightly higher proportion of young children aged 0-35 months (47%) than older children aged 36-

71 months (44%) received antibiotics. In each category of children by residence, social group or

wealth quintile, at least 40 percent of the children were given antibiotics. Use of ORS and ORS plus

zinc was relatively higher in urban areas (44 percent and 16 percent respectively) than in rural areas

(37 percent and 11 percent respectively). Use of ORS also increased with wealth quintile. For

example, among children from the lowest wealth quintile, 33 percent were given ORS and 9 percent

were given ORS plus zinc, whereas among children from the highest wealth quintile, 45 percent were

given ORS and 15 percent were given ORS with zinc.

The variation in the source of ORS across the categories of residence, social group or wealth quintile

was similar to the source of treatment for diarrhoea. For a higher proportion of children from urban

areas than from rural areas, ORS was obtained from private health facilities (57 percent in urban vs.

42 percent in rural), whereas for a lower proportion of them it was obtained from AWCs (8 percent

in urban vs. 22 percent in rural). For a relatively higher proportion of children from STs (27 percent),

ORS was obtained from AWCs, compared to their counterparts from other social groups (12-19

percent).

CHILD HEALTH CARE


Table 5.7: Liquids/fluids given under oral rehydration as a part of diarrhoea treatment and source of ORS

Among children aged 0-5 years who had diarrhoea in the 15 days preceding the survey, percentage received

antibiotics to treat the diarrhoea, percentage who were given oral rehydration therapy (ORT) and percent

distribution of those who received ORS by its source, according to background characteristics

Characteristics

Percentage

of children

received

antibiotics as

treatment of

diarrhoea

Liquid/fluid given to drink

during diarrhoea Number of

children

sought

treatment

for

diarrhoea

Place from where ORS procured from

Caregiver Institution Other

Any

Home

Availab

le Fluid

(HAF*)

ORS ORS &

Zinc AWC ANM ASHA

Govt.

Health

Institut

ions

Pvt

Health

facility

Purcha

sed

from

market

Other

Age of Child (in

months)

<6 37.4 16.8 32.4 10.2 688 9.1 3.9 3.4 23.8 54.1 14.7 3.0

06-11 51.0 19.5 36.7 13.0 868 11.4 2.0 4.2 25.8 52.3 15.5 2.7

12-23 47.6 24.2 40.2 14.8 1,573 13.5 3.8 4.4 23.1 49.2 15.1 2.9

24-35 50.3 26.9 45.8 12.3 1,067 17.0 8.5 4.4 19.9 50.0 12.3 2.6

36-47 43.2 27.3 43.1 10.9 933 30.7 13.6 5.4 19.5 35.1 15.5 1.1

48-59 45.7 30.7 33.7 12.7 864 20.4 10.7 5.0 20.2 39.8 16.4 1.2

0-35 47.3 22.7 39.6 13.0 4,196 13.5 4.8 4.2 22.8 50.7 14.3 2.8

36-59 44.4 28.9 38.6 11.7 1,798 26.3 12.3 5.2 19.8 37.1 15.9 1.1

Sex of the Child

Male 47.1 24.6 40.5 12.4 3,171 16.9 6.2 4.5 21.9 47.3 15.5 1.9

Female 45.8 24.6 38.0 12.8 2,822 17.7 8.1 4.5 22.0 45.9 13.9 2.8

Residence

Urban 44.7 26.1 44.1 16.1 1,788 8.4 3.9 0.9 22.1 56.5 13.0 2.8

Rural 47.2 23.9 37.3 11.2 4,205 21.9 8.7 6.4 21.8 41.5 15.7 2.0

Religion

Hindu 45.8 23.9 39.1 12.0 4,769 17.2 7.0 4.8 21.4 46.9 14.5 2.6

Muslim 46.3 25.7 38.6 15.3 919 15.1 4.7 1.6 23.3 48.1 17.9 1.1

Christian 62.5 33.1 53.7 18.3 134 30.9 24.7 12.8 16.8 42.8 12.1 1.0

Sikh 59.4 23.2 29.1 8.5 50 * * * * * * *

Jain * * * * 21 * * * * * * *

Buddhist 69.0 36.1 38.1 10.1 57 14.2 1.5 5.8 36.3 54.3 0.3 0.1

No religion * * * * 5 * * * * * * *

Other (34.8) (34.8) (67.4) (15.2) 40.0 (3.1) (0.0) (6.3) (40.6) (12.5) (34.4) (3.1)

Social Group

Scheduled Caste 48.4 24.8 39 12.8 1,246 18.8 7.2 5.0 23.4 40.5 14.3 4.4

Scheduled Tribe 42.8 26.2 36.8 13.2 671 26.7 10.1 11.4 25.5 34.3 12.2 1.6

OBC 49.0 23.5 38.5 12.3 2,601 17.4 7.2 3.0 21.8 50.5 13.7 1.2

Others 42.5 25.0 42.3 13.0 1,434 12.1 5.6 3.8 19.4 51.1 17.6 2.9

Do Not Know 26.2 (42.8) (36.9) (8.0) (41.0) * * * * * * *

Wealth Index

Lowest 45.5 24.6 33.4 9.2 1,279 26.0 7.6 7.2 23.5 34.4 14.8 1.3

Second 42.4 22.3 37.0 10.5 1,182 19.3 3.7 4.2 30.2 42.2 10.5 2.6

Middle 47.3 26.8 39.9 14.6 1,254 17.9 10 6.3 21.0 41.8 21.1 2.5

Fourth 49.0 24.8 42.1 14.5 1,298 15.2 9.5 2.0 18.4 49.1 16.1 3.2

Highest 48.0 24.0 45.3 14.8 980 9.0 3.4 3.3 18.0 64.9 10.4 1.6

Total 46.5 24.6 39.3 12.6 5,993 17.3 7.0 4.5 21.9 46.7 14.8 2.3


CHILD HEALTH CARE


5.2.2 Fever and Acute Respiratory Infection (ARI)

Fever as it is not a disease, however, is a symptom of infections of various kinds. In areas with

malaria, fever can be due to malarial infection. As with any patient, children with suspected malaria

should have parasitological confirmation of diagnosis before treatment begins, and for confirmed

cases treatment should be provided.46 RSOC asked interviewed women about each child below age

six, whether in the 15 days prior to the survey, the child had fever. For all the children who had

fever, further information was collected about blood test and administration of anti-malarial drug

treatments.

ARI or Pneumonia takes a large toll of children below age five. Early diagnosis and appropriate case

management with rational use of antibiotics remains one of the most effective interventions to

prevent death due to pneumonia. The ARI guidelines by the Government of India are being revised

with the inclusion of the latest available global evidence. The guidelines are: If the child has a cold,

cough and fever with normal respiratory rate and no evidence of chest recession then the child can

be managed at home with paracetamol for fever. If the child has a cold, cough, and fever with

increased respiratory rate, but no evidence of chest recession, then the child is suffering from

pneumonia. Such a child needs to be treated at the nearest health centre. If the child has a cold,

cough and fever, with increased respiratory rate as well as evidence of chest recession along with

colour change on tongue and lips, then the child is suffering from severe pneumonia. Such a child

needs to be treated in the nearest hospital because the child needs admission and injections with

antibiotics.

RSOC asked interviewed women about each child below age six, whether in the 15 days prior to the

survey, the child had an illness with a cough, did the child breathe faster than usual with short, rapid

breaths or had difficulty breathing, and fast breathing or difficulty in breathing was due to a problem

in the chest or to a blocked or runny nose. Furthermore, a question on whether treatment was given

for the illness was also asked. Children with a cough accompanied by chest related short, rapid

breathing are classified as having symptoms of ARI.

Table 5.8 presents prevalence of fever among children aged 0-71 months during 15 days prior to the

survey by selected characteristics. The table also shows the proportion of children with a fever for

whom blood test was carried out and proportion who were given anti-malarial drug. The prevalence

of cough and symptoms of ARI and proportion of children for whom medical treatment/advice was

sought are also presented in the table. The prevalence of fever among children aged 0-71 months

was 13.6 percent, more than twice the prevalence of diarrhoea (6.4 percent), 15 percent of the

children with fever had blood test carried out and 18 percent were given anti-malarial drug. The

prevalence of fever was higher among younger children aged 0-35 months (14.5 percent) than

among older children aged 36-71 months (12.5 percent). The prevalence of fever among children

aged 6-23 months was much higher, at 16 percent.

46www.who.int/malaria/areas/high_risk_groups/children/en/

CHILD HEALTH CARE


Table 5.8: Prevalence and management of fever and symptoms of ARI by selected characteristics

Percentage of children aged 0-5 years, who had fever in 15 days preceding the survey, percentage of children with fever for whom blood was taken from his/her finger for

testing, who took anti-malarial drugs and percentage who had symptoms of acute respiratory infection (ARI) in the last 15 days preceding the survey and percentage

sought advice or treatment for the illness, according to background characteristics.

Characteristics

Fever Symptoms of ARI

Percentage with fever

Number of children 0-5

years

Percentage for whom blood

was taken from his/her finger

for testing

Percentage who took

anti-malarial

drugs

Number of children

with fever

Percentage of children who had cough in the last

15 days preceding the survey

Percentage of children

with symptoms

of ARI

Percentage received

advise/treatment for ARI

Number of children

with symptoms

of ARI

Age of Child (in months) <6 10.6 9,281 8.7 14.0 985 14.8 8.8 82.8 818 06-11 16.6 8,489 13.1 16.2 1,406 19.1 10.7 77.9 911 12-23 16.3 17,791 14.7 18.1 2,899 18.7 10.2 75.7 1,807 24-35 13.7 18,602 14.5 19.5 2,551 16.6 9.2 76.5 1,705 36-47 12.5 18,993 17.7 19.5 2,370 15.0 7.4 76.1 1,413 48-59 12.5 19,449 18.4 19.5 2,426 13.6 6.9 75.6 1,333 0-35 14.5 54,163 13.6 17.7 7,841 17.4 9.7 77.4 5,240 36-59 12.5 38,442 18.1 19.5 4,796 14.3 7.1 75.8 2,746

Sex of the Child Male 13.8 48,453 15.3 19.2 6,671 16.6 8.9 78.1 4,331 Female 13.5 44,151 15.3 17.5 5,965 15.5 8.3 75.4 3,655

Residence Urban 13.2 28,232 16.1 16.4 3,739 14.9 7.6 79.9 2,145 Rural 13.8 64,372 14.9 19.2 8,898 16.6 9.1 75.8 5,841

Mother education No Education 13.4 31,443 12.2 17.7 4,200 15.0 8.6 75.4 2,696 Below Primary 16.0 4,573 11.6 17.3 730 20.2 11.1 71.1 506 Completed Primary 15.7 14,298 16.9 19.8 2,239 18.3 10.3 75.6 1,469 Completed Middle 14.2 13,978 15.3 16.8 1,986 18.0 8.9 79.3 1,243 Completed Secondary 13.1 12,720 18.8 23.6 1,660 15.1 7.7 77.3 985 Completed Higher Secondary and

above 11.7 15,592 18.8 15.6 1,821 14.1 7.0 81.9 1,086

CHILD HEALTH CARE


Characteristics

Fever Symptoms of ARI

Percentage with fever

Number of children 0-5

years



for testing

Percentage who took

anti-malarial

drugs

Number of children

with fever

Percentage of children who had cough in the last



with symptoms

of ARI

Percentage received

advise/treatment for ARI

Number of children

with symptoms

of ARI

Religion Hindu 13.2 72,487 16.0 19.3 9,536 16.0 8.5 76.9 6,130 Muslim 16.1 15,269 11.5 14.4 2,461 17.5 9.9 78.5 1,507 Christian 11.2 2,339 27.3 29.5 263 12.3 5.8 49.4 135 Sikh 13.2 1,342 7.4 10.8 178 12.5 7.3 79.6 98 Jain 9.7 163 * * 16 8.2 4.2 * 7 Buddhist 23.3 573 15.1 14.2 134 19.4 12.3 89.8 70 No religion 10.8 60 * * 6 15.6 10.3 * 6 Other (11.5) 372 (28.9) (13.4) 43 14.4 8.6 72.7 32

Social Group Scheduled Caste 14.4 18,733 14.4 18.9 2,689 17.2 9.0 78.0 1,691 Scheduled Tribe 11.6 10,641 19.6 22.6 1,233 14.1 7.9 66.4 844 OBC 13.8 37,251 15.7 19.8 5,141 16.5 8.8 78.1 3,261 Others 13.5 25,057 14.1 15.1 3,390 15.2 8.3 78.1 2,069 Do Not Know 19.5 919 9.1 3.4 179 23.7 13.2 81.5 121

Wealth Index Lowest 14.8 18,922 13.9 19.0 2,795 17.9 10.6 73.9 1,998 Second 13.5 18,918 14.2 16.5 2,555 16.3 8.6 73.0 1,631 Middle 14.3 19,139 15.0 18.5 2,742 16.6 8.9 77.1 1,705 Fourth 13.1 18,756 18.1 20.3 2,458 15.1 7.8 80.0 1,470 Highest 12.4 16,870 15.4 17.5 2,086 14.3 7.0 83.2 1,182

Total 13.6 92,604 15.3 18.4 12,637 16.1 8.6 76.9 7,986


CHILD HEALTH CARE


Among the children who had fever, the proportion of children who got their blood test done and

who were given anti-malarial drug showed an increasing trend with the child’s age. However, the

increase was modest. The prevalence of fever among children from urban and rural areas, as well as

male and female children, was almost same. The prevalence of fever did not hold any consistent

relationship with either mother’s education or wealth quintile. Similarly, the proportion of children

who had a blood test and who were given anti-malarial drugs did not vary by gender or residence,

and did not show any trend with either by mother’s education or wealth quintile.

Almost one in every six (16 percent) children aged 0-5 had cough during the 15 days prior to the

survey. However, all those who had cough did not show the symptoms of ARIs. Only about 50

percent of the children (8.6 percent of all children) having cough had breathing faster than usual

with short, rapid breaths or had difficulty in breathing, and the difficulty in breathing was due to a

problem in the chest or to a blocked or runny nose (i.e. symptoms of ARI). For more than three-

quarters (77 percent) of the children with ARI, medical advice/treatment was sought.

Similar to the prevalence of fever, the prevalence of cough and symptoms of ARI was relatively

higher among younger children (17.4 percent and 9.7 percent respectively) aged 0-35 months than

the older children (14.3 percent and 7.1 percent respectively) aged 36-71 months. A relatively

smaller proportion (8.8 percent) of infants below six months had symptoms of ARI, however the

proportion increased to 10.7 percent among older infants aged 6-11 months and decreased

thereafter. For at least 75 percent of children in each age-group advice or treatment was sought.

There was no or minor difference in the prevalence of symptoms of ARI among male and female

children, and in proportion for whom medical help was sought. The prevalence of ARI symptoms was

a little higher in rural areas (9.1 percent) than in urban areas (7.6 percent), though in both areas

medical help was sought for 76-80 percent of affected children. With increases in mother’s

education and wealth quintile, there was a decrease in the prevalence of symptoms of ARI and an

increase in the proportion of children who received medical help, though the differences were not

very significant. For example, 10.6 percent of the children from the lowest wealth quintile showed

symptoms of ARI and 74 percent of them received medical help as against 7.0 percent from the

highest wealth quintile showing symptoms and 83 percent receiving medical help.

Annexure Table 5.9 presents prevalence and management of diarrhoea and fever across the states,

and Annexure Table 5.10 shows the state-level variation in the prevalence and management of ARI.

5.3 HEALTH CHECK-UP OF CHILDREN

Generally, children are taken to a health facility only in the event of a health problem. As the first

five years of life are very critical, it is essential that children’s health is regularly monitored by health

professionals. To assess how far this routine monitoring of health happens, RSOC asked all mothers

of children aged 0-71 months, whether the health of the child was checked in the three months prior

to the survey either when child was ill or even when he/she was not ill. For all the children who had

a check-up, it was further asked what had been the place of the check-up. Table 5.11 shows the

percentage of children who had check-ups, either when they were ill or otherwise and percentage

CHILD HEALTH CARE


distribution of such children by place where the latest check-up was done. These percentages give

an idea about the proportion of young children who are currently under medical supervision.

Table 5.11: Health check-up of children 0-71 months

Percentage of children aged 0-6 years, who had health check-up done in the six months preceding the survey,

and percent distribution of those who had health check- up by place of last check-up, by background

characteristics

Characteristics

Percentage who

had health

check-up at least

once in the 3

months

preceding the

survey47

Number

of

Children

Place of last check-up48

Number of

children aged 0-6

years who had

health check-up in

3 months

preceding the

survey

Govt.

Hospital

/Health

Centre

Private

Hospital

/Clinic

AWC Other Don't

know

Age of the child

(Months)

<6 25.5 9,281 23.0 63.2 5.7 3.2 4.9 2,363

06-11 31.2 8,489 21.5 66.6 5.7 1.6 4.6 2,649

12-23 27.9 17,791 19.0 66.6 6.1 2.5 5.8 4,965

24-35 24.6 18,602 22.8 63.9 5.9 2.3 5.1 4,575

36-47 15.0 18,993 20.1 67.0 10.3 2.5 0.1 2,858

48-59 13.8 19,449 20.4 66.6 10.9 2.0 0.1 2,675

60-71 12.3 17,253 23.6 62.2 10.4 3.5 0.3 2,120

Child age

0-35 26.9 54,163 21.3 65.2 5.9 2.4 5.2 14,552

36-71 13.7 55,694 21.2 65.5 10.5 2.6 0.2 7,653

Sex of the Child

Male 21.0 57,567 20.6 66.0 7.5 2.4 3.4 12,073

Female 19.4 52,290 22.0 64.5 7.6 2.5 3.5 10,131

Residence

Urban 21.9 33,434 18.5 73.8 3.5 1.5 2.7 7,332

Rural 19.5 76,423 22.6 61.1 9.5 2.9 3.9 14,872

Wealth Index

Lowest 16.2 22,672 23.5 57.3 9.9 3.5 5.8 3,681

Second 17.6 22,576 25.8 58.3 8.2 2.4 5.2 3,983

Middle 20.8 22,491 22.7 62.6 9.0 2.6 3.1 4,668

Fourth 23.0 22,027 21.7 67.9 6.6 1.5 2.3 5,071

Highest 23.9 20,091 13.9 77.1 4.6 2.6 1.9 4,801

Total 20.2 1,09,857 21.3 65.3 7.5 2.5 3.5 22,204

47Health check-up done in last three months preceding survey irrespective of any illness

48Last check-up refers to the most recent health check-up done in the 3 months preceding the survey

CHILD HEALTH CARE


One in every five children (20 percent) had a health check-up in three months prior to survey. A large

proportion (65 percent) of children who had a health check-up, were taken to a private health

facility. About one-fifth (21 percent) had a check-up in a government health facility and a small

proportion (8 percent) had check-ups in AWCs. Younger children were more likely to be taken for

health check-ups than their older counterparts. More than one-quarter (27 percent) of children aged

0-35 months had health a check-up in comparison to only 14 percent of children aged 36-71 months.

In fact, almost one-third (31 percent) of children aged 6-11 were taken to a health facility. The

discussion in the earlier sections has shown that the prevalence of all the childhood diseases was the

highest among these children aged 6-11 months. So, the highest proportion of infants aged 6-11

months was under medical supervision. Almost equal proportion of male and female children and

children from urban and rural areas had health check-ups. The only difference was that utilization of

government health facilities and AWCs was higher in rural areas and utilization of private health

facilities was higher in urban areas. With an increase in the wealth quintile, there was an increase in

the practice of taking children for a health check-up, though the increase was modest. The

proportion of children taken for health check-up increased from 16 percent among children in the

lowest wealth quintile to 24 percent in the highest wealth quintile. With better economic status,

there was an increase in the utilization of private health facilities with a corresponding decrease in

the use of government health facilities and AWCs.

Annexure Table 5.12 presents the state-wise percentage of children who had check-ups when they

were ill or otherwise and percent distribution of such children by place where the latest check-up

was done.

5.4 ROLE OF ANGANWADI CENTRES

With the objective to improve the nutritional and health status of children in the age-group 0-6

years the ICDS’s AWCs provide a package of services comprising: (1) supplementary nutrition, (2)

immunization, (3) health check-up, and (4) referral services for all children below age six. The various

health services provided for children in AWCs by AWW and Primary Health Centre (PHC) staff,

include regular health check-ups, recording of weight, immunization, management of malnutrition,

treatment of diarrhoea, de-worming and distribution of simple medicines etc. During health check-

ups and growth monitoring, AWWs are supposed to refer sick or malnourished children in need of

prompt medical attention to the PHC or its sub-centre. The AWW has also been oriented to detect

disabilities in young children. She is supposed to enlist all such cases in a special register and refer

them to the medical officer of the PHC/sub-centre.

To assess the role of AWCs in providing immunization and health services, both in the form of

providing basic treatment in case of child morbidity and referral service, the percentage of children

for whom AWC services were used for different purposes were brought together in Table 5.10. The

various purposes for which AWC services are used are: (1) immunization, (2) treatment/advice

during diarrhoea episode and receipt of ORS, (3) health check-up, and (4) referral in case of

morbidity or disability. It may be noted that the percentages not only reflect the role AWCs play in

providing preventive and curative health services for young children, but also reflect the extent to

CHILD HEALTH CARE


which AWC services are utilized by people. The proportion of children who received immunization

from AWC was 49 percent (Table 5.10). About 11 percent of the children received advice or

treatment from AWC in case of diarrhoea. Seventeen percent of those who were given ORS for

diarrhoea, received it from AWCs. About eight percent of children who had a health check-up in the

three months preceding the survey had it in an AWC. Only a small proportion (7 percent) of children

was referred to health facilities during illness by an AWW. In short, the Table 5.13 shows that in

providing immunization AWCs are playing major role, whereas in providing curative or referral

service their role is modest.

There was no difference in the extent to which all the AWC services were provided to male and

female children. In rural areas, AWCs are playing a major role in providing various child health

related services. A majority of children in rural areas received immunization (59%) from AWCs. The

proportion of children in rural areas for whom different services were availed from AWCs was

almost twice of that in urban areas. AWCs are playing a major role in providing services to the

children from socially and economically disadvantaged communities. The proportions of children

from STs, children whose mother had less education and children from the lower wealth quintiles for

whom different services were availed from AWCs were much higher in comparison to their

respective counterparts. For example, among the ST children, 62 percent received immunization

from AWC.

CHILD HEALTH CARE


Table 5.13: Role of Anganwadi Centre in child health Percentage of children according to various services received from AWC for health, by background characteristics

Characteristics

Aged 0-35 Months Aged 0-71 Months

Immunization Diarrhoea and its management Health check-up Referral to any health facility

Percentage of children who received most

of the vaccination in

AWC

Number of children who received at least one vaccine

Percentage of children who had

diarrhoea in the 15 days preceding the survey for whom advice/treatment

was sought

Number of children who had diarrhoea in the 15 day preceding the

survey

Percentage of children who had diarrhoea in the


received ORS from AWC49


survey and received ORS

Percentage of children who

had last health check-up3 in an

AWC in last 3 months

Number of children who

had health check-up in 3

months preceding the

survey

Percentage referred to any health facility

during Illness50

Number of children

Sex of the Child

Male 48.5 24,270 10.0 2,778 16.6 1,601 7.5 12,073 6.6 14,200 Female 49.1 21,470 11.6 2,270 18.1 1,316 7.6 10,131 6.6 12,465

Residence

Urban 24.7 13,875 5.5 1,501 8.8 1,022 3.5 7,332 4.6 7,838 Rural 59.3 31,866 12.9 3,547 21.9 1,895 9.5 14,872 7.4 18,828

Mother education

No Education 63.8 13,893 13.3 1,534 24.0 738 7.8 5,700 5.9 8,515 Below Primary 55.3 2,127 10.6 262 20.1 166 10.6 1,065 3.9 1,593 Completed Primary 54.3 7,109 9.0 885 16.6 486 9.0 3,717 8.2 4,616 Completed Middle 48.5 7,283 9.8 810 19.9 494 8.5 3,519 5.5 4,425 Completed Secondary 39.6 6,621 9.5 734 9.5 491 7.1 3,519 8.1 3,471 Completed Higher Secondary and above 25.8 8,707 9.9 823 12.5 543 4.8 4,684 7.1 4,046

Religion

Hindu 51.9 36,215 11.1 3,952 17.4 2,275 8.0 17,448 7.0 20,613 Muslim 37.2 7,139 5.8 823 14.2 462 5.6 3,562 4.1 4,742 Christian 30.7 1,053 20.7 122 29.3 95 1.6 550 11.4 591 Sikh 35.6 735 (12.2) 44 * 20 4.6 239 4.4 331 Jain 41.8 105 * 19 * 6 (0.0) 53 (14.8) 44 Buddhist 46.2 280 15.3 58 12.4 31 12.9 243 11.7 220 No religion (35.3) 26 * 5 * 5 * 13 * 19 Other 37.3 188 (5.4) 25 * 23 11.2 96 4.1 105

49Children who had diarrhoea in the last 15 days preceding the survey. 50 Children received health check-up in last three months irrespective of any illness. ( ) Based on 25-49 unweighted cases. * Percentage not shown; based on fewer than 25 unweighted cases.

CHILD HEALTH CARE


Characteristics


Immunization Diarrhoea and its management Health check-up Referral to any health facility



AWC

Number of children who received at least one vaccine


diarrhoea in the 15 days preceding the survey for whom advice/treatment

was sought


survey



received ORS from AWC49


survey and received ORS

Percentage of children who

had last health check-up3 in an

AWC in last 3 months

Number of children who

had health check-up in 3


survey

Percentage referred to any health facility

during Illness50

Number of children

Social Group

Scheduled Caste 54.4 9,043 8.7 1,057 19.5 603 6.0 4,171 7.2 5,630 Scheduled Tribe 62.1 5,308 17.4 532 27.3 308 13.9 2,123 8.9 2,759 OBC 51.5 18,370 10.3 2,170 17.1 1,242 5.2 9,321 6.8 11,003 Others 35.9 12,665 10.5 1,240 11.8 746 9.7 6,374 4.9 6,940 Do Not Know 29.1 354 (4.4) 49 * 18 7.0 215 3.6 333

Wealth Index

Lowest 69.0 8,745 14.1 1,068 25.7 519 9.9 3,681 6.2 5,769 Second 59.1 9,265 12.5 995 19.7 523 8.2 3,983 6.7 5,487 Middle 52.3 9,510 12.0 1,070 18.0 606 9.0 4,668 8.0 5,631 Fourth 38.6 9,436 7.8 1,075 15.7 698 6.6 5,071 7.3 5,306 Highest 24.8 8,785 6.5 840 8.5 570 4.6 4,801 4.3 4,472

Total 48.8 45,741 10.7 5,048 17.3 2,917 7.5 22,204 6.6 26,665

CHILD HEALTH CARE


The state-wise percentages of utilization of AWC services for various purposes are shown in Table

5.14. There is a large variation in the utilization of AWCs for availing specific services across the

states. Similarly, within a state there is a difference in the extent to which different services are

availed for children.

In Nagaland (1 percent), Manipur (3 percent), Jammu & Kashmir (4 percent) and Meghalaya (5

percent) AWCs have played a very modest role in providing immunization services. In these four

states five percent or less of immunized children got their immunization in AWCs. In contrast, in

Jharkhand (79 percent), Odisha (83 percent) and Bihar (81 percent), more than three-quarters of

children received immunization in AWCs. Not a single child in Assam, West Bengal and Manipur

received either treatment or advice during diarrhoea episodes or ORS from AWC. In Jammu &

Kashmir, Bihar, Uttarakhand and Sikkim less than five percent of the children received treatment and

ORS from AWCs. Only in Jharkhand (30 percent), Andhra Pradesh (21 percent) and Maharashtra (19

percent) more than one-fifth of children for whom treatment for diarrhoea was sought, received it in

AWCs. Even in these three states more than one-fifth of children who were given ORS for diarrhoea,

received it from AWCs.

It was already pointed out that the role of AWC in health check-ups is quite modest, as only eight

percent of the children who had health check-up in the three months preceding the survey had it in

AWCs. In many states, like Assam, Jammu & Kashmir, Meghalaya, Manipur, and Uttarakhand, less

than one percent of the children who had health check-up in three months preceding the survey,

had it in AWCs. Only in Sikkim (25 percent) and Gujarat and Maharashtra (18 percent in both) a

relatively larger proportion of children had health check-ups in AWCs. At national level, AWCs’ role

in referral service was modest. In most of the states like Nagaland, Mizoram, Rajasthan, Assam, West

Bengal and Haryana not even two percent of the children were referred to a health facility. Only in

Andhra Pradesh a relatively large proportion (22 percent) of mothers reported that AWW referred

their child to a health facility. The preceding discussion points out that overall, in many states—

Nagaland, Mizoram, Assam, Jammu & Kashmir, Meghalaya, Manipur and Uttarakhand—AWCs are

playing a minimal role in providing preventive and curative health care services to children. In

contrast, in Jharkhand, Chhattisgarh, Gujarat and Andhra Pradesh AWCs play a relatively larger role.

Even in Bihar and Madhya Pradesh they are playing a role in providing preventive and curative

health care services.

CHILD HEALTH CARE


Table 5.14: Role of AWC in child health by state

Percentage distribution of children according to various services received from AWC for child health, by state

State

Immunization Diarrhoea and

its management Health check-up Weight and Growth

Referral to any health

facility

Aged 0-35 Months

Aged 0-71 Months



AWC


15 days preceding the

survey for whom advice/treatment

was sought

Percentage of children who had diarrhoea in the 15

days preceding the survey received ORS from

AWC


last health check-up3 in an AWC

in last 3 months

Percentage of children weighed last in an AWC in 3 months



whose mother

had discussion with AWW

on nutritional status of the child

Percentage referred to any health

facility during Illness

India 48.8 10.7 17.3 7.5 59.4 24.6 6.6 North

Delhi 8.1 11.8 9.3 3.2 9.1 7.4 5.7 Haryana 48.6 7.3 12.7 10.0 44.3 12.7 1.9 Himachal Pradesh 23.0 6.9 26.1 6.7 79.6 42.7 9.4 Jammu & Kashmir 4.4 1.1 (2.0) 0.4 (7.2) (9.4) 2.1 Punjab 29.1 5.6 * 3.8 (21.1) (18.9) 2.8 Uttar Pradesh 49.9 3.1 7.4 2.0 36.1 16.3 2.6 Uttarakhand 28.6 3.4 (3.0) 0.1 16.3 4.9 3.9

Central Chhattisgarh 71.8 2.3 9.6 8.7 90.3 44.4 2.4 Madhya Pradesh 74.4 8.9 21.7 6.1 73.2 47.9 3.6

East Bihar 80.9 0.1 2.3 1.6 62.9 23.3 2.6 Jharkhand 79.2 30.3 40.9 8.3 79.6 51.6 6.2 Odisha 83.2 14.1 23.7 9.5 86.0 24.1 4.1 West Bengal 12.4 0.0 0.0 10.8 52.1 11.7 1.8

Northeast Arunachal Pradesh 10.2 17.3 18.6 2.7 (51.7) (24.1) 3.3 Assam 27.0 0.0 0.0 0.0 21.1 2.5 1.8 Manipur 2.5 0.0 0.0 0.3 * * 2.4 Meghalaya 5.2 3.8 10.8 0.2 9.2 3.3 2.0 Mizoram 20.9 15.8 11.3 2.4 87.9 8.6 1.0 Nagaland 1.4 * * * * * 0.6 Sikkim 18.9 3.3 4.5 25.1 60.8 53.5 12.5 Tripura 31.9 (9.8) (11.6) 1.3 51.5 37.2 8.5

West Rajasthan 62.0 4.1 6.8 2.5 39.5 11.2 1.3 Goa 8.7 6.3 9.5 2.8 43.0 23.1 3.6 Gujarat 53.0 11.6 22.7 18.0 63.2 36.1 13.7 Maharashtra 38.4 19.0 25.3 17.9 72.0 31.6 7.8

South Andhra Pradesh 60.5 21.3 (29.1) 3.3 71.1 28.1 21.8 Karnataka 42.6 6.8 13.7 2.8 55.8 22.9 12.5 Kerala 8.8 12.4 15.0 3.9 27.1 12.4 9.4 Tamil Nadu 17.8 10.4 18.1 2.8 42.7 20.4 10.2



CHAPTER 6 NUTRITION OF CHILDREN AND ADOLESCENT GIRLS

Adequate nutrition is a basic human need and prerequisite for health and well-being of all, especially for

children and adolescents. Promotion of nutrition is one of the key essential elements of primary health

care. Though, the nutritional status of all the population groups is of concern, maternal and child

nutrition acquires greater importance. The level of child malnutrition in India is a matter of serious

concern.

This chapter on ‘Nutrition of Children and Adolescent Girls’ presents the findings of RSOC 2013-14

related to nutritional status of children and childhood feeding practices. It also looks into the role of

Anganwadi Centres (AWCs) of Integrated Child Development services (ICDS) in growth monitoring of the

children. Additionally, the chapter also discusses nutritional status of adolescent girls. The specific topics

included in the chapter are: (1) birth-weight and extent of low birth-weight (2) infant and young child

feeding (IYCF) practices, (3) nutritional status of children, (4) Weight monitoring of young children, (5)

Nutritional status of adolescent girls and (6) role of AWCs of ICDS in weight monitoring of the children.

6.1 BIRTH-WEIGHT

Achieving reduction in the incidence of low birth-weight babies is one of the measures for the reduction

in morbidity and mortality during infancy, especially during the neo-natal stage. World Health

Organization (WHO) has defined low birth-weight as weight at birth of less than 2,500 grams; which is

based on epidemiological observations that infants weighing less than 2,500 grams are approximately 20

times more likely to die than heavier babies. A birth-weight below 2,500 gram contributes to a range of

poor health outcomes. A baby’s low weight at birth is either the result of preterm birth (before 37

weeks of gestation) or due to restricted foetal (intrauterine) growth. Low birth-weight is closely

associated with foetal and neonatal mortality and morbidity, inhibited growth and cognitive

development, and chronic diseases later in life. In case of institutional births, babies are generally

weighed immediately after the birth. In case of home births, Anganwadi worker (AWW) and the primary

health workers like ANM or ASHA are expected to make home visits to weigh the baby within 24 hours

of birth.51

For every live-birth that occurred during the three year period prior to the survey to ever married

women interviewed, RSOC collected information on whether a baby was weighed within 24 hours of

birth, and for all the babies weighed, baby’s birth-weight was asked. Table 6.1 presents data on

51United Nations Children’s Fund and World Health Organization, Low Birthweight: Country, regional and global estimates.

UNICEF, New York, 2004.

Home Based Newborn Care Operational Guidelines, Ministry of Health and Family Welfare, Government of India, 2011.



percentage of babies weighed within 24 hours of birth and percent distribution of babies who were

weighed by birth-weight, according to selected characteristics. Little more than two-thirds (69 percent)

of the babies were weighed within 24 hours of birth. In case of a small proportion of babies, though they

were weighed, mother could not recall baby’s birth-weight. Among the babies whose birth-weight was

reported, 19 percent weighed less than 2,500 grams.

Table 6.1: Birth-weight by selected characteristics

Percentage of live births in three years preceding the survey, who were weighed within 24 hours of birth, and

percent distribution of births with reported birth-weight by weight at birth, according to selected characteristics.

Characteristics

Weighed

within 24

hours of

birth

Number of

live births in

the last three

years

Birth-weight of the

child

Number of live-

births whose birth-

weight was

reported < 2.5 Kg

2.5 kg and

more

Mother's age at birth (years)

<20 72.3 4,182 20.2 79.8 3,025

20-34 69.0 47,977 18.5 81.5 33,117

35-49 56.7 2,391 18.4 81.6 1,355

Birth order

1 77.1 25,575 19.1 80.9 19,727

2 70.7 16,502 17.9 82.1 11,661

3+ 49.0 12,473 18.5 81.5 6,108


No Education 47.3 17,616 22.7 77.3 8,340

Below Primary 67.5 2,615 19.5 80.5 1,764

Completed Primary 72.5 8,351 19.3 80.7 6,055

Completed Middle 74.9 8,562 18.7 81.3 6,411

Completed Secondary 84.6 7,602 18.4 81.6 6,433

Completed Higher

Secondary and above 86.6 9,804 14.0 86.0 8,493

Residence

Urban 79.7 16,319 18.4 81.6 13,006

Rural 64.1 38,230 18.7 81.3 24,491

Social Group

Scheduled Caste 65.3 10,976 19.6 80.4 7,167

Scheduled Tribe 63.7 6,311 21.6 78.4 4,018

OBC 67.4 21,886 18.0 82.0 14,759

Others 75.5 14,827 17.6 82.4 11,196

Do Not Know 64.8 550 20.6 79.4 357

Wealth Index

Lowest 49.9 10,977 22.3 77.7 5,483

Second 61.2 11,248 19.3 80.7 6,882

Middle 71.7 11,213 19.7 80.3 8,039

Fourth 79.1 11,092 17.6 82.4 8,779

Highest 83.0 10,020 15.6 84.4 8,314

Total 68.7 54,550 18.6 81.4 37,497



The percentage of babies weighed within a day of birth was decreasing with mother’s age and order of

the birth. Among babies of order three or more, only 49 percent were weighed within a day of birth

compared to 77 percent of first order babies. The percentage of babies weighed within a day of birth

was higher in urban areas (80%) compared to rural areas (64%). The proportion of babies weighed was

higher among babies from Other castes (76%) compared to their counterparts from the other three

social groups (64-67%). With an increase in mother’s education as well as household economic status,

indicated by wealth index, there was a sharp increase in the proportion of babies weighed. The

proportion of the babies weighed increased from 47 percent among those whose mother had no

education to 87 percent among those having mothers who completed Higher Secondary or had higher

education. Similarly, the percentage of babies weighed within a day of birth increased from 50 percent

in the lowest wealth quintile to 83 percent in the highest wealth quintile.

The proportion of babies reported to be low birth-weight babies did not vary much with either residence

or mother’s age and baby’s order of the birth. Though, among the babies from different social groups

the incidence of low birth-weight babies did not differ much, a slightly higher proportion of babies from

the ST (22%) had low birth-weight. The incidence of low birth-weight babies decreased monotonically

with both, mother’s education and household wealth quintile. Almost one-fourth (23%) of the babies to

mothers with no education had birth-weight below 2,500 grams compared to only 14 percent of babies

to mothers who completed Higher Secondary or had higher education. Similarly, the proportion of low

birth-weight babies decreased from 22 percent among babies from the lowest wealth quintile to 16

percent among the highest wealth quintile.

The state-level variation in the proportion of babies weighed within 24 hours and proportion of low-

birth weight babies is presented in Table 6.2. The proportion of babies reported to be weighed at birth

varied from the lowest of 17 percent in Nagaland to the highest of 98 percent in Kerala and Tamil Nadu.

In five states—Nagaland (17%), Uttar Pradesh (28%), Jammu & Kashmir and Bihar (46% in both) and

Uttarakhand (47%)—less than 50 percent of the babies were weighed at birth. On the contrary, in Goa

(95%), Tamil Nadu and Kerala (98% in both) practically all the babies got weighed within 24 hours of

birth. In all the states, higher proportion of babies in urban areas was weighed than those in rural areas.

The urban-rural differences were much wider in the states where only a smaller proportion of babies got

weighed, whereas they were much smaller in the states where a large proportion of babies got weighed.



Table 6.2: Birth weight by state

Among live-births in the three years preceding the survey, the percentage who were weighed within 24 hours of

birth, and percent distribution of those with reported birth weight by birth weight by residence, according to

states

State

Urban Rural Total

Weighed

within 24

hours of

birth

Birth weight of

the child Weighed

within 24

hours of

birth

Birth weight of

the child Weighed

within 24

hours of

birth

Birth weight of

the child

< 2.5

Kg

2.5 kg

and

more

< 2.5

Kg

2.5 kg

and

more

< 2.5

Kg

2.5 kg

and

more

India

North

Delhi

Haryana

Himachal Pradesh

Jammu & Kashmir

Punjab

Uttar Pradesh

Uttarakhand

Central

Chhattisgarh

Madhya Pradesh

East

Bihar

Jharkhand

Odisha

West Bengal

Northeast

Arunachal Pradesh

Assam

Manipur

Meghalaya

Mizoram

Nagaland

Sikkim

Tripura

West

Rajasthan

Goa

Gujarat

Maharashtra

South

Andhra Pradesh

Karnataka

Kerala

Tamil Nadu

79.7

76.4

73.5

82.5

67.5

68.3

35.0

66.2

79.8

74.2

54.9

71.4

92.6

82.7

86.8

86.6

85.8

87.9

95.7

32.2

93.3

93.7

72.1

95.2

88.7

89.5

91.7

93.9

99.1

97.3

18.4

21.9

17.2

13.4

15.0

20.0

21.6

13.0

15.6

22.7

13.5

15.0

20.8

16.6

6.0

16.0

6.7

12.1

3.0

13.5

8.9

14.4

20.3

16.2

19.7

19.1

18.6

17.3

13.4

18.0

81.6

78.1

82.8

86.6

85.0

80.0

78.4

87.0

84.4

77.3

86.5

85.0

79.2

83.4

94.0

84.0

93.3

87.9

97.0

86.5

91.1

85.6

79.7

83.8

80.3

80.9

81.4

82.7

86.6

82.0

64.1

74.7

74.1

74.2

38.3

63.6

26.4

38.7

64.3

56.6

44.9

51.7

83.7

74.9

57.9

71.0

58.1

58.9

86.8

11.0

86.3

73.1

53.2

93.9

87.4

87.4

91.8

86.8

97.5

98.2

18.7

23.4

22.6

18.1

17.0

21.2

22.8

15.2

17.4

23.3

15.2

14.6

18.5

17.1

14.2

13.1

7.6

9.8

1.1

24.4

10.4

20.2

24.5

17.7

19.4

21.9

18.4

17.2

12.6

15.6

81.3

76.6

77.4

81.9

83.0

78.8

77.2

84.8

82.6

76.7

84.8

85.4

81.5

82.9

85.8

86.9

92.4

90.2

98.9

75.6

89.6

79.8

75.5

82.3

80.6

78.1

81.6

82.8

87.4

84.4

68.7

76.4

73.9

74.9

45.9

65.3

28.2

47.1

67.6

61.0

46.0

55.9

85.2

77.4

65.1

73.0

67.0

64.6

91.7

16.5

87.8

78.1

57.8

94.7

87.9

88.4

91.8

89.5

98.2

97.8

18.6

21.9

20.9

17.7

16.2

20.7

22.5

14.2

16.9

23.1

15.0

14.7

18.9

16.9

11.5

13.6

7.3

10.4

2.2

18.9

10.0

18.5

23.2

16.7

19.5

20.6

18.4

17.2

13.0

16.7

81.4

78.1

79.1

82.3

83.8

79.3

77.5

85.8

83.1

76.9

85.0

85.3

81.1

83.1

88.5

86.4

92.7

89.6

97.8

81.1

90.0

81.5

76.8

83.3

80.5

79.4

81.6

82.8

87.0

83.3



The incidence of low birth-weight babies varied across the states, from the lowest of two percent in

Mizoram to 23 percent in Madhya Pradesh, Rajasthan and Uttar Pradesh. Along with Mizoram, in four

other states from the North-east region—Manipur (7%), Sikkim and Meghalaya (10% in both) and

Arunachal Pradesh (12%)—incidence of low birth-weight was at lower side. At the same time, in many

states such as Uttar Pradesh, Madhya Pradesh, Rajasthan, Maharashtra, Punjab, Haryana and Delhi 20 to

23 percent of the babies had low birth weight. In most of the states, incidence of low birth weight was

lower in urban than rural areas.

6.2 INFANT AND YOUNG CHILDREN FEEDING PRACTICES

Indian children have the same growth and development potential as all children worldwide. Optimal

nutrition in the first two years of life—including good breastfeeding, complementary feeding and care

and hygiene practices—are critical to prevent stunting in infancy and early childhood and break the

intergenerational cycle of under nutrition. The correct or good breastfeeding practices include initiation

of breastfeeding within the first hour of life, exclusive breastfeeding for the first six months and

continued breastfeeding for at least two years. After the completion of six months, children need to be

fed the right foods both in quantity and quality along with mother’s milk. RSOC collected detailed data

on IYCF practices for all the children below the age of 24 months. The IYCF practices are assessed using

the indicators recommended by WHO and UNICEF. IYCF is a set of well-known and common

recommendations for appropriate feeding of new-born and children under two years of age. IYCF

includes the following care practices: Optimal IYCF practices include:

a) Early initiation of breastfeeding; immediately after birth, preferably within one hour.

b) Exclusive breastfeeding for the first six months of life, i.e, 180 days (no other foods or

fluids, not even water; but allows infant to receive ORS, drops, syrups of vitamins,

minerals and medicines when required).

c) Timely introduction of complementary foods (solid, semi-solid or soft foods) after the

age of six months, i.e. 180 days.

d) Continued breastfeeding for two years or beyond

e) Age appropriate complementary feeding for children 6-23 months, while continuing

breastfeeding. Children should receive food from four or more food groups: [(1) grains,

roots and tubers, legumes and nuts; (2) dairy products ; (3) flesh foods (meat fish,

poultry); (4) eggs, (5) vitamin A rich fruits and vegetables; (6) other fruits and

vegetables] and fed for a minimum number of times (two times for breastfed infants, 6-

8 months; three times for breastfed children, 9-23 months; four times for non-breastfed

children, 6-23 months)

f) Active feeding for children during and after illness.52

52Indicators for assessing infant and young child feeding practices: conclusions of a consensus meeting held on 6–8 November 2007 in

Washington D.C., USA.

UNICEF, Nutrition Wins. How Nutrition Makes Progress in India, Unicef, 2013, New Delhi, India.



6.2.1 Initiation of breastfeeding

There is an ample research indicating benefits of early initiation of breastfeeding. Early initiation of

breastfeeding means breastfeeding all normal new-borns (including those born by caesarean section) as

early as possible after birth, ideally within the first hour. Initiation of breastfeeding within one hour of

birth reduces neo-natal mortality by up to 22 percent by averting deaths due to sepsis, pneumonia,

diarrhoea and hypothermia. From the first breast milk the baby receives colostrum, which protects the

baby in a number of ways. Colostrum is rich in immunologically active cells, antibodies and other

protective proteins, and thus serves as the baby’s first immunization and protects it against many

infections. It helps to regulate the baby’s own developing immune system. Colostrum contains growth

factors, which help the infant’s intestine to mature and function effectively. This makes it more difficult

for micro-organisms and allergens to get into the baby’s body. Colostrum is rich in Vitamin A, which

helps protect the eyes and reduce infection. Colostrum, the milk secreted in the first two-three days,

must not be discarded but should be fed to the newborn as it contains high concentration of protective

immunoglobulins and cells. No pre-lacteal fluid should be given to the newborn.53

All the eligible interviewed women who delivered a live birth in 24 months prior to survey were asked

whether they ever breastfed the child and if breastfed, when the breastfeeding was started, since in

many cases women squeeze out the first breastmilk before they start feeding the child. Further, it was

asked whether they fed the child first yellow thick breastmilk, i.e., colostrum. It was also asked whether

they fed the child any other thing before starting breastfeeding.

Table 6.3 presents percentage of children aged 0-23 months ever breastfed; percentage breastfed

within an hour of birth and within a day; and the percentage of children who were given pre-lacteal

feeds. Practice of breastfeeding is almost universal in India, as all but four percent of the children were

ever breastfed. However, only 45 percent children were breastfed within an hour, in all, 81 percent of

the children were breastfed within a day. RSOC shows that most of the babies (86 percent) were fed first

yellow thick milk.

Almost equal proportion of children from each category of gender, residence, religion, social group,

mother’s education or wealth index was ever breastfed. Initiation of breastfeeding was also not

influenced by any of these variables. Practice of early initiation of breastfeeding was more prevalent in

Christian and Buddhist religions. More than one-half of children from the Christian (58 percent) and

Buddhist (51 percent) religions were breastfed within an hour as compared to 32 to 45 percent in other

religions. Relatively higher proportion of children from STs (55 percent) was breastfed in comparison 42

to 45 percent from the remaining three social groups. Mother’s education or wealth index did not show

any uniform pattern in the practice of early initiation of breastfeeding.

FACT SHEET: Compiled by UNICEF Malaysia Communications,2007; Sources: UNICEF and WABA BREASTFEEDING – THE REMARKABLE FIRST HOUR OF LIFE: GUIDELINES FOR ENHANCING OPTIMAL INFANT AND YOUNG CHILD FEEDING PRACTICES; Ministry of Health and Family Welfare, Government of India, 2013 Programming Guide Infant and Young Child Feeding June 2012, Nutrition Section, Programmes, UNICEF New York Infant and Young Child 53

Factors associated with the introduction of prelacteal feeds in Nepal: findings from the Nepal Demographic and Health Survey 2011

Vishnu Khanal1*, Mandira Adhikari2, Kay Sauer13 and Yun Zhao1 International Breastfeeding Journal 2013, 8:9 doi:10.1186/1746-4358-8-9



Table 6.3: Initial breastfeeding among children aged 0-23 months

Percentage of children aged 0-23 months, who were ever breastfed, the percentage who started breastfeeding

within an hour, and one day of birth, the percentage who were fed colostrum (first yellow thick breast milk/khees),

received a pre-lacteal feed, by background characteristics.

Characteristics Ever

breastfed

Initiation of breastfeeding Percentage fed first

yellow thick breastmilk

Percentage received a pre-lacteal

feed*

Number of children

aged 0-23 months

Immediately/within an hour of

birth

Within one day of birth

Age of the Child in months

Less than 6 97.0 44.9 81.4 87.0 21.2 9,377 6-11 97.4 45.1 81.8 87.6 22.2 8,568 12-23 94.6 44.2 80.4 84.6 22.7 18,002

Sex of the Child

Male 95.7 43.8 80.6 85.5 22.6 18,996 Female 96.0 45.5 81.4 86.4 21.7 16,949

Residence

Urban 95.7 45.6 80.6 88.2 21.1 10,640 Rural 96.0 44.2 81.1 85.0 22.6 25,306

Mother education

No Education 94.9 39.9 77.4 80.7 25.8 11,508 Below Primary 95.9 47.5 81.1 85.3 19.0 1,701 Completed Primary 97.1 47.6 83.2 88.3 20.4 5,466 Completed Middle 96.4 46.3 83.4 87.7 20.3 5,650 Completed Secondary 96.0 47.0 83.0 88.9 19.3 4,986 Completed Higher Secondary and above 96.2 46.3 81.8 89.6 21.8 6,636

Religion of the head of the household

Hindu 96.1 45.1 81.2 86.7 21.9 28,208 Muslim 95.5 41.4 80.1 82.7 23.5 5,959 Christian 94.8 58.0 87.9 87.7 14.8 756 Sikh 93.1 32.3 70.5 82.0 33.7 540 Jain 83.5 34.6 64.5 70.3 36.0 90 Buddhism 95.2 50.6 82.6 90.0 8.9 222 No Religion (96.9) (53.1) (84.4) (93.8) (12.5) 17 Other 92.4 47.8 82.8 87.6 23.8 155

Caste

Scheduled Caste 96.7 43.1 81.5 87.2 22.0 7,361 Scheduled Tribe 96.0 54.7 84.2 87.3 19.3 4,205 OBC 95.8 42.3 80.3 84.0 24.3 14,381 Others 95.4 44.8 80.3 87.3 20.5 9,666 Do Not Know 98.0 43.3 78.3 88.7 21.0 334

Wealth Index

Lowest 95.6 42.5 80.6 83.2 21.9 7,250 Second 95.8 44.3 81.2 84.6 21.9 7,405 Middle 96.3 46.1 81.7 86.8 21.3 7,481 Fourth 96.6 47.6 82.6 87.9 22.5 7,180 Highest 95.1 42.3 78.7 87.5 23.4 6,629

Total 95.9 44.6 81.0 86.0 22.2 35,947




In India, there is a practice of feeding a baby with some food before the initiation of breastfeeding which

is a pre-lacteal feed. The type of pre-lacteal feeds depends on the culture. It may include ghee, honey,

sugar, sugar juice, cow/goat milk etc. All pre-lacteal feeds are mainly provided for non-nutritional

reasons such as clearing the throat/bowel; or thinking that mother’s milk is insufficient or the colostrum

is too heavy for the new born to digest. Pre-lacteal feeds have lesser nutrients and immunological values

and often likely to introduce contaminants. RSOC collected information from eligible women with child

aged 0-23 months, whether child was fed anything in the first three days of birth, and the type of food

given. Nearly one-fourth (22 percent) children aged 0-23 months were given pre-lacteal feeds. The

practice of giving pre-lacteal feeds was more or less uniform across all the categories of gender,

residence, social group, mother’s education or wealth index.

Milk was the most common pre-lacteal feed; one in every eight children (12 percent) was given milk

(Table 6.4). Other pre-lacteal feeds included honey, plain water, sugar or glucose water and janamghuti.

Table 6.4: Type of pre-lacteal liquids given

Percentage of children under two years of age who received a pre-lacteal feed, by type of pre-lacteal feed given to

the child during first 3 days of delivery, according to residence

Particulars Residence

Urban Rural Total

Percentage of children aged 0-23 months received any pre-

lacteal feed 21.1 22.6 22.2

Number of children 0-23 aged months 10,640 25,306 35,947

Type of pre-lacteal liquids given

Milk other than breast milk 11.4 12.0 11.8

Plain water 3.5 4.3 4.1

Sugar or Glucose water 2.1 2.1 2.1

Gripe Water 0.9 0.9 0.9

Sugar-Salt-Water Solution 0.6 0.7 0.6

Fruit Juice 0.4 0.2 0.3

Infant Formula 2.2 1.4 1.6

Honey 3.6 4.4 4.2

Janamghuti 2.1 2.5 2.4

Other 1.6 2.1 1.9

Number of children 0-23 months received a pre-lacteal feed 2,247 5,722 7,969

The data on children ever breastfed, children breastfed within an hour of birth, fed colostrum and given

pre-lacteal feeds across the states are presented in Table 6.5. In all the states 90 percent or more

children were ever breastfed; and except in Delhi (94 percent), Haryana and Jammu & Kashmir (91

percent in both) in all the remaining states at least 95 percent of the children were ever breastfed.



Table 6.5: Breastfeeding practices by state

Percentage of children under two years of age, by various breastfeeding practices, by states*

State

Percentage of children who were

Ever breastfed Initiated breastfeeding

within one hour of birth

Fed first yellow thick

breast milk

Received a pre-

lacteal feed

India 95.9 44.6 86.0 22.2

North

Delhi 93.6 39.1 95.9 18.8

Haryana 91.3 38.4 96.2 35.8

Himachal Pradesh 99.4 52.4 92.8 23.8

Jammu & Kashmir 91.0 13.9 94.2 27.3

Punjab 96.6 34.5 90.2 42.6

Uttar Pradesh 97.4 23.2 84.1 35.1

Uttarakhand 99.5 52.1 90.2 28.2

Central

Chhattisgarh 99.7 47.2 95.4 9.8

Madhya Pradesh 97.2 43.1 86.9 18.0

East

Bihar 98.7 37.1 86.3 27.3

Jharkhand 96.5 28.2 82.0 22.2

Odisha 99.1 76.4 96.5 19.6

West Bengal 100.0 45.4 93.9 12.9

North-east

Arunachal Pradesh 98.0 73.1 99.7 5.3

Assam 96.1 72.1 86.0 5.1

Manipur 98.2 62.9 95.2 26.6

Meghalaya 99.6 65.5 96.7 7.8

Mizoram 98.1 93.8 99.0 4.0

Nagaland 99.0 66.7 95.3 1.2

Sikkim 100.0 60.5 90.3 5.5

Tripura 99.0 43.9 96.2 6.8

West

Rajasthan 98.2 39.6 91.3 28.6

Goa 98.7 53.6 95.5 13.4

Gujarat 98.1 44.0 89.3 20.5

Maharashtra 96.0 57.6 93.9 15.8

South

Andhra Pradesh 94.7 55.4 92.8 13.2

Karnataka 96.2 50.5 86.2 20.4

Kerala 99.5 70.3 97.7 8.5

Tamil Nadu 100.0 74.4 94.2 11.2

* Percentages at state level are calculated for children aged 0-5 months.



Though breastfeeding was nearly universal across the states, there was wide variation in the practice of

early initiation of breastfeeding. Early initiation of breastfeeding within one hour varied from the lowest

of 14 percent in Jammu & Kashmir to the highest of 94 percent in Mizoram. In most of the states from

the north, central, east and west regions the extent of early initiation of breastfeeding was low. The

exception is in Himachal Pradesh and Uttarakhand (52 percent in both), Odisha (76 percent), Goa (54

percent) and Maharashtra (58 percent) where in case of majority of the children breastfeeding was

initiated within an hour of birth. In all the states from southern region and north-eastern region, with

the exception of Tripura, majority of the children were breastfed within one hour of birth. Though, there

was variation in the extent of early initiation of breastfeeding in all the states, 80 percent or more

children were fed with first yellow thick milk. At national level, the proportion of children who received

pre-lacteal feeds was 22 percent. The proportion varied across the states from the lowest of one

percent in Nagaland to 43 percent in Punjab. In general, the practice of giving pre-lacteal feeding was

more prevalent in those states where initiation of breastfeeding was delayed.

6.2.2 Exclusive Breastfeeding and Continuation of Breastfeeding by Age One and Two

For all the children born during two years prior to survey and surviving at the time of survey,

information on whether the child was breastfed on the day and night before the survey day, was

collected. In addition, data on the liquids and solid food given on the day and night before the survey

day was also collected. Table 6.6 presents percentage of children aged 0-5 months who were breastfed

and exclusively breastfed by selected characteristics. Exclusive breastfeeding for the first six months

means that an infant receives only breast milk from his or her mother or a wet nurse, or expressed

breast milk, and no other liquids or solids, not even water. The only exceptions include administration of

oral rehydration solution, oral vaccines, vitamins, minerals supplements or medicines. Most (96%) of the

children aged 0-5 were breastfed at the time of survey. However, in addition to breast milk, many of

these children were given some other fluids or semi-solid or soft foods. So in all 65 percent of the

children aged 0-5 months were exclusively on breast milk. The extent of exclusive breastfeeding was

almost same among the male and female babies and in both the rural and urban areas. Educated

women are expected to be more aware of benefits of exclusive breastfeeding. However, the extent of

exclusive breastfeeding was decreasing with mother’s education. The proportion of children aged 0-5

months who were exclusively breastfed decreased from 67 percent among children with mother having

no education to 62 percent among children with mother having secondary and above education. The

extent of exclusively breastfeeding also decreased with better economic status. The proportion of

children aged 0-5 months who were exclusively breastfed decreased from 70 percent in the lowest

wealth quintile to 62 percent in the highest wealth quintile.

As mentioned previously the optimal breastfeeding practices include continuation of breastfeeding up

to two years and beyond. The recommended indicators for measuring the continuation of breastfeeding

are proportion of children breastfed tillage one (measured by proportion of children aged 12-15 months

with continued breastfeeding) and age two years (measured by proportion of children aged 20-23

months with continued breastfeeding). Eighty-five percent of the children were continued to be given

breastfeeding till age one and 68 percent of the children were breastfed by age two.



The prevalence of continued breastfeeding by age one and two was almost same among male and

female children. The practice of continuing breastfeeding was much prevalent in rural than urban areas;

71 percent of the children in rural areas were breastfed by age two as compared to only 60 percent in

the urban areas. among the children from four social groups, the highest proportion of children from the

STs (90 percent by age one and 74 percent by age two) were continued to be breastfed by age one and

two.

Table 6.6: Exclusive breastfeeding and continued breastfeeding by age one and two

Percentage of children aged 0-5 months who are currently breastfed and who are currently exclusively breastfed,

percentage of children aged 12-15 months and 20-23 months who are currently breastfed according to selected

characteristics.

Characteristics

Children aged 0-5 months Children aged 12-15

months

Children aged 20-23

months

Currently

breastfed

Exclusive

breast

feeding

Number

of

children

Currently

breastfed

Number of

children

Currently

breastfed

Number of

children

Sex of child

Male 95.3 64.9 4,912 85.2 3,500 68.2 2,696

Female 95.9 64.8 4,368 84.3 3,154 66.6 2,395

Residence

Urban 95.3 64.2 2,549 79.3 2,029 59.7 1,574

Rural 95.7 65.1 6,731 87.1 4,626 70.9 3,517

Mother education

No Education 95.8 67.0 3,206 88.9 1,996 75.4 1,630

Below Primary 96.6 67.8 438 89.5 296 74.6 279

Completed Primary 96.0 64.6 1,389 85.4 1,036 68.3 780

Completed Middle 95.1 65.3 1,383 83.9 1,116 66.7 820

Completed Secondary 95.0 61.7 1,287 83.1 858 60.7 700

Completed Higher

Secondary and above 95.3 62.3 1,577 78.9 1,352 55.8 882

Religion

Hindu 96.0 65.7 7,331 85.0 5,236 68.6 3,933

Islam 94.3 62.6 1,521 85.1 1,059 66.3 882

Christian 95.0 58.8 194 73.2 136 55.2 125

Sikh 93.0 53.8 130 85.7 104 50.7 83

Jain * * 26 * 24 * 10

Buddhism 91.2 76.8 43 85.7 45 51.5 37

No Religion * * 6 * 3 * 3

Other 90.8 63.9 29 78.0 47 (78.6) 18

Social-group

Scheduled Caste 95.5 67.1 1,935 87.6 1,390 70.2 958

Scheduled Tribe 95.9 64.3 1,125 89.6 697 73.6 604

Other Backward Class 94.8 64.0 3,680 81.6 2,618 65.0 2,068

Others 96.6 64.5 2,452 85.0 1,903 65.7 1,413

Do Not Know 99.2 69.5 89 97.0 46 (90.7) 48



Characteristics

Children aged 0-5 months Children aged 12-15

months

Children aged 20-23

months

Currently

breastfed

Exclusive

breast

feeding

Number

of

children

Currently

breastfed

Number of

children

Currently

breastfed

Number of

children

Wealth Index

Lowest 96.2 70.0 2,022 90.2 1,257 78.8 999

Second 95.7 67.2 1,977 87.3 1,306 75.0 1,135

Middle 95.4 61.6 1,892 85.4 1,433 63.7 1,031

Fourth 96.4 62.8 1,784 82.4 1,334 59.2 953

Highest 94.0 61.7 1,606 78.8 1,324 59.1 974

Total 95.6 64.9 9,281 84.8 6,654 67.5 5,091


* Percentage not shown; based on fewer than 25 unweighted cases.

Mother’s education and better economic status had led to early discontinuation of breastfeeding. With

increase in mother’s education the proportion of breastfed children by age one has decreased from 89-

90 percent among children whose mothers either had no education or studied below primary level to 79

percent among children whose mothers had completed higher secondary school. The decrease in the

proportion of breastfed children by age two with mother’s education was much sharper from 75 percent

among children whose mothers had no education to 56 percent among children with mother having

higher secondary schooling. The drop in the continuation of breastfeeding with higher economic status

also followed the same pattern.

The state-level variation in the prevalence of exclusive breastfeeding among children below the age of

six months, continuation of breastfeeding by age one and two is presented in Annexure-A Table 6.7.

6.3.3 Complementary Feeding

By the time child completes six months of life, breast milk alone is no longer enough to meet the

nutritional needs of the infant, and at this age complementary foods need to be added to the diet of the

child. The transition from exclusive breastfeeding to family foods, referred to as complementary

feeding, typically from six months of age. It is recommended by WHO that complementary feeding

should be timely, meaning that all infants should start receiving foods in addition to breast milk from six

months onward, when the need for energy and nutrients exceeds what can be provided through

exclusive breastfeeding.54However, infants are vulnerable during the transition phase, from exclusive

breast milk to introduction of complementary feeding over and above breast milk. For ensuring the

54www.who.int/nutrition/topics/complementary_feeding/en/



nutritional needs of a young child are met, breastfeeding must continue along with observing the

following practices for appropriate complementary feeding.

For the assessment and monitoring of the practice of complementary feeding WHO has developed an

indicator of complementary feeding. The indicator, ‘Introduction of solid, semi-solid or soft foods’ is the

proportion of infants 6-8 months of age who receive solid, semi-solid or soft foods during the previous

day of measurement.

Data was collected from eligible women on liquids and solid, semi-solid and soft foods fed to all children

aged 6-23 months during 24 hours preceding the survey. Using this data, the percentage of children

aged 6-8 months introduced complementary food is estimated (Table 6.8). The data reveals that 51

percent children aged 6-8 months in India received complementary foods; in other words in case of 51

percent of children, introduction of complementary food is timely. It also implies that, remaining 49

percent of the children are still on just breast milk. Little higher proportion of male children aged 6-8

months (53 percent) got complementary food than female children (48 percent). Children from urban

areas are more likely to receive complementary food, as 58 percent of children aged 6-8 months from

urban areas were receiving complementary food compared to 47 percent from rural areas.

Table 6.8: Percentage of children aged 6-8 months who were fed complementary foods

Percentage of children aged 6-8 months who were fed complementary food

Characteristics

Percentage of children aged 6-8

months who were fed

complementary food

Number of children

6-8 months

Sex of the Child

Male 52.9 2,369

Female 47.8 2,134

Residence

Urban 58.1 1,384

Rural 47.1 3,118

Social Group

Scheduled Caste 45.2 878

Scheduled Tribe 45.5 558

OBC 50.8 1,806

Others 55.6 1,196

Do Not Know 61.5 65

Wealth Index

Lowest 41.2 850

Second 44.5 826

Middle 49.9 912

Fourth 53.7 1,057

Highest 62.1 857

Total 50.5 4,502



The proportion of children aged 6-8 months receiving complementary food increased from 41 percent

among children from the lowest wealth quintile to 62 percent among children in the highest wealth

quintile. The practice of feeding complementary food seems to be positively associated with better

economic status, though even for more than one-third of the children aged 6-8 months in the highest

wealth quintile complementary feeding was not timely.

The state-level variation in the percentage of children aged 6-8 months who were introduced

complementary feeding is presented in Annexure-A Table 6.7.

Type of complementary food items

Table 6.9 shows the types of complementary food items given to the children aged 0-23 months on the

day and night preceding the survey, according to their breastfeeding status. Even though, it is

recommended that children aged below six months should be only breastfed, a large proportion of them

were given liquid and solid food items. Five percent of breastfed babies below the age of two months

were given animal milk and three percent were given powder milk/formula. With increase in age the

proportion of babies given other liquid food increased. The proportion of breastfed children decreases

from 95 percent among children below age nine months to 71 percent among children aged 18-23

months (not shown in the table). About 11 percent of the breastfed babies aged 4-5 months were given

cow/buffalo milk and seven percent were given formula/powder milk. By age 18-23 months, 38 percent

of the breastfed children received animal milk and 15 percent received powder milk. Higher proportion

of non-breastfed than children in each age-group received other milks as compared to their breastfed

counterpart. However, among the non-breastfed children aged 0-23 months, 22 percent received

formula/powder milk and 54 percent received animal milk. In other words, many of the non-breastfed

children did not receive any milk. Even among the very young non-breastfed children in the age-group 0-

5 months only 26-39 percent received animal milk and 13-17 percent received formula. The practice of

giving water to the baby was quite prevalent. Even nine percent of the breastfed children aged 0-2

months were given water to drink.

With increase in age there was a sharp increase in the proportion of babies given different kind of solid

or semi-solid food items. In each age-group, a higher proportion of non-breastfed than breastfed

children received solid/semi-solid food. However, after completion of age one when the frequency of

breastfeeding decreases substantially, almost equal proportion of breastfed and non-breastfed children

received solid/semi-solid food. The most common solid/semi-solid food both breastfed and non-

breastfed children aged 6-23 months received were food items made from grain/roots/tubers (70

percent of breastfed and 83 percent of non-breastfed children) and those made from pulses/lentils (40

percent of breastfed and 48 percent of non-breastfed children). Feeding babies with fruits, vegetables,

eggs or flesh food is not common. Even among the older children aged 18-23 months, 28-35 percent of

either breastfed or non-breastfed children received vitamin A rich fruits/vegetables, 27-31 percent

received dark leafy vegetables and 15-21 percent received other fruits and vegetables. Similarly, about

9-13 percent of the babies aged 18-23 months received eggs and 10-12 percent received meat/fish etc.



Table6.9: Liquids consumed by children aged 6-23 months in the day or night preceding the interview

Percentage of children 6-23 months of age, consumed any liquids in the day or night preceding the interview, by breastfeeding status and age

Liquids Solid or Semi-solid foods

Number

of

children

6-23

months

Age

(Months)

Plain

water

Water

items

such as

Dal/Rice

water

Powder

milk/

Formula

Cow's/Buffalo's/

Goat's/

Other animal’s

milk

Juice or

Juice

drinks

(mango,

orange,

apple,

lemon

etc.)

Butter

milk/beaten

curd

Any

other

Liquids

Fortified

baby

foods

such as

Cerelac

etc.

Food

made

from

grains,

roots

and

tubers

Food

made

from

pulses/

lentils/

legumes

and

nuts

Dairy

products

(cheese,

paneer,

dahi and

other

food

made

from

milk)

Flesh

foods

(meat,

fish, and

liver/organ

meats)

Eggs

Vitamin A

rich fruits

and

vegetables

Any dark,

green

leafy

vegetables

Any other

fruits and

vegetables

Any

other

solid

or

semi-

solid

food

BREASTFEEDING CHILDREN

<2 9.3 2.7 3.4 5.4 0.7 0.5 0.9 1.9 3.0 1.5 0.7 0.6 0.3 0.8 0.6 0.6 0.6 2,395

02-03 15.8 4.6 5.2 8.5 0.6 0.7 2.2 4.4 5.6 3.6 1.2 0.8 0.8 1.6 1.4 1.1 0.9 3,180

04-05 25.0 7.1 6.6 11.3 1.5 1.1 1.6 7.4 8.6 3.7 1.3 0.7 0.4 1.4 1.5 1.1 1.2 3,296

06-08 58.7 27.5 12.9 21.5 4.6 2.0 5.8 19.2 39.7 17.1 4.2 2.3 2.1 7.9 5.9 3.9 7.1 4,225

09-11 77.7 45.7 13.7 27.3 7.0 3.3 7.5 23.0 64.0 34.3 6.0 3.8 4.9 16.7 13.4 7.9 9.7 3,643

12-17 85.1 56.9 14.5 35.2 10.9 5.5 10.0 24.7 78.1 45.9 7.9 7.7 7.3 25.4 21.9 13.0 12.6 8,154

18-23 88.3 62.2 15.3 37.5 11.9 6.8 10.5 24.1 83.1 50.3 9.1 9.9 8.6 28.4 26.8 15.2 13.5 5,599

06-23 79.5 50.6 14.3 31.8 9.3 4.8 8.9 23.2 69.5 39.5 7.2 6.6 6.2 21.3 18.6 10.9 11.3 21,622

Total 61.5 37.4 11.6 25.1 6.9 3.6 6.8 17.8 51.0 28.9 5.4 4.9 4.5 15.5 13.6 8.0 8.3 30,493

NON- BREASTFEEDING CHILDREN

<2 43.8 25.1 12.5 25.5 11.7 7.2 12.6 7.1 25.9 19.3 7.9 4.2 4.5 12.6 17.7 11.0 8.1 115

02-03 43.8 30.1 15.8 28.6 7.7 5.4 10.2 13.5 26.3 21.4 12.4 5.3 4.7 12.2 9.0 8.4 4.5 136

04-05 56.8 35.2 17.3 39.0 8.9 6.9 14.1 10.5 40.9 29.3 9.6 8.7 5.5 16.9 13.6 10.5 5.3 159

06-08 71.7 51.6 25.4 49.5 9.9 15.2 9.8 28.2 58.2 27.7 11.8 6.8 5.5 17.1 14.8 15.4 6.0 230

09-11 79.7 48.1 25.4 47.9 13.3 6.2 10.7 35.5 70.7 38.7 8.2 6.1 5.4 24.4 19.1 11.9 11.1 390

12-17 89.4 62.3 20.5 56.9 19.8 11.8 14.7 31.5 83.7 49.1 14.6 10.6 9.5 33.8 27.3 18.6 17.4 1,712

18-23 90.2 64.9 22.2 56.2 19.6 11.5 11.8 28.5 86.3 50.4 11.7 12.3 13.0 35.2 31.0 21.0 15.2 2,325

06-23 88.1 61.9 22.0 55.5 18.6 11.3 12.7 30.2 82.6 47.8 12.5 10.9 10.7 32.9 27.8 19.1 15.2 4,658

Total 84.9 59.4 21.5 53.6 17.9 10.9 12.7 28.6 78.5 45.9 12.3 10.5 10.3 31.4 26.7 18.3 14.5 5,067



Age appropriate complementary feeding for children 6-23 months

In addition to the indicator of timely complementary feeding, three more globally agreed indicators of

age appropriate complementary feeding are: (1) minimum dietary diversity, (2) minimum meal

frequency and (3) minimum acceptable diet. These indicators better reflect the quality and quantity of

food given to children aged 6-23 months. The ‘Minimum dietary diversity’ is the proportion of children

6-23 months of age who receive foods from four or more food groups out of seven groups. The seven

food groups include the following:

a. Grains, roots and tubers

b. Legumes and nuts

c. Dairy products (milk, yoghurt, cheese)

d. Flesh foods (meat, fish, poultry, and liver/organ meats)

e. Eggs

f. Vitamin A rich fruits and vegetables

g. Other fruits and vegetables

The indicator of ‘minimum meal frequency’ is the proportion of breastfed and non-breastfed children 6-

23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-

breastfed children) the minimum number of times or more: two for 6-8 months, three for 9-23 months,

and four for 6-23 months (if not breastfed). The indicator of ‘minimum acceptable diet’ is the proportion

of children 6-23 months of age who had both minimum meal frequency and dietary diversity (in both

breastfed and non-breastfed children). This is a composite indicator which reflects both quality of diet

and frequency of complementary feeding.

Table 6.10 presents percentage of breastfed and non-breastfed children, who on the day and night prior

to survey received food with minimum dietary diversity, minimum meal frequency and minimum

acceptable diet. In the age-group of 6-23 months, most (82 percent) of the children are breastfed.

Among these breastfed children, 36 percent were fed the recommended number of times, only 20

percent children met the required dietary diversity and only 11 percent breastfed children received

minimum acceptable diet. In other words, for most of the children aged 6-23 months complementary

feeding was not of acceptable quality. Among the non-breastfed children, though a relatively larger

proportion of them received food for recommended minimum number of times (63 percent) and with

minimum dietary diversity (33 percent), only 12 percent of the non-breastfed children received

minimum acceptable diet. For the combined group of breastfed and non-breastfed children aged 6-23

months, only 11 percent received minimum acceptable diet.



Table6.10: Infant and young child feeding (IYCF) practices Percentage of children 6-23 months who were fed a minimum number of times, with minimum dietary diversity and a minimum acceptable diet during the day

or night preceding the survey, by background characteristics.

Characteristics

Among breastfed children, percentage fed:

Number of

breastfed children

6-23 months

Among non-breastfed children, percentage fed:

Number of non-

breastfed children

6-23 months

Among all (both breastfed or non-breastfed) children, percentage fed:

Number of

children 6-23

months

Minimum number of

times55

Minimum dietary

diversity56

Minimum acceptable

diet57

Minimum number of

times

Minimum dietary

diversity

Minimum acceptable

diet

Minimum number of

times

Minimum dietary

diversity

Minimum acceptable

diet

Age of child (Months)

06-08 38.1 6.7 5.4 4,225 55.6 17.5 4.5 230 39.0 7.3 5.4 4,455

09-11 26.3 14.2 7.0 3,643 60.7 20.8 9.9 390 29.7 14.8 7.3 4,034

12—17 36.7 24.1 12.2 8,154 62.2 34.0 13.3 1,712 41.1 25.8 12.4 9,867

18-23 40.9 27.4 15.1 5,599 65.2 36.6 12.9 2,325 48.0 30.1 14.4 7,924

Sex of the Child

Male 36.8 20.7 11.5 11,479 62.7 32.0 11.6 2,393 41.2 22.6 11.5 13,872

Female 35.8 19.0 9.9 10,142 63.8 34.8 13.2 2,264 40.9 21.9 10.5 12,406

Residence

Urban 37.7 23.0 11.5 6,247 65.3 37.2 15.2 1,769 43.8 26.1 12.4 8,016

Rural 35.7 18.6 10.4 15,375 62.0 31.0 10.7 2,888 39.9 20.6 10.4 18,263

Mother education

No Education 35.1 16.3 9.7 6,939 60.8 27.6 8.3 1,159 38.8 17.9 9.5 8,098

Below Primary 42.5 18.6 10.4 1,074 58.0 21.2 7.0 174 44.7 18.9 9.9 1,248

Completed Primary 36.0 18.8 10.0 3,354 64.6 34.0 12.6 659 40.7 21.3 10.4 4,013

Completed Middle 35.9 22.1 10.7 3,462 63.6 35.0 13.5 754 40.9 24.4 11.2 4,216

Completed Secondary 35.5 21.9 11.5 2,885 61.7 34.6 14.3 788 41.1 24.6 12.1 3,674

Completed Higher Secondary and above

37.9 24.2 12.8 3,907 66.7 38.8 15.3 1,123 44.3 27.4 13.3 5,030

55Minimum number of times means feeding solid or semi-solid food at least twice a day for breastfed children aged 6-8 months; feeding solid or semi-solid food 3 or more times a

day for breastfed children 9-23 months and feeding solid or semi-solid food 4 or more times a day including milk feeding for non-breastfed children during the previous day. 56

Minimum dietary diversity means children received three or more food groups for breastfed children and four or more food groups for non-breastfed children (Food groups are: a. foods made from grains or roots and tubers, including bread, chapatti, rice, chichi, noodles, porridge, biscuits, idli or any other food, also includes fortified baby food like Cerelac etc. ; b. Food made from pulses/lentils/legumes and nuts; c. Dairy products (cheese, paneer, dahi and other food made from milk); d. Flesh foods (meat, fish, and liver/organ meats); e. eggs; f. vitamin A-rich fruits and vegetables; g. any other fruits and vegetables) 57

Minimum acceptable diet: Breastfed children6-23 months of age who had at least minimum dietary diversity and minimum meal frequency during the previous day and non- breastfed children6-23 months of age who receive at least 2 milk feedings, had at least minimum dietary diversity (not including milk feeds) and the minimum meal frequency during the previous day.



Characteristics

Among breastfed children, percentage fed:

Number of

breastfed children

6-23 months

Among non-breastfed children, percentage fed:

Number of non-

breastfed children

6-23 months

Among all (both breastfed or non-breastfed) children, percentage fed:

Number of

children 6-23

months

Minimum number of

times55

Minimum dietary

diversity56

Minimum acceptable

diet57

Minimum number of

times

Minimum dietary

diversity

Minimum acceptable

diet

Minimum number of

times

Minimum dietary

diversity

Minimum acceptable

diet

Religion

Hindu 36.3 19.6 10.6 16,993 62.8 33.6 12.5 3,580 40.9 22.0 11.0 20,573

Muslim 36.5 20.4 11.1 3,599 65.9 32.1 11.9 763 41.6 22.4 11.3 4,362

Christian 35.9 28.0 10.9 415 56.9 46.1 18.5 144 41.3 32.7 12.8 560

Sikh 35.0 19.6 10.7 315 61.6 12.7 5.3 92 41.0 18.1 9.4 407

Jain (34.5) (24.1) (10.3) 44 * * * 19 43.3 24.1 6.8 63

Buddhist 39.9 20.3 10.4 144 (57.5) (57.5) (20.0) 34 43.9 23.5 10.0 178

No religion * * * 8 * * * 2 * * * 11

Other 41.2 23.0 13.7 103 * * * 23 47.0 28.3 14.7 126

Total 36.3 19.9 10.7 21,622 63.3 33.4 12.4 4,658 41.1 22.3 11.0 26,279

( ) Based on 25-49 unweighted cases. * Percentage not shown; based on fewer than 25 unweighted cases.



Majority of the children (50 percent or more) in each age-group did not meet the minimum dietary

diversity nor they were fed for the minimum number of times. Even among the children aged 18-23

months only 14 percent received minimum acceptable diet. There was no difference in feeding practices

followed while feeding male and female children and in rural and urban areas. Feeding practices

improved with increase in mother’s education and wealth index. The better feeding practices with either

mother’s education or wealth index were mainly because of the fact that educated or wealthy mothers

feed their children from diverse food groups.

The percentages of breastfed and non-breastfed children, who on the day and night prior to survey

received food with minimum dietary diversity, minimum meal frequency and minimum acceptable diet

across the states, are presented in the Annexure-A Table 6.11.

6.3 MICRO-NUTRIENT SUPPLEMENTATION

Micro-nutrients are essential vitamins and minerals required in small quantity for healthy body. Regular

intake of vitamins and nutrients such as vitamin A, iron and iodine is essential to ensure good growth

and development in infants, and optimal cognitive development among the pre-school children. In

addition, supplementation and deworming improves health and nutrition. Vitamin A deficiency is a

leading cause of preventable blindness, morbidity and mortality among pre-school children.

To understand whether infants and young children below two years are fed food rich in vitamin A and

iron, RSOC collected data on the vitamin A rich and iron rich food consumed by children aged 6-23

months during 24 hours preceding survey. Children who consumed meat and organ meats, fish, eggs,

pumpkin, carrots, sweet potatoes that are yellow or orange inside, dark green leafy vegetables, ripe

mango, papaya, cantaloupe and jackfruit are considered as given vitamin A rich food. The iron rich food

included meat and organ meats, fish, poultry, eggs or dark green leafy vegetables. For all the children

aged 6-71 months data on vitamin A supplementation, Iron and Folic Acid (IFA) dose and deworming

medicine given during six months preceding the survey was also collected. Table 6.12 presents the

percentage of children aged 6-23 months that received vitamin A and iron rich food in 24 hours prior to

survey. The table also gives percentage of children aged 6-59 months who received vitamin A

supplementation, IFA dose and deworming medicine during six months preceding the survey. Among all

the infants and young children aged 6-23 months, 36 percent were fed with vitamin A-rich food and 43

percent were fed iron-rich food.



Table 6.12: Micro-nutrient supplementation

Percentage of children aged 6-23 months who consumed Vitamin A rich and iron rich foods in the day or night preceding the survey, percentage of children 6-

59 months given Vitamin A and Iron Folic acid supplements in the last 6 months and percentage given deworming medication in the last six months preceding

the survey, by background characteristics.

Characteristics

Children aged 6-23 Months Children aged 6-59 Months

Percentage who

consumed foods

rich in Vitamin A

in last 24 hours58

Percentage who

consumed foods

rich in iron in last

24 hours59

Number of

children 6-

23 months

Percentage

given Vitamin A

supplements in

last 6 months

Percentage

given Iron &

Folic

supplements in

last 6 months

Percentage

given de-

worming

medication in

last 6 months

Number of

children 6-

59 months

Sex of the Child

Male 36.0 42.8 13,872 44.8 13.1 27.8 43,541

Female 36.9 42.5 12,407 45.6 13.8 27.4 39,783

Residence

Urban 38.9 49.8 8,016 48.3 15.2 30.0 25,683

Rural 35.4 39.5 18,263 43.8 12.7 26.6 57,640

Mother education

No Education 32.2 35.0 8,098 37.5 9.9 20.1 28,237

Below Primary 42.1 43.4 1,248 43.2 9.8 30.4 4,135

Completed Primary 36.1 41.8 4,013 46.0 14.6 30.0 12,909

Completed Middle 38.0 44.4 4,216 45.4 12.1 29.7 12,594

Completed Secondary 37.5 46.2 3,674 54.9 18.7 33.1 11,433

Completed Higher Secondary

and above 40.1 51.6 5,030 52.3 17.5 33.3 14,015

58Includes meat and organ meats, fish, eggs, pumpkin, carrots, sweet potatoes that are yellow or orange inside, dark green leafy vegetables, ripe mango, papaya, cantaloupe,

and jackfruit.

59Includes meat and organ meats, fish, poultry, eggs or dark green leafy vegetables.



Characteristics


Percentage who

consumed foods

rich in Vitamin A

in last 24 hours58

Percentage who

consumed foods

rich in iron in last

24 hours59

Number of

children 6-

23 months

Percentage

given Vitamin A

supplements in

last 6 months

Percentage

given Iron &

Folic

supplements in

last 6 months

Percentage

given de-

worming

medication in

last 6 months

Number of

children 6-

59 months

Religion

Hindu 35.6 41.6 20,573 46.5 14.0 28.0 65,156

Muslim 39.5 45.9 4,362 37.5 9.5 24.8 13,748

Christian 48.9 62.9 560 54.5 21.4 32.4 2,145

Sikh 30.9 36.9 407 37.7 5.9 13.2 1,213

Jain 27.8 30.3 63 53.1 27.7 51.1 136

Buddhist 35.4 35.8 178 65.1 25.2 61.3 529

No religion * * 11 30.1 16.0 27.7 53

Other 43.5 54.7 126 35.8 13.5 28.3 343

Social Group

Scheduled Caste 34.3 38.6 5,334 43.4 12.3 24.4 16,797

Scheduled Tribe 36.3 39.6 3,043 46.0 15.4 28.2 9,515

OBC 34.4 41.4 10,513 45.5 13.7 25.5 33,571

Others 40.9 48.5 7,147 46.4 13.5 32.8 22,610

Do Not Know 45.2 50.6 242 24.6 1.9 33.2 830

Wealth Index

Lowest 32.8 35.4 5,125 37.5 8.7 23.0 16,899

Second 35.3 38.9 5,333 42.8 10.9 25.3 16,941

Middle 36.8 42.2 5,515 46.8 15.8 27.7 17,247

Fourth 36.5 45.9 5,344 50.2 16.7 31.3 16,972

Highest 40.9 51.3 4,961 48.8 15.1 31.2 15,264

Total 36.4 42.7 26,279 45.2 13.4 27.6 83,324

* Percentage not shown; based on fewer than 25 unweighted cases.



There was no difference in feeding vitamin A and iron rich food to both male and female children.

Almost equal proportion of both male and female children was fed vitamin A and iron rich foods. A

higher proportion of children from urban areas was fed vitamin A rich foods (39 percent urban vs 35

percent rural) and iron rich foods (50 percent urban vs 40 percent rural). The proportion of children who

were fed vitamin A rich foods did not show any specific pattern with mother’s education, though the

proportion of children who received iron rich foods shows an increase with mother’s education.

Children from the wealthier households were more likely to receive vitamin A and iron rich foods. The

proportion of children who were fed vitamin A rich foods and iron rich foods, both, showed positive

association with wealth index.

RSOC shows that less than one-half of children (45 percent) aged 6-59 months received vitamin A

supplementation in six months preceding the survey. In government programmes, deworming medicine

is given along with vitamin A supplementation. However, only 28 percent of the children received it. The

coverage of IFA supplementation was much lower as only 13 percent of the children aged 6-59 months

received IFA supplementation in six months preceding the survey. The coverage of all the three, i.e.,

vitamin A, IFA and deworming medicine was same among male and female children. It was higher in

urban areas than rural areas, though the urban-rural difference in each of the proportions of children

who received vitamin A, IFA and deworming medicine was less than five percentage points. Among the

children from four social groups, there was no difference in the coverage of vitamin A, IFA and

deworming medicine. With increase in both, mother’s education as well as wealth index, there was an

increase in the coverage of vitamin A and iron supplementation and deworming medicine, though the

increase was moderate and not uniform across the categories of mother’s education or wealth quintile.

The percentage of children aged 6-23 months that received vitamin A and iron rich food in 24 hours

prior to survey and the percentage of children aged 6-59 months who received vitamin A

supplementation, IFA dose and deworming medicine during six months preceding the survey by states is

shown in Annexure-A Table 6.13.

6.4 NUTRITIONAL STATUS OF CHILDREN

Undernutrition among the pre-school children is one of the major public health concerns in India.

Malnutrition limits development and the capacity to learn. It also costs lives: about 50 per cent of all

childhood deaths are attributed to malnutrition. Malnutrition in early childhood has serious, long-term

consequences because it impedes motor, sensory, cognitive, social and emotional development.

Malnourished children are less likely to perform well in school and more likely to grow into

malnourished adults, at greater risk of disease and early death.

Government of India is committed to tackling child malnutrition. The National Policy for children, 2013

states that, ‘Every child has a right to adequate nutrition and to be safeguarded against hunger,

deprivation and malnutrition. The state commits to securing this right for all children through access,

provision and promotion of required services and supports for holistic nurturing, well-being with



nutritive attainment of all children.’ The AWCs under ICDS) provide take home rations for children aged

6-35 months and morning breakfast and hot cooked meal to children aged 36-71 months.

For the anthropometric measurement each interviewing team included one health investigator who was

responsible for all the anthropometric measurements. Each health investigator carried a scale and a

measuring board. The digital salter scale was used for weight measurement. The scale had an accuracy

level of 100 grams and could measure weights ranging from 5 kg to 150 kg. The length of children below

two years of age was measured using an infantometer and the height of children aged two to five years

was measured using a stadiometer. Both the infantometer and stadiometer could be used to measure

the length/height up to an accuracy level of 0.1 cm (one tenths of a centimetre). In cases where the

child or infant was not able to stand on the scale on her own, then a differential method of capturing

weight of the child/infant was used. The mother/caregiver of the child was asked to hold the child and

stand on the scale. The combined weight of the mother/caregiver and child was recorded. Once this was

done the mother was asked to stand on the scale without the child/infant and the weight of the

mother/caregiver alone was recorded. The difference in the two weight recordings was the actual

weight of the child.

For the assessment of nutritional status of children WHO child growth standards were used. The

nutritional status of children was assessed using three indicators; (1) height for age (stunting), (2) weight

for height (wasting) and (3) weight for age (underweight). The data on height, weight and age in months

was converted into Z scores using WHO’s ANTHRO software.

Children whose Z score for height for age below minus three standard deviations (-3 SD) from the

median of the reference population are considered to be severely stunted or too short for their age.

Children with Z score between minus three standard deviation (- 3SD) and minus two standard deviation

(- 2SD) are considered as moderately stunted. Stunting is associated with chronic malnutrition. Studies

have documented an inverse correlation between stunting, cognitive and physical development in pre-

schoolers and consequently lower intelligence levels in older children and functional impairment in

adulthood both in terms of intellectual and physical aspects.

Children whose weight for height Z score below minus three standard deviation (-3 SD) from the median

of the reference population are considered to be severely wasted or too thin for their height. Children

with Z score between minus three standard deviation (- 3SD) and minus two standard deviation (- 2SD)

are considered as moderately wasted. Wasting is the result of acute malnutrition in the recent period.

While stunting has long term implications for adult health and productivity; wasting is closely linked to

child mortality.

The weight for age or underweight is a composite index of height-for-age and weight-for-height. It takes

into account both acute and chronic malnutrition. Children whose weight for age Z score below minus

three standard deviation (-3 SD) from the median of the reference population are considered to be

severely underweight or too light for their age. Children with Z score between minus three standard

deviation (-3SD) and minus two standard deviation (-2SD) are considered as moderately



underweight.60Table 6.14 and Figure 6.1 present proportion of children who are stunted, wasted and

underweight according to selected characteristics. RSOC shows that in India among the children aged 0-

59 months 39 percent are stunted, i.e., they are short for their age, 15 percent are wasted or thin for

their height and 29 percent are underweight or light for their age. Out of 39 percent of stunted children,

17 percent are severely stunted and remaining 21 percent are moderately stunted. In other words,

every sixth child in India is severely stunted. About 5 percent of the children are severely wasted and 10

percent are severely underweight.

Figure 6.1: Percentage of children age 0-59 months who are Stunted, Wasted and Underweight, India, RSOC, 2013-14

Prior to RSOC, the nutritional status of Indian children was assessed in NFHS-3 in 2005-06. NFHS-3

estimated the proportion of stunted, wasted and underweight children at 48 percent, 20 percent and 43

percent respectively. The RSOC results imply improvement in nutritional status of children as measured

by all the three indicators of height for age, weight for height and weight for age as shown in Figure 6.2.

The stunting has decreased by a rate of 1.3 percentage points per year during seven years between

2005-6 and 2013-14, and underweight proportion has decreased by 2.0 percentage points per year. The

level of wasting was lower compared to that of stunting and underweight and hence decreased at

slower rate of 0.7 percentage points per year.

60Mata, L., Simhon, A., Urrutia, J.J., Kronmal, R.A. Natural History of Rotavirus Infection in the Children of Santa MaríaCauqué. Prog Food Nutr

Sci.7(1983): 167–177.

De Onis, M. Measuring Nutritional Status in Relation to Mortality. Bull World Health Organ. 78(2000): 1271-1214.

Pelletier, D.L. The Relationship between Child Anthropometry and Mortality in Developing Countries: Implications for Policy, Programs and Future Research. J Nutr.124 (10 Suppl, 1994): 2047S-2081S.

17

39

5

15

10

29

Severely stunted Stunted Severely wasted Wasted Severleyunderweight

Underweight



Figure 6.2: Change in the child nutritional status

Percentage of children aged 0-59 months who are Stunted, Wasted and Underweight, India, NFHS-3 and RSOC, 2013-14

Among the youngest children aged below six months, 17 to 18 percent are stunted, wasted as well as

underweight. The proportion of stunted and underweight children increases with age, thereafter. By the

time of completion of two years, 46 percent of the children are stunted and 33 percent are

underweight. From age two onwards there is slight decrease in both the proportions but beyond age

two, they fluctuate thereafter.

There are no gender differentials in the nutritional status of Indian children. Children from rural areas

are more likely to be stunted (42 percent rural vs 32 percent urban) and underweight (32 percent rural

vs 24 percent urban) in comparison to their urban counterparts. However, children from both the areas

are equally likely to be wasted. Considering the levels of all the three indicators of nutrition, among

children from all the different religion groups, those from the Sikh and Jain religion are least likely to be

undernourished and those from Hindu and Islam are more likely to be undernourished. The proportion

of children who are stunted, wasted as well as underweight is the highest among ST (42 percent, 19

percent and 37 percent respectively) children and the lowest among those belonging to Other castes (34

percent, 14 percent and 24 percent respectively). With the increase in mother’s education as well as in

the wealth index, there is a decrease in the prevalence of undernutrition. The proportion of stunted and

underweight children decreases monotonically from the lowest to the highest wealth quintile. The

extent of wasting also reduces with wealth quintile, however the reduction is small. Though,

undernutrition is the lowest among children from the highest wealth quintile, even in this wealthiest

group every fourth (27 percent) child is stunted and every fifth child (19 percent) is underweight.

48

20

43 39

15

29

Stunted Wasted Underweight

NFHS-3 (2005-06)

RSOC (2013-14)



Table 6.14: Nutritional status of children

Percentage of children aged 0-59 months classified by their nutritional status according to three anthropometric indices—height-for-age, weight-for-height,

weight-for-age by background characteristics

Characteristics

Height-for-age Weight-for-height Weight-for-age

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

-3 SD

(Severely

Stunted)

-2 SD

(Stunted)

-3 SD

(Severely

Wasted)

-2 SD

(Wasted)

-3 SD

(Severely

Underweig

ht)

-2 SD

(Underwei

ght)

Age of the child (months)

<6 8.3 17.1 0.0 8,841 6.3 17.8 -0.3 8,069 7.4 17.8 -0.5 9,451

06-08 11.3 23.9 -0.7 4,313 5.8 16.5 -0.4 4,115 9.5 22.9 -0.9 4,525

09-11 12.2 29.5 -0.9 3,955 5.8 18.1 -0.5 3,829 10.0 26.6 -1.1 4,151

12-17 17.1 37.7 -1.3 9,638 5.3 16.2 -0.5 9,203 9.5 26.4 -1.1 10,010

18-23 22.7 45.8 -1.7 7,802 5.6 16.5 -0.5 7,529 12.0 33.3 -1.4 8,214

24-35 18.5 42.8 -1.5 18,272 4.3 14.3 -0.5 17,825 9.1 30.1 -1.3 19,082

36-47 18.7 44.1 -1.7 18,608 3.6 13.7 -0.5 18,236 9.4 31.6 -1.4 19,188

48-59 19.5 43.1 -1.8 16,142 3.8 13.7 -0.6 15,810 9.6 35.0 -1.6 16,654

Sex of the Child

Male 17.6 39.5 -1.4 45,149 4.8 15.6 -0.5 43,384 10.0 30.0 -1.3 47,150

Female 16.9 37.9 -1.3 42,423 4.4 14.5 -0.5 41,231 8.9 28.7 -1.2 44,124

Residence

Urban 13.2 32.0 -1.1 26,624 4.8 15.0 -0.4 25,516 6.9 24.3 -1.1 27,680

Rural 19.1 41.6 -1.5 60,947 4.5 15.1 -0.5 59,099 10.6 31.6 -1.3 63,593

Mother education

No education 25.1 48.7 -1.8 28,478 4.5 15.3 -0.6 27,718 14.2 37.9 -1.6 29,799

Below Primary 19.2 44.1 -1.6 4,279 3.8 15.2 -0.6 4,122 10.6 34.3 -1.5 4,406

Completed Primary 16.0 39.8 -1.4 13,208 4.7 15.2 -0.6 12,775 8.7 30.9 -1.3 13,685

Completed Middle 13.9 35.4 -1.3 12,808 4.7 15.2 -0.5 12,443 7.3 25.8 -1.2 13,278

Completed Secondary 12.2 31.3 -1.1 11,656 4.9 14.5 -0.4 11,161 5.7 22.4 -1.0 12,129

Higher Secondary and

above 10.3 26.3 -0.9 14,204 4.7 14.5 -0.3 13,584 5.2 18.7 -0.8 14,822

Mother not interviewed 13.7 32.5 -1.0 2,939 5.1 17.2 -0.5 2,812 9.8 27.6 -1.0 3,154



Characteristics

Height-for-age Weight-for-height Weight-for-age

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

Percentage below

Mean

Z-

Score

Number

of

Children

0-59

months

-3 SD

(Severely

Stunted)

-2 SD

(Stunted)

-3 SD

(Severely

Wasted)

-2 SD

(Wasted)

-3 SD

(Severely

Underweig

ht)

-2 SD

(Underwei

ght)

Religion

Hindu 17.0 38.6 -1.4 68,461 4.7 15.5 -0.5 66,149 9.4 29.7 -1.3 71,338

Muslim 19.9 42.1 -1.5 14,430 4.2 13.4 -0.4 14,058 10.3 30.5 -1.3 15,046

Christian 14.0 32.2 -1.1 2,302 4.4 15.4 -0.2 2,213 7.5 21.9 -1.0 2,443

Sikh 12.7 28.7 -1.1 1,261 3.7 10.7 0.1 1,144 6.1 17.4 -0.5 1,257

Jain 10.3 20.0 -0.6 128 4.5 11.9 0.2 125 2.9 15.9 -0.2 157

Buddhist 8.5 26.7 -0.9 587 5.3 22.0 -0.7 545 5.4 26.2 -1.0 614

No Religion 20.1 34.5 -1.2 52 3.9 11.3 0.0 51 3.4 26.4 -1.1 56

Other 13.7 34.8 -1.2 351 2.8 16.5 -0.5 330 12.0 29.2 -1.2 361

Social Group

Scheduled Caste 19.3 42.4 -1.5 17,756 4.9 15.5 -0.6 17,160 10.8 32.7 -1.4 18,509

Scheduled Tribe 19.5 42.3 -1.5 10,122 5.3 18.7 -0.6 9,642 13.0 36.7 -1.5 10,594

OBC 17.8 38.9 -1.4 34,993 4.4 14.8 -0.5 33,881 9.3 29.3 -1.3 36,580

Others 14.2 33.9 -1.2 23,790 4.4 13.6 -0.4 23,047 7.0 23.6 -1.0 24,666

Do Not Know 16.1 43.9 -1.5 911 5.3 15.4 -0.9 884 11.2 35.1 -1.6 924

Wealth Index

Lowest 25.8 50.7 -1.8 17,869 5.0 17.0 -0.7 17,335 16.3 42.1 -1.7 18,650

Second 20.4 43.9 -1.6 17,815 4.5 15.4 -0.5 17,315 11.3 34.0 -1.5 18,652

Middle 16.1 38.3 -1.3 17,953 4.7 14.8 -0.5 17,304 8.1 28.0 -1.2 18,768

Fourth 12.7 32.7 -1.1 17,879 4.3 14.9 -0.4 17,227 6.0 23.1 -1.0 18,565

Highest 10.7 26.7 -0.9 16,056 4.4 13.0 -0.3 15,434 5.1 18.6 -0.8 16,639

Total 17.3 38.7 -1.4 87,572 4.6 15.1 -0.5 84,615 9.5 29.4 -1.3 91,273



Table 6.15 presents state-wise percentage of stunted, wasted and underweight children. The

nutritional status of children below age five varies substantially across the states. The variation is

quite noticeable in prevalence of stunted and underweight children. The proportion of stunted

children varies from the lowest of 19 percent in Kerala to 50 percent in Uttar Pradesh. Along with

Kerala, in Goa (21 percent) and Tamil Nadu (23 percent) also the extent of stunting is relatively

low. In these three states less than one-fourth of the children are stunted and less than 10 percent

are severely stunted. Except these three states, in all the remaining states at least 10 percent of

the children are severely stunted and at least 25 percent are severely or moderately stunted. At

the other extreme of the spectrum of stunting are the states of Uttar Pradesh (50 percent) and

Bihar (49 percent) where every second child is stunted and every fourth child is severely stunted.

Along with these two states, even in Jharkhand (47 percent), Chhattisgarh and Meghalaya (43

percent in both), Gujarat, Madhya Pradesh and Assam (41-42 percent) stunting is at higher side

compared to national level. Though, the stunting is the lowest in Kerala, Goa and Tamil Nadu, the

prevalence of underweight children is not low in these states. Rather in Manipur and Mizoram (14-

15 percent) the proportion of underweight children is the lowest. In the states of Jharkhand (42

percent), Bihar (37 percent), Madhya Pradesh (36 percent), Uttar Pradesh, Chhattisgarh, Gujarat

and Odisha (34 percent in each) nutritional status of children is worse even considering the

proportion of underweight children, where one-third or more children are underweight. Wasting

is the lowest in Sikkim (5 percent) and the highest in Tamil Nadu, Maharashtra, Andhra Pradesh,

and Gujarat (19 percent in each).



Table 6.15: Nutritional status of children by state

Percentage of children aged 0-59 months classified by their nutritional status according to three anthropometric indices, height-for-age, weight-for-height,

weight-for-age, by state

State

Height-for-Age Weight-for-Height Weight-for-Age

Percentage below

Mean Z-

Score

Percentage below

Mean Z-

Score

Percentage below

Mean Z-

Score

-3 SD (Severely

Stunted)

-2 SD

(Stunted)

-3 SD (Severely

Wasted)

-2 SD

(Wasted)

-3 SD (Severely

Underweight)

-2 SD

(Underweight)

India 17.3 38.7 -1.4 4.6 15.1 -0.5 9.5 29.4 -1.3

North

Delhi 14.1 29.1 -0.8 4.6 14.3 -0.2 4.9 19.4 -0.8

Haryana 19.3 36.5 -1.4 2.7 8.8 -0.1 7.5 22.7 -1.0

Himachal Pradesh 16.2 34.2 -1.3 3.9 10.1 -0.3 5.5 19.5 -1.0

Jammu & Kashmir 12.6 31.7 -1.2 2.5 7.1 0.1 5.3 15.4 -0.7

Punjab 13.1 30.5 -1.1 3.2 8.7 0.3 4.3 16.0 -0.4

Uttar Pradesh 28.4 50.4 -1.9 2.9 10.0 -0.3 12.9 34.3 -1.5

Uttarakhand 13.9 34.0 -1.2 2.6 9.3 -0.4 5.9 20.6 -1.1

Central

Chhattisgarh 16.4 43.0 -1.7 2.4 12.9 -0.8 9.9 33.9 -1.6

Madhya Pradesh 18.6 41.6 -1.5 5.4 17.5 -0.8 12.1 36.1 -1.5

East

Bihar 26.1 49.4 -1.9 3.9 13.1 -0.5 14.7 37.1 -1.6

Jharkhand 23.7 47.4 -1.7 3.7 15.6 -0.8 16.1 42.1 -1.6

Odisha 15.5 38.2 -1.5 4.9 18.3 -0.8 11.0 34.4 -1.5

West Bengal 12.8 34.7 -1.4 3.9 15.3 -0.8 8.9 30.0 -1.4

Northeast

Arunachal Pradesh 19.6 28.4 -0.9 7.1 17.0 -0.3 13.3 24.6 -1.2

Assam 21.0 40.6 -1.7 2.7 9.7 0.0 7.0 22.2 -1.2

Manipur 12.6 33.2 -1.2 2.4 7.1 -0.2 3.5 14.1 -0.8

Meghalaya 29.4 42.9 -1.8 5.2 13.1 0.5 16.0 30.9 -1.4

Mizoram 15.3 26.9 -0.7 6.2 14.3 0.4 6.1 14.8 -0.5

Nagaland 15.8 29.1 -1.3 4.8 11.8 1.0 7.9 19.5 -0.4

Sikkim 11.0 28.0 -1.2 1.4 5.1 0.1 6.4 15.8 -0.9

Tripura 15.0 31.0 -1.1 7.0 17.1 -0.3 16.8 30.5 -1.4



State

Height-for-Age Weight-for-Height Weight-for-Age

Percentage below

Mean Z-

Score

Percentage below

Mean Z-

Score

Percentage below

Mean Z-

Score

-3 SD (Severely

Stunted)

-2 SD

(Stunted)

-3 SD (Severely

Wasted)

-2 SD

(Wasted)

-3 SD (Severely

Underweight)

-2 SD

(Underweight)

West

Rajasthan 17.3 36.4 -1.4 2.9 14.1 -0.7 11.2 31.5 -1.4

Goa 6.6 21.4 -0.7 4.9 15.4 -0.4 2.0 16.1 -0.7

Gujarat 18.3 41.7 -1.4 6.7 18.6 -0.5 10.1 33.5 -1.4

Maharashtra 10.0 35.4 -1.1 6.3 18.7 -0.5 5.7 25.1 -1.1

South

Andhra Pradesh 12.0 35.3 -1.0 6.0 19.1 -0.5 4.7 22.3 -0.9

Karnataka 15.0 34.2 -1.1 6.3 17.0 -0.5 9.8 28.9 -1.3

Kerala 8.0 19.4 -0.6 5.4 15.5 -0.1 5.7 18.5 -0.6

Tamil Nadu 9.3 23.3 -0.7 6.3 19.0 -0.5 6.1 23.3 -0.9



Figure 6.3: Percentage of children aged 0-59 months who are stunted by state, RSOC, 2013-14

6.5 NUTRITIONAL STATUS OF ADOLESCENT GIRLS

Healthy and well-nourished adolescent girls hold the key to unlock India’s child nutrition challenge. The

poor nutritional status of adolescent girls in India and their poor diets perpetuate the vicious cycle of

nutrition deprivation that passes on from mothers to daughters, from one generation to the next. To

assess the magnitude of undernutrition among adolescent girls, RSOC measured nutritional status of all

the girls aged 10-18 in all surveyed households. The weight and height were converted into Body Mass

Index (BMI) using the following formula;

BMI = 100* Weight in kilograms/(Height in metres)2

All the girls with BMI below 17.0 and BMI between 17 and 18.5 are classified as severely thin and

moderately thin, respectively. Similarly, those with BMI above 30 and BMI between 25 and 30 are

classified as overweight and obese respectively.

19 21

23

27 28 28 29 29 31 31 32

33 34 34 34 35 35 35 36 37 38 39

41 42 42 43 43

47 49 50

Ke

rala

Go

a

Tam

il N

adu

Miz

ora

m

Sikk

im

Aru

nac

hal

Pra

de

sh

Nag

alan

d

De

lhi

Pu

nja

b

Trip

ura

Jam

mu

& K

ash

mir

Man

ipu

r

Utt

arak

han

d

Him

ach

al P

rad

esh

Kar

nat

aka

We

st B

en

gal

An

dh

ra P

rad

esh

Mah

aras

htr

a

Raj

asth

an

Har

yan

a

Od

ish

a

Ind

ia

Ass

am

Mad

hya

Pra

des

h

Gu

jara

t

Me

ghal

aya

Ch

hat

tisg

arh

Jhar

khan

d

Bih

ar

Utt

ar P

rad

esh



Figure 6.4: The nutritional status of adolescent girls, RSOC, 2013-14

Table 6.16 presents distribution of adolescent girls aged 10-18 with different characteristics by their

nutritional status. RSOC shows that 44 percent of the adolescent girls aged 10-18 were severely thin and

additional 19 percent were moderately thin or under-nourished, so in all 63 percent of the girls were

thin or undernourished. A small proportion of the girls were either overweight (2 percent) or obese (1

percent). Only about one-third (34 percent) of the adolescent girls were neither underweight nor

overweight. The percentage of undernutrition was relatively higher among girls from rural areas (64

percent) than those from the urban areas (59 percent).

Undernutrition was much widespread among the girls aged 10-14, as 77 percent of them were thin

compared to 45 percent of the girls aged 15-18. The prevalence of undernutrition was much higher

among girls who were never married (63 percent) than those who were ever married (29 percent). Most

probably, the differentials by marital status are really the differentials by age as most of the married

girls are older than never married girls.

Among the girls from four social groups, the prevalence of thin girls was lower among those belonging

to Other castes (59 percent) compared to the other three groups (63-66 percent). The nutritional status

of the girls improved with economic status, as the proportion of thin girls decreased from 66 percent

among the girls from the lowest wealth quintile to 57 percent among the girls from the highest wealth

quintile. It may be noted that even in the households from the highest wealth quintile, majority of the

girls (57 percent) are thin.

43.6

18.9

34

2.2 1.3

Severely thin

Moderately thin

Normal

Over-weight

Obese



Table 6.16: Nutritional status of adolescent girls

Percent distribution of adolescent girls aged 10-18 by BMI level according to background characteristics

Characteristics

Body Mass Index (BMI) in kg/m2

Mean

BMI

Number of

adolescent

girls

Underweight Normal Overweight/obese

<17

(severely

thin)

17.0-18.4

(moderately

thin)

<18.5

(total

thin)

18.5-24.9

≥25.0

(overweight

or obese)

25.0-29.9

(over-

weight)

≥30.0

(obese)

Age of Girl

(Years)

10-14 61.4 15.8 77.2 20.1 2.7 1.6 1.1 17.04 25,186

15-18 22.0 22.6 44.7 50.9 4.5 2.9 1.6 19.33 20,374

Marital status*

Never married 44.6 18.9 63.6 33.1 3.4 2.1 1.3 18.00 44,030

Ever married 12.4 16.7 29.1 64.4 6.6 5.0 1.6 20.47 1,521

Not stated * * * * * * * * 9

Residence

Urban 40.2 18.7 59.0 35.2 5.8 3.4 2.4 18.56 12,903

Rural 44.9 18.9 63.9 33.5 2.6 1.7 0.9 17.88 32,658

Social Group

Scheduled

Caste 46.4 19.2 65.7 31.6 2.7 1.9 0.8 17.67 9,360

Scheduled

Tribe 45.1 19.8 64.9 31.8 3.3 2.1 1.2 18.67 4,942

OBC 43.4 19.2 62.6 34.1 3.4 2.0 1.4 17.98 19,241

Others 40.8 17.7 58.5 37.1 4.4 2.9 1.5 18.32 11,728

Do Not Know 52.9 21.7 75.0 22.3 3.1 0.8 2.3 17.14 289

School

attendance

Ever attended 24.8 23.1 48.0 47.6 4.4 2.9 1.5 19.27 4,697

Never

attended 37.0 20.2 57.2 38.1 4.7 1.6 3.1 19.90 3,433

Currently

attended 46.9 18.1 65.0 31.7 3.3 2.2 1.1 17.75 36,560

Dropout 33.7 23.5 57.3 40.9 1.8 1.2 0.5 18.25 870

Wealth Index

Lowest 47.9 18.5 66.4 31.3 2.3 1.4 0.9 17.94 9,349

Second 45.1 19.1 64.3 33.1 2.7 1.5 1.2 17.80 10,237

Middle 43.4 20.5 63.9 33.2 2.9 1.6 1.3 17.94 9,372

Fourth 41.8 18.0 59.8 34.7 5.5 3.9 1.6 18.38 8,920

Highest 38.7 18.1 56.9 38.7 4.4 2.9 1.6 18.39 7,682

Total 43.6 18.9 62.5 34.0 3.5 2.2 1.3 18.07 45,561




Table 6.17 presents the distribution of adolescent girls by nutritional status across the states. There is a

large variation in the nutritional status of adolescent girls across the states. The proportion of under-

nourished or thin girls was the lowest at 35 percent in Mizoram. Along with Mizoram, in Sikkim (38

percent), Meghalaya (40 percent) and Tripura (48 percent) the nutritional status of adolescent girls was

better. Except these four states, in all the remaining states, majority (50 percent or more) of the

adolescent girls were undernourished (thin). The prevalence of undernutrition was the highest in Goa

and Rajasthan (74 percent each) where three in every four girls were thin. Even in Andhra Pradesh,

Karnataka, Bihar (68-69 percent in each state) and Madhya Pradesh, Odisha, Maharashtra, Jharkhand,

Gujarat and Chhattisgarh (65 percent in each state) and Himachal Pradesh (64 percent) the prevalence

of under-nutrition were higher than national level.

The proportion of overweight or obese girls was low in most of the states. Only in Andhra Pradesh,

Tripura and Tamil Nadu (8 percent in each), the proportion of overweight/obese girls was at a higher

side. In most of the states the proportion of thin girls was higher in rural areas than in urban areas. At

the same time, the proportion of overweight/obese girls was relatively higher in urban than rural areas,

though the urban-rural differentials were not very large.



Table 6.17: Nutritional status of adolescent girls by state

Percent distribution of adolescent girls age 10-18 years by BMI levels according to states

State

Urban Rural Total


Mean

BMI


Mean

BMI


Mean

BMI

Under-

weight

(<18.5)

Normal

(18.5-

24.9)

Overweight/

obese

(≥25.0)

Under-

weight

(<18.5)

Normal

18.5-

24.9)

Overweight

/obese

(≥25.0)

Under-

weight

(<18.5)

Normal

(18.5-

24.9)

Overweight/

obese

(≥25.0)

India 59.0 35.2 5.8 18.56 63.9 33.5 2.6 17.88 62.5 34.0 3.5 18.07

North

Delhi 59.8 34.0 6.2 18.29 53.3 43.3 3.4 19.49 59.6 34.2 6.2 18.32

Haryana 56.1 37.4 6.4 18.67 62.0 34.6 3.4 18.08 59.9 35.6 4.5 18.29

Himachal Pradesh 52.7 43.0 4.3 18.68 64.8 34.4 0.8 17.66 63.8 35.1 1.1 17.74

Jammu & Kashmir 36.4 54.4 9.2 20.03 56.9 36.2 6.9 18.76 52.2 40.4 7.4 19.06

Punjab 51.2 44.3 4.5 18.87 59.9 37.0 3.1 18.09 56.9 39.5 3.6 18.36

Uttar Pradesh 58.5 38.4 3.1 18.13 59.1 40.0 0.9 17.77 59.0 39.7 1.4 17.84

Uttarakhand 54.6 43.3 2.1 18.24 56.2 42.0 1.7 18.03 55.9 42.3 1.8 18.08

Central

Chhattisgarh 64.4 31.9 3.7 17.99 65.4 33.5 1.1 17.70 65.2 33.2 1.5 17.75

Madhya Pradesh 60.8 38.2 1.0 17.66 65.7 32.1 2.2 19.30 64.5 33.6 1.9 18.90

East

Bihar 61.0 36.0 3.1 18.20 69.0 30.0 1.0 17.30 68.0 30.7 1.3 17.41

Jharkhand 58.7 36.9 4.5 18.20 66.5 30.7 2.7 17.33 64.8 32.1 3.1 17.52

Odisha 55.5 37.8 6.7 19.08 66.4 31.8 1.8 17.52 64.5 32.8 2.6 17.78

West Bengal 51.8 40.5 7.6 19.00 60.6 36.4 3.0 17.85 58.1 37.6 4.4 18.19

Northeast

Arunachal Pradesh 45.3 53.9 0.8 17.96 62.1 35.2 2.8 17.14 56.4 41.5 2.1 17.42

Assam 56.2 37.2 6.5 18.93 61.7 35.7 2.6 18.04 60.9 35.9 3.2 18.17

Manipur 51.6 44.6 3.8 18.92 55.6 43.7 0.7 18.31 54.3 44.0 1.7 18.50

Meghalaya 31.0 55.8 13.2 20.84 44.3 50.9 4.8 18.89 40.3 52.3 7.3 19.47

Mizoram 36.8 57.6 5.6 24.80 32.5 63.7 3.8 20.05 35.2 59.8 5.0 23.04

Nagaland 56.0 42.4 1.6 17.99 52.4 46.9 0.7 18.46 53.7 45.2 1.0 18.28

Sikkim 40.8 51.1 8.1 20.35 36.9 56.0 7.0 20.07 37.9 54.8 7.3 20.14

Tripura 59.8 32.1 8.0 18.50 44.3 47.6 8.1 19.32 47.8 44.1 8.1 19.13



State

Urban Rural Total


Mean

BMI


Mean

BMI


Mean

BMI

Under-

weight

(<18.5)

Normal

(18.5-

24.9)

Overweight/

obese

(≥25.0)

Under-

weight

(<18.5)

Normal

18.5-

24.9)

Overweight

/obese

(≥25.0)

Under-

weight

(<18.5)

Normal

(18.5-

24.9)

Overweight/

obese

(≥25.0)

West

Rajasthan 64.5 30.8 4.7 17.99 77.3 21.6 1.1 16.80 74.4 23.7 1.9 17.07

Goa 75.2 21.1 3.7 16.55 72.1 25.4 2.5 17.11 74.0 22.8 3.2 16.77

Gujarat 63.2 29.5 7.2 18.68 66.1 30.6 3.3 17.19 64.9 30.1 5.0 17.83

Maharashtra 64.5 31.7 3.8 18.01 64.7 30.5 4.8 18.20 64.6 31.1 4.4 18.12

South

Andhra Pradesh 65.8 22.6 11.6 19.80 70.4 23.0 6.6 17.98 68.7 22.9 8.4 18.65

Karnataka 65.9 29.0 5.1 18.10 69.7 27.8 2.5 17.74 68.3 28.2 3.4 17.88

Kerala 57.8 38.8 3.4 17.99 52.5 46.1 1.4 18.09 54.6 43.1 2.2 18.05

Tamil Nadu 47.7 43.0 9.3 19.32 52.2 41.2 6.7 19.08 50.1 42.0 7.9 19.19



6.6 ROLE OF ANGANWADI CENTRES

With the objective to improve the nutritional status of children in the age-group 0-6 years the ICDS

Programme provides supplementary food to all the children below age six years. In AWCs, all children

below three years of age are weighed once in a month and children aged 3-6 are weighed once in three

months. AWWs are trained to plot the weight of children in growth chart, classify the children according

to nutritional status and counsel the mothers.

Table 6.18 provides data on role of AWCs in providing deworming medicine and weight monitoring

according to selected characteristics of children. It may be noted that the percentages not only reflect

the role AWCs play in providing these services to young children, but also reflect the extent to which

AWC services are utilized by people. Little more than one-half (51 percent) of those children who

received deworming medicine in six months prior to the survey, received it in AWCs. Among those

children who had a growth chart and weighed in the three months preceding the survey, 59 percent

were weighed in AWCs and in case of 25 percent of the children who were weighed; mother had

discussion with AWW on nutritional status of the child.

There is no difference in the extent to which all the AWC services were provided to male and female

children. In rural areas, AWCs are playing a major role in providing various child health related services.

Majority of the children in rural areas received deworming medicine (62%) from AWCs. Seventy-two

percent of the children in rural areas, who had a growth chart and weighed in the three months

preceding the survey, were weighed in AWCs. The proportions of children in rural areas for whom

different services were availed from AWCs were almost twice of those in urban areas. AWCs are playing

a major role in providing services to the children from socially and economically disadvantaged children.

The proportions of children from STs, children whose mother had less education and children from the

lower wealth quintiles for whom different services were availed from AWCs were much higher in

comparison to their respective counterparts. For example, among the ST children, 69 percent received

deworming medicine from AWC and 78 percent of those who were weighed, were weighed in AWC.



Table 6.18: Role of AWC in child nutrition by state

Percentage distribution of children according to various services received from AWC for Child Nutrition, by

selected characteristics.

Characteristics

Deworming Medicine Weight and Growth

Aged 6-59 Months Aged 0-71 Months Percentage of children who

received deworming

medicines from AWC in the 6

months preceding the survey

Number of children received

deworming medicines in 6

months preceding the survey


weighed last in an AWC in 3


survey

Percentage of children whose

mother had discussion with

AWW on nutritional status

of the child

Number of children

weighed in last 3

months

Sex of the Child

Male 51.0 12,113 57.5 24.3 5,305 Female 51.1 10,897 61.6 25.1 4,719

Residence

Urban 30.3 7,693 35.7 16.6 3,254

Rural 61.5 15,317 70.8 28.5 6,770 Mother education

No Education 65.4 5,689 76.8 27.7 1,776 Below Primary 54.5 1,257 73.1 22.5 522 Completed Primary 58.6 3,872 70.3 31.6 1,756 Completed Middle 51.1 3,736 63.8 25.8 1,598 Completed Secondary 47.1 3,789 55.2 24.6 1,878 Completed Higher

Secondary and above 29.7 4,667 37.0 17.3 2,494

Religion

Hindu 55.0 18,243 61.5 25.7 8,307

Muslim 33.6 3,408 47.7 18.1 1,226 Christian 35.6 695 51.2 22.0 334 Sikh 37.6 160 (37.8) (11.1) 40 Jain 47.0 70 * * 19 Buddhist 59.6 324 71.1 43.2 68 No religion * 15 * * 5 Other 33.6 97 55.1 11.9 39

Social Group

Scheduled Caste 59.5 4,095 64.3 26.4 1,929

Scheduled Tribe 69.1 2,684 78.3 36.0 1,191 OBC 51.3 8,544 58.3 24.3 3,930 Others 40.9 7,411 49.6 19.7 2,863 Do Not Know 16.4 275 66.7 10.0 111

Wealth Index

Lowest 69.9 3,879 81.1 29.0 1,475

Second 61.1 4,282 73.4 30.2 1,770 Middle 55.4 4,779 70.5 31.6 2,165 Fourth 45.4 5,308 52.7 22.5 2,372 Highest 28.7 4,762 30.6 12.9 2,242

Total 51.1 23,010 59.4 24.6 10,024




The state-wise percentages of utilization of AWC services for various purposes are shown in Table

6.19. There is a large variation in the percentage of children who received deworming medicine from

AWCs. In Meghalaya, Manipur and Nagaland among those children who received deworming

medicine, less than two percent received it in AWCs, whereas in Madhya Pradesh (84 percent),

Odisha (85 percent) and Rajasthan (82 percent) more than three-fourths of them received it in

AWCs.

It was already pointed out that AWCs are playing a major role in weight monitoring, as majority (59

percent) of those children who had a growth chart and weighed in the three months preceding the

survey, were weighed at AWCs. In many states like Mizoram (88 percent), Chhattisgarh (90 percent),

Odisha (86 percent), Jharkhand (80 percent) and Himachal Pradesh (80 percent) more than four-fifth

of the children who were weighed, were weighed at AWCs.

The preceding discussion points out that overall, in many states—Nagaland, Mizoram, Assam,

Jammu & Kashmir, Meghalaya, Manipur and Uttarakhand—AWCs are playing minimal role in

providing preventive and curative health care services to children and their growth monitoring. On

the contrary, in Jharkhand, Chhattisgarh, Gujarat and Andhra Pradesh they are playing relatively

larger role. Even in Bihar and Madhya Pradesh they are playing a role in providing preventive and

curative health care services to children and growth monitoring.



Table 6.19: Role of AWC in child nutrition by state

Percentage distribution of children according to various services received from AWC for Child Nutrition, by

state

State

Deworming Medicine Weight and Growth


Percentage of children who received

deworming medicines from AWC in

the 6 months preceding the survey


weighed last in an AWC

in 3 months preceding

the survey

Percentage of children whose

mother had discussion with AWW

on nutritional status of the child

India 51.1 59.4 24.6

North

Delhi 32.5 9.1 7.4

Haryana 46.4 44.3 12.7

Himachal Pradesh 68.2 79.6 42.7

Jammu & Kashmir 6.8 (12.5) (9.4)

Punjab 23.4 (27.0) (18.9)

Uttar Pradesh 44.5 36.1 16.3

Uttarakhand 12.7 16.3 4.9

Central

Chhattisgarh 48.6 90.3 44.4

Madhya Pradesh 83.5 73.2 47.9

East

Bihar 46.6 62.9 23.3

Jharkhand 74.3 79.6 51.6

Odisha 85.0 86.0 24.1

West Bengal 7.7 52.1 11.7

Northeast

Arunachal Pradesh 17.8 (51.7) (24.1)

Assam 25.1 21.1 2.5

Manipur 1.5 * *

Meghalaya 2.8 9.2 3.3

Mizoram 16.1 87.9 8.6

Nagaland 1.6 * *

Sikkim 16.8 60.8 53.5

Tripura 27.3 51.5 37.2

West

Rajasthan 82.1 39.5 11.2

Goa 22.1 43.0 23.1

Gujarat 57.2 63.2 36.1

Maharashtra 55.5 72.0 31.6

South

Andhra Pradesh 60.5 71.1 28.1

Karnataka 52.9 55.8 22.9

Kerala 12.3 27.1 12.4

Tamil Nadu 24.8 42.7 20.4




CHAPTER 7 UTILIZATION OF ICDS SERVICES

7.1 BACKGROUND

Under the ICDS programme, a package of six services are provided through Anganwadi centres

(AWC), comprising supplementary food, immunization, health check-up, referral services, pre-school

non-formal education and nutrition and health education. Supplementary food includes

supplementary feeding, growth monitoring and promotion; and prophylaxis against vitamin A

deficiency and control of nutritional anaemia. Children below the age of six, pregnant and nursing

mothers are identified in the community by the Anganwadi worker (AWW) and are provided

supplementary feeding support. The children are weighed regularly to monitor their growth. Health

check-ups include recording of weight, immunization, management of malnutrition, treatment of

diarrhoea, de-worming etc. During health check-ups and growth monitoring, sick or malnourished

children, in need of prompt medical attention, are referred to the Primary Health Centre (PHC) or

sub-centre. The non-formal pre-school education for children aged 3-6 years is a significant input for

providing a sound foundation for learning and development of the child. Another component of the

ICDS programme is Nutrition, Health and Education (NHE) with a goal of capacity-building of women

so that they can take care of their own and child’s health, nutrition and development.

The information on awareness and utilization of relevant services provided at AWC and other related

issues were collected from the lactating mothers (for children aged 0-5 months), mothers of children

aged 6-71 months, and currently pregnant women aged 15-49 years. The data collected was

analysed and is presented in the following sections.

7.2 AWARENESS OF SERVICES AVAILABLE AT ANGANWADI CENTRE

The mothers of children aged 0-71 months were probed regarding their awareness of all the six

services available at AWCs and such a probing was also done amongst currently pregnant women

regarding the five services, which are relevant to them. The mothers and currently pregnant women

were first asked to respond spontaneously about the services provided at AWC, failing which they

were further probed by prompting. However, for the present analysis only spontaneous responses

on awareness were considered. Table 7.1 shows that among the mothers of children aged 0-71

months, 94 percent were aware of at least one service. As expected the maximum awareness was

about supplementary food (89 percent), followed by immunization (58 percent), pre-school

education (47 percent), health check-up (31 percent), nutrition and health education (18 percent)

and referral services (13 percent). Only 10 percent mothers of children aged 0-71 months were

aware of all the six services whereas about 6 percent of the mothers did not have awareness of any

service. Awareness of at least one service was more among the mothers of 36-71 months old

children (97 percent) than the mothers of 0-35 months-old children (90 percent). Even by type of

services provided at AWC, a higher proportion of mothers of 36-71 months children were aware of

services like supplementary food, immunization and pre-school education as compared to mothers

of 0-35 months-old children. About 93 percent of currently pregnant women were aware about at

least one of the five services about which they were probed.



Table 7.1: Awareness of services provided at AWC

Percentage of mothers of children aged 0-35 months, 36-71 months, 0-71 months and currently pregnant

women aged 15-49 years covered by an AWC, aware of various services provided at AWC, RSOC 2013-14.

Services

Mothers of

children aged

0-35 months

Mothers of

children aged

36-71 months

Mothers of

children aged

0-71 months

Currently

pregnant

women

Percentage aware of any services 90.2 96.6 94.0 93.4

Services provided at AWC

Supplementary food 85.1 91.0 88.5 87.7

Immunization 57.4 59.8 58.4 59.6

Pre-school Education* 41.7 49.9 46.6 -

Health Check-up 29.4 30.5 30.6 29.9

Referral Services 12.2 13.4 13.2 11.0

Nutrition and Health education 17.2 18.6 18.3 16.5

Percentage not aware of any services 9.8 3.4 6.0 6.6

Percentage aware of all the 6 services 9.3 9.7 9.5 8.3

Number of women 44,485 42,944 70,209 5,247

* Awareness of preschool education was not asked to currently pregnant women

Table 7.2 shows that awareness of at least one service was more among the rural mothers of 0-71

month’s old children (95 percent) than their counterparts from the urban areas (90 percent). This

may be due to the fact that ICDS services are primarily given in rural areas and urban slums. The

awareness of any service was the lowest among mothers aged 15-19 years and it increased gradually

with the age of the mother. A little higher proportion of mothers belonging to the lowest wealth

quintile were aware of at least one service (95 percent) than the mothers from the highest quintile

(91 percent). This may be because mostly the mothers belonging to the lowest quintiles are

dependent on AWC services. However, no differential in awareness of at least one service was seen

among mothers by their religious affiliations and social group composition. Tables 7.3 to 7.6 given

in Annexure-A present awareness by different services for mothers of children aged 0-35 months,

mothers of children aged 36-71 months, mothers of children aged 0-71 months and in respect of

currently pregnant women by few select characteristics. Analysis based on these tables further

shows that a higher proportion of mothers from the lowest quintile were aware of the

supplementary food from AWC. On the contrary, awareness of other services such as immunization,

pre-school education and health check-up from AWC was more amongst the mothers from the

highest quintile.



Table 7.2: Awareness of services provided at AWC (any service)

Percentage of mothers of children aged 0-35 months, 36-71 months, 0-71 months and currently pregnant

women aware of any services provided at AWC by background characteristics, RSOC, 2013-14.

Characteristics

Aware of any services

Percentage Mothers of

children 0-35 months

Number of

mothers

Percentage Mothers of children 36-71 months

Number of

mothers

Percentage Mothers of children 0-71 months

Number of

mothers

Percentage Currently pregnant women

Number of

currently pregnant women

Age

15-19 91.6 1,349 99.1 140 93.0 1,419 94.1 240

20-24 91.4 16,634 96.0 7,889 93.2 20,211 92.7 2,352

25-29 89.7 16,824 96.1 18,312 93.7 26,880 94.2 1,905

30-34 89.0 6,615 97.2 10,254 94.9 13,661 94.7 531

35-39 88.6 2,266 97.8 4,379 95.6 5,604 87.7 182

40-44 89.0 542 97.9 1,360 96.4 1,646 (96.3) 23

45-49 92.0 256 97.9 609 97.4 788 * 14

Residence

Urban 84.1 11,853 95.3 11,176 90.3 19,093 91.3 1,205

Rural 92.5 32,632 97.1 31,767 95.4 51,116 94.0 4,042


No education 90.5 14,272 96.1 16,335 94.4 23,304 92.2 1,842

Below Primary (Class - 1 to 4)

94.3 2,217 97.9 2,429 96.7 3,740 93.2 281

Completed Primary (Class 5-7)

93.2 6,904 97.7 6,873 95.8 11,003 96.3 854

Completed Middle (Class 8 -9)

91.2 7,190 96.6 6,218 94.6 10,880 94.2 817

Completed Secondary (Class 10-11)

89.4 6,268 96.4 5,404 93.3 9,747 94.4 617

Completed Higher Secondary (Class 12)

85.6 7,634 96.3 5,686 90.9 11535 91.8 836

Religion

Hindu 90.4 34,877 96.7 33,905 94.2 55,464 93.6 3,942

Muslim 89.5 7,192 95.7 6,786 93.3 10,858 92.0 1,045

Christian 88.5 1,135 97.4 1,222 93.5 1,957 97.9 118

Sikh 90.7 693 97.5 585 94.1 1,066 97.0 77

Jain 88.8 105 (97.5) 42 90.8 128 * 13

Buddhist/Neo-Buddhist

92.4 285 98.4 247 95.1 446 (90.2) 35

No religion (95.8) 31 (94.9) 26 98.3 47 * 1

Other 93.0 167 97.6 130 95.2 242 83.1 16

Social Group

Scheduled Caste 91.5 9,125 96.8 9,105 94.7 14,428 93.1 1,121

Scheduled Tribe 93.9 5,300 97.8 5,073 96.2 8,182 95.9 616

OBC 90.0 17,721 96.3 17,446 93.8 28,017 92.8 2,217

Other 88.0 11,890 96.4 10,869 92.8 18,839 93.4 1,231

No Response 93.3 450 98.7 451 96.1 743 95.2 62

Wealth index

Lowest 91.8 9,133 96.3 9,517 94.8 14,059 93.2 1,146

Second 92.3 9,419 96.9 9,345 95.4 14,739 93.0 1,183

Middle 92.8 9,358 97.3 9,129 95.6 14,916 94.4 1,115

Fourth 89.1 8,975 96.8 8,178 93.3 14,275 92.1 970

Highest 84.1 7,600 95.4 6,775 90.5 12,219 94.5 833

Total 90.2 44,485 96.6 42,944 94.0 70,209 93.4 5,247

*Percentage not shown; based on fewer than 25 unweighted cases., ( ) Percentage based on 25-49 unweighted cases



Awareness on services provided at AWCs among mothers of children aged 0-71 months by states is

shown in Table 7.7. The table shows that the awareness of at least one service from AWC ranges

from 82 percent in Delhi to almost 100 percent in Odisha and Chhattisgarh. The awareness on

supplementary food provided by AWC was the lowest in Haryana (66 percent) and almost universal

in Odisha (99 percent). Awareness of immunization services from AWC was low (below 20 percent)

in West Bengal, Nagaland, Sikkim and Manipur and was reported high (more than 75 percent) in

Haryana, Andhra Pradesh, Rajasthan and Jharkhand.

Table 7.7: Awareness on services provided at AWC by state

Percentage of mothers of children aged 0-71 months covered by an AWC, aware of any service and specific services provided at AWC by states, RSOC, 2013-14.

State

Percentage aware of

any one of the

services

Type of Services provided at AWC Percentage

aware of all the 6 services

Supplementary Food

Immunization Pre-school Education

Health Check-

up

Referral Services

Nutrition and Health education

India 94.0 88.5 58.4 46.6 30.6 13.2 18.3 9.5 North

Delhi 81.5 76.8 59.6 47.9 35.1 13.3 16.4 8.8 Haryana 88.1 66.1 75.5 38.5 27.2 16.3 15.2 9.7 Himachal Pradesh 92.6 91.5 49.6 55.7 43.6 22.6 31.6 19.7 Jammu & Kashmir 89.3 87.4 33.5 57.5 19.8 8.7 13.8 6.6 Punjab 92.2 85.6 69.4 58.9 24.8 8.9 13.8 5.9 Uttar Pradesh 91.3 82.7 63.7 39.0 16.2 6.8 7.3 3.8 Uttarakhand 93.3 84.7 64.2 62.9 26.3 5.6 13.6 3.4

Central Chhattisgarh 99.2 97.2 57.5 33.0 19.4 3.4 8.1 1.9 Madhya Pradesh 94.6 87.0 69.9 43.3 31.5 17.6 17.9 11.4

East Bihar 92.1 79.1 68.7 50.0 14.9 8.0 10.1 3.1 Jharkhand 97.8 93.7 87.0 54.6 38.8 9.7 14.6 4.5 Odisha 99.8 99.4 30.6 22.8 17.1 2.1 2.8 1.1 West Bengal 98.3 97.5 7.8 43.4 21.6 0.8 4.2 0.4

Northeast Arunachal Pradesh 97.7 97.1 33.6 87.6 18.3 4.0 25.2 3.2 Assam 97.9 97.2 34.4 60.4 13.9 2.7 6.7 1.9 Manipur 98.1 96.5 15.9 78.5 3.3 0.8 35.7 0.1 Meghalaya 93.2 91.0 33.7 41.3 16.3 6.9 12.4 5.0 Mizoram 97.9 97.0 66.7 84.9 47.9 9.6 78.7 8.4 Nagaland 84.3 82.3 8.3 25.8 4.2 1.9 4.4 0.9 Sikkim 90.5 86.3 13.0 38.3 34.1 14.4 29.0 2.8 Tripura 98.4 96.2 68.5 71.9 29.3 5.1 28.7 2.3

West Rajasthan 97.7 93.3 82.3 53.9 24.7 4.4 7.1 2.1 Goa 95.7 94.0 40.4 48.2 29.3 5.9 15.9 3.6 Gujarat 86.7 82.5 74.2 50.1 50.8 15.5 26.1 13.0 Maharashtra 91.4 86.6 60.4 46.7 48.7 10.7 21.5 5.8

South Andhra Pradesh 98.0 93.1 78.7 59.1 57.1 40.2 53.5 30.8 Karnataka 94.1 92.5 60.2 44.9 31.8 16.4 19.7 14.0 Kerala 94.5 87.5 65.3 65.8 49.9 29.7 40.7 25.4 Tamil Nadu 92.4 86.8 44.6 36.7 33.7 27.1 33.5 24.6



7.3 UTILIZATION OF AWC SERVICES

The mothers of children aged 0-71 months and currently pregnant women were first asked to

spontaneously report on the type of services received by them or their children from Anganwadi

centre. In case of services where they failed to give any spontaneous response, were further probed.

The analysis on utilization of services is based on both the responses and is presented in Tables 7.8

and 7.9.

Table 7.8: Utilization of AWC services

Percentage of mothers of children aged 0-5 months, children aged 6-35 months and children aged 36-71

months and currently pregnant women, availing any service, specific services and all services, RSOC, 2013-14.

Services

Mothers of

Children aged

0-5 months

Children aged

6-35 months

Children aged

36 - 71 months

Currently

Pregnant

women

Percentage availing any services from

AWC 47.8 53.6 47.5 45.9

Type of services availed

Supplementary food 42.4 49.2 44.2 40.7

Immunization 33.0 41.9 34.1 35.9

Pre-school education - - 38.7 -

Health check-up 29.6 31.7 26.7 26.7

Referral services 11.8 12.1 10.7 11.0

Nutrition and health education or

advice on feeding and care of young

children*

16.1 18.5 16.6 -

Other 6.5 4.9 5.4 2.8

Availed all services 8.2 9.1 8.1 7.0

Number of children/pregnant women

availing any service from AWC 8,469 41,181 47,873 5,247

* Not asked to pregnant women



Table 7.8 show that 48 percent mothers of children aged 0-5 months and 46 percent currently

pregnant women reported receiving at least one service from AWC. Comparatively more children

aged 6-35 months (54 percent) or their mothers received at least one service from AWC than

children aged 36-71 months, lactating mothers and currently pregnant women. The services mostly

received were supplementary food, immunization, pre-school education and health check-up. As

regards other services such as health and nutrition education and referral services, they were

reported to be availed by less than one fifth of the mothers each. The table further shows that 8

percent lactating mothers, 9 percent children aged 6-35 months or their mothers, 8 percent children

aged 36-71 months or their mothers and 7 percent currently pregnant women reported availing all

the six services from the AWCs.

Table 7.9 shows that a higher proportion of lactating mothers (mothers of children 0-5 months) in

the rural areas (53 percent) availed at least one service from AWC than their counterparts in the

urban areas (33 percent). Almost a similar pattern was observed in case of children aged 0-35

months; children aged 36-71 months and currently pregnant women. Table 7.9 further shows that

education level of mothers has no definitive bearing on utilization of services from the Anganwadi

centres. For instance, amongst the illiterate mothers of children aged 36-71 months, 49 percent had

received at least one service from the AWCs against 31 percent amongst the children whose

mothers had completed higher secondary. Similarly, the utilization of at least one service from the

AWCs had an inverse relationship with the rise in wealth index. Against 57 percent children aged 36-

71 months using at least one service from the AWCs from the lowest wealth quintile reported, the

corresponding percentage from the highest quintile was just 28 percent. Similar patterns were also

observed in the utilization of services from the AWCs amongst other beneficiary groups. Tables 7.10

to 7.13 in Annexure-A provide the details of type of services by background characteristics for

different beneficiary groups.



Table 7.9: Utilization of AWC services (any service)

Percentage among mothers of children aged 0-5 months, children aged 6-35 months and 36-71 months and currently pregnant women residing in the area being covered by AWC, availing any service by background characteristics, RSOC, 2013-14.

Characteristics

Percentage availing any services from AWC

Mothers

of

Children

aged 0-5

months

Number

of

mothers

Children

aged 6-35

months

Number

of

Children

Children

aged 36-

71

months

Number

of

Children

Currently

Pregnant

women

Number

of

currently

Pregnant

women

Residence

Urban 32.9 2,023 40.3 10,913 34.9 12,268 33.8 1,205

Rural 52.5 6,446 58.4 30,268 51.9 35,605 49.6 4,042

Mother's education

No education 47.6 2,953 52.6 13,376 48.5 18,598 44.4 1,842

Below Primary (Class - 1 to 4) 57.7 423 66.7 2,060 66.4 2,691 44.1 281

Completed Primary (Class 5-7) 53.7 1,278 61.1 6,456 54.5 7,666 48.7 854

Completed Middle (Class 8 -9) 53.3 1,297 57.2 6,678 49.1 6,875 47.9 817

Completed Secondary (Class

10-11)

44.5 1,182 51.4 5,726 42.6 5,937 47.5 617


(Class 12)

37.3 1,335 43.0 6,885 30.5 6,105 44.1 836

Religion

Hindu 50.2 6,718 54.9 32,257 48.5 37,609 49.2 3,942

Muslim 39.2 1,356 48.7 6,719 44.1 7,787 32.6 1,045

Christian 36.0 185 55.2 1,028 47.1 1,342 58.3 118

Sikh 23.0 117 32.0 644 28.4 646 25.4 77

Jain * 23 (31.3) 82 (35.7) 45 * 13

Buddhist/Neo-Buddhist 45.2 41 65.3 264 59.8 266 (46.3) 35

No Religion * 6 * 26 (57.1) 31 * 1

Other 34.4 64 52.9 160 51.8 147 53.5 16

Social Group

Scheduled Caste 51.3 1,801 57.0 8,436 49.6 10,193 47.4 1,121

Scheduled Tribe 59.2 1,041 65.7 4,893 60.6 5,665 60.5 616

OBC 46.4 3,373 50.2 16,583 43.1 19,520 43.0 2,217

Other 41.3 2,171 50.1 10,837 46.1 11,994 41.8 1,231

Do Not Know 59.9 83 68.3 431 64.8 502 60.7 62

Wealth index

Lowest 59.3 1,909 62.0 8,446 57.1 10,749 50.6 1,146

Second 51.0 1,877 59.2 8,824 55.3 10,533 48.2 1,183

Middle 48.5 1,778 57.5 8,716 49.7 10,191 49.2 1,115

Fourth 41.6 1,581 49.3 8,390 40.9 9,046 46.3 970

Highest 33.3 1,324 36.3 6,804 27.7 7,353 31.5 833

Total 47.8 8,469 53.6 41,181 47.5 47,873 45.9 5,247

*Percentage not shown; based on fewer than 25 unweighted cases. ( ) Percentage based on 25-49 unweighted cases



Tables 7.14-7.17 given in Annexure-A present the state-wise utilization of services across different

groups, i.e., lactating mothers, children aged 6-35 months, children aged 36-71 months and currently

pregnant women.

As is seen from these tables, there is a wide variation among the states by different types of services

availed from AWC. Figure 7.1 portrays such a variation for utilization of at least one service from

AWC among the children aged 36-71 months. It ranged from 14 percent in Nagaland to 79 percent in

Tripura. There are 13 states wherein the level of utilization of at least one service is below the

national average (48 percent). The states reporting higher percentage of children utilizing at least

one Anganwadi service were Tripura (79 percent), Assam (75 percent), West Bengal (74 percent),

Gujarat (72 percent) and Manipur (71 percent). States reporting low utilization of at least one service

from AWC were Nagaland (14 percent), Delhi (14 percent), Punjab (21 percent), Haryana (21

percent), Rajasthan (23 percent) and Uttar Pradesh (24 percent).

Figure 7.1: Percentage of children aged 36-71 months availing any service from AWC

When analysed by individual services, almost a similar variation is observed in terms of utilization of

supplementary food and pre-school education amongst children aged 36-71 months. The top five

states in terms of utilization of supplementary food were Tripura (79 percent), Assam (73 percent),

Manipur (71 percent), Gujarat (70 percent) and West Bengal (70 percent) whereas the bottom five

states were Delhi (14 percent), Nagaland (14 percent), Haryana (18 percent), Punjab (21 percent)

and Rajasthan (22 percent). As regards utilization of pre-school education services, it ranged

between Nagaland reporting the minimum (2 percent) and Gujarat, the maximum (60 percent). Such

variations were also observed in other category of respondents namely, lactating mothers (Table

7.14); children aged 6-35 months (Table 7.15) and currently pregnant women (Table 7.17).

79 75 74 72 71 69 68

64 64 63 63 62 58 57

49 48 48 47 42

38

30 29 27 26 24 23 21 21

14 14

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7.4 REASONS FOR NOT AVAILING AWC SERVICES

At the national level, around half of the respondents residing in areas covered by AWC (lactating

mothers: 52 percent; mothers of children aged 6-35 months: 46 percent; mothers of children aged

36-71 months: 53 percent; and currently pregnant women: 54 percent) reportedly did not avail any

service from AWCs. The corresponding proportions were higher in the urban areas as compared to

the rural areas.

Table 7.18: Non-utilization of AWC services by beneficiaries

Percentage of lactating mothers, mothers of children aged 6-35 months, children aged 36-71 months and currently pregnant women residing in area covered by AWC, who did not avail any service from AWC, RSOC, 2013-14.

Characteristics

Urban Rural Total

Mothers of children aged (in months)

Pregnant woman


Pregnant woman


Currently Pregnant women 0-5 * 6-35 36-71 0-5 * 6-35 36-71 0-5 * 6-35 36-71

Percentage not availing any services from AWC

67.1 59.7 65.1 66.2 47.5 41.6 48.1 50.4 52.2 46.4 52.5 54.1

Number living in an area covered by an AWC

2,023 10,913 12,268 1,205 6,446 30,268 35,605 4,042 8,469 41,181 47,873 5,247

* Mothers with children aged 0-5 months are lactating mothers

The respondents who did not receive any service from AWCs were further probed about the reasons

for not availing the services. Table 7.19 shows that the majority of the respondents across the four

categories cited, ‘Did not feel the need of services from AWC’ as the reason. This was followed by

‘AWC is far off’, ‘Quality of services not up to the mark’ and ‘AWW’s/AWH’s behaviour is bad’.

Table 7.19: Non-utilization of AWC services by beneficiaries (reasons)

Percentage of lactating mothers, mothers of children aged 6-35 months, mothers of children aged 36-71 months and currently pregnant women residing in AWC area, who reported not taking any service from AWC by reasons for non-utilization, RSOC, 2013-14.

Reasons Mothers of children aged Currently

Pregnant women

0-5 months 6-35 months 36-71 months

Quality of services not up to the mark/good 8.6 8.6 7.8 6.2 Did not feel the need of services from AWC 22.6 23.2 22.5 19.0 Nobody to accompany the child/me 6.3 8.8 7.9 5.1 AWW's/AWH’s behaviour is bad 6.7 7.2 8.7 10.0 I feel me/my child is discriminated 4.1 4.3 2.8 3.9 AWC is far off 12.8 14.2 15.8 12.4

Number not availing any services from an AWC 4,419 19,106 25,114 2,837



7.5 REASONS FOR NOT AVAILING SUPPLEMENTARY FOOD

The respondents who received at least one service from AWC but did not receive supplementary

food were probed about the reasons for the same as supplementary food forms the most basic and

essential service. Table 7.20 shows that of those who were availing at least one service from AWC at

the national level around 11 percent lactating mothers, 8 percent children aged 6-35 months, 7

percent children aged 36-71 months and 11 percent currently pregnant women did not avail

supplementary food. The major reasons cited for not receiving supplementary food is ‘Food is not

distributed in AWC’ in case of lactating mothers (12 percent) and children aged 6-35 months (19

percent), ‘Not aware that mother/child is eligible to get food from AWC’ for children aged 36-71

months, and ‘Do not need food from AWC’ in case of currently pregnant women (27 percent). As is

seen from the table 7.20, there are other concomitant reasons also, mostly emanating from supply

side issues, which prevent the beneficiaries from availing the benefits of supplementary food.

Table 7.20: Reasons for not availing supplementary food

Percentage of mothers of children aged 0-5 months, children aged 6-35 months, children aged 36-71 months and currently pregnant women covered by an AWC, who reported not availing supplementary food from AWC by reasons thereof , RSOC 2013-14

Reasons Mothers of

children aged 0-5 months

Children 6-35 months

Children 36 - 71 months

Currently Pregnant women

Percentage not taking supplementary food from AWC

11.2 8.1 7.1 11.3

Number who received at least one service from AWC

4,050 22,075 22,758 2,410

Reasons for not taking supplementary food

AWC often remains closed 2.9 3.4 5.9 11.0

AWC far away from home 9.9 10.1 13.3 16.2

Food is not distributed in AWC 12.4 18.8 12.6 0.0

Supplementary food is out of stock for most of the days

4.4 4.9 6.8 0.0

Quality of food provided at AWC is generally not edible

2.4 2.9 3.7 11.9

Mother/my child does not like AWC food 3.1 4.4 5.6 0.0

Do not need food from AWC 5.7 7.4 6.8 26.6

Family members oppose 2.7 2.0 1.0 0.0

Unable to go to AWC for receiving food as all are working people

7.0 16.4 7.3 0.0

Not aware about food supplementation at AWC

10.2 8.4 8.2 0.0

Not aware that mother/child is eligible to get food from AWC

6.9 13.2 17.7 0.0

Feel mother/child is discriminated 7.8 6.6 2.4 12.9

Treatment at AWC not well 0.0 0.0 0.0 11.7

Number not taking supplementary food 455 1,793 1,617 272



7.6 TYPE OF SUPPLEMENTARY FOOD PROVIDED AT AWC

There are different types of food provided in AWCs under ICDS programme and it varies for different

target groups depending upon the place of serving and also in order to meet their specific

requirements. These are—hot cooked meal (HCM), ready to eat (RTE), take home ration (THR) and

morning snacks.

Beneficiary Type of supplementary food suggested/provided under ICDS

Children 6-35 months THR/RTE (Take Home Ration/Ready to Eat)

Children 36-71 months HCM (Hot Cooked Meal) and Morning Snacks

Pregnant and Lactating Women THR (Take Home Ration)/RTE (Ready to Eat)

It is observed that the type of supplementary food given to different target groups is not uniform

across the states.

Table 7.21 presents type of supplementary foods received by the lactating mothers and children

aged 6-71 months according to their background characteristics. Around 42 percent of the lactating

mothers reported to have received supplementary food. The proportion of children aged 6-35

months and 36-71 months receiving supplementary food from AWC was 49 percent and 44 percent

respectively. As expected, utilization of supplementary food is better in the rural areas than in the

urban areas. There do not seem to be any definitive differential in utilization basis education level of

mothers. Lactating mothers as well as children aged 6-71 months belonging to SC and ST categories

were availing supplementary food in a higher proportion as compared to their counterparts

belonging to OBC and Others categories.

With regard to wealth quintiles, the receipt of supplementary food from AWC is negatively

correlated with the rise in wealth index. For instance, 53 percent lactating mothers from the lowest

wealth quintile reported receiving supplementary food from AWC against 27 percent from the

highest wealth quintile. Similarly, a higher proportion of children aged 36-71 months from the

lowest quintile (54 percent) received supplementary food as compared to their counterparts from

the highest quintile (24 percent).

As per the laid down standard, HCM is prescribed for children aged 36-71 months. However, it is

seen that only 88 percent children aged 36-71 months received HCM. Close to 25 percent children of

36-71 months age-group had received RTE/THR or a combination of HCM and RTE/THR during the

month under reference. Deviating from the prescribed protocol, 27 percent lactating mothers and

39 percent children aged 6-35 months had received HCM. More than two-thirds lactating mothers

(79 percent) and children aged 6-35 months (70 percent) received THR.

The reasons for such deviations could be many and this study has not probed into this matter

deeply. However, one can attribute this mainly to the delay in replenishment of ingredients of HCM

in the AWCs. It was reported by a few AWWs that whenever, stock of the main ingredients are not

replenished in time; children are fed with THR or RTE food item available in the AWC.

Further only 22 percent children aged 36-71 months reportedly received morning snacks. There

were no rural urban differentials in the type of food received by lactating mothers and children aged



36-71 months. However, more children aged 6-35 months from urban areas (43 percent) received

HCM than children from rural areas (37 percent).

State-wise analysis on utilization of supplementary food from AWC and types of food thereof for

children aged 6-35 months and 36-71 months is given in Table 7.22 given in Annexure-A.

State-wise analysis on utilization of supplementary food and services provided at AWC for lactating

women (mothers with child aged 0-5 months) and pregnant women is given in Table 7.23 in

Annexure-A.



Table 7.21: Supplementary food received by children Percentage of mothers of children aged 0-5 months, children aged 6-35 months and 36-71 months covered by AWCs, by receipt of supplementary food and type of food received, by selected background characteristics, RSOC 2013-14

Characteristics

Children aged 0-5 months Children aged 6-35 months Children aged 36-71 months

Percentage received

Supplementary food

Number* HCM RTE/ THR

Number@

Percentage received

Supplementary food


Number@

Percentage received

Supplementary food


Morning Snacks

Number@

Residence Urban 28.7 2,023 27.6 76.0 579 36.7 10,913 43.1 66.3 4,000 31.1 12,268 88.5 25.4 19.7 3,816 Rural 46.7 6,446 26.6 79.0 3,009 53.8 30,268 37.3 70.6 16,259 48.7 35,605 87.7 24.4 22.1 17,323

EMW's education No Education 41.4 2,953 20.7 84.5 1,224 47.0 13,376 34.0 74.9 6,280 45.2 18,598 85.7 26.1 20.8 8,404 Below Primary (Class 1 - 4)

54.0 423 32.6 72.8 229 63.2 2,060 45.1 61.5 1,303 63.3 2,691 93.5 17.3 24.8 1,704


48.1 1,278 29.6 76.3 613 57.4 6,456 40.1 68.3 3,704 50.9 7,666 89.9 22.5 22.0 3,902


48.4 1,297 30.3 74.1 627 52.7 6,678 42.0 65.7 3,516 45.2 6,875 88.5 25.4 22.7 3,109


39.7 1,182 29.1 75.3 470 47.3 5,726 41.3 66.8 2,707 39.7 5,937 89.7 22.1 19.7 2,356

Completed H.S. and above(Class 12+)

31.8 1,335 28.7 77.9 425 39.9 6,885 35.9 71.9 2,750 27.2 6,105 83.8 30.6 22.4 1,664

Social Group Scheduled Caste 46.7 1,801 23.8 78.8 841 53.0 8,436 37.9 69.8 4,470 46.6 10,193 87.3 23.6 19.6 4,747 Scheduled Tribe 53.8 1,041 21.0 86.3 559 62.8 4,893 34.5 76.5 3,071 57.9 5,665 91.2 23.5 27.4 3,278 OBC 40.4 3,373 19.8 85.8 1,363 45.1 16,584 30.1 78.2 7,481 39.1 19,520 84.6 28.8 21.9 7,635 Other 35.9 2,171 42.4 64.2 780 45.7 10,837 51.6 55.6 4,955 43.0 11,994 90.3 21.2 20.0 5,160 Don’t know 53.6 83 (75.0) (25.0) 32 65.6 431 82.3 20.9 283 63.5 502 98.4 3.6 11.0 319

Wealth index Lowest 53.1 1,909 18.6 85.1 1,014 57.0 8,446 34.6 72.3 4,811 53.7 10,749 87.9 20.7 20.7 5,770 Second 46.4 1,877 30.5 75.9 871 54.9 8,824 37.6 69.3 4,846 52.3 10,533 89.2 23.9 22.1 5,507 Middle 43.8 1,778 33.4 73.0 779 53.2 8,716 42.2 66.1 4,634 46.3 10,191 87.7 25.2 20.6 4,719 Fourth 35.9 1,581 25.6 80.0 567 45.3 8,391 41.6 69.0 3,796 37.3 9,046 88.5 26.4 22.8 3,377 Highest 26.8 1,324 27.9 75.9 355 32.0 6,804 35.4 74.4 2,172 24.0 7,353 82.7 33.7 23.7 1,766

Total 42.4 8,469 26.7 78.5 3,587 49.2 41,181 38.5 69.8 20,259 44.2 47,873 87.8 24.5 21.6 21,139

( ) Percentage based on 25-49 unweighted cases. HCM=Hot Cooked Meal, RTE=Ready To Eat, THR=Take Home Ration. * Number of children residing in area covered by AWC, @ Number of children

received supplementary food.



Figure 7.2 presents the proportion of children aged 36-71 months who received supplementary food from AWCs

by states. The percentage of such children ranged from 78 percent in Tripura to 14 percent in Delhi. The

percentage of children aged 36-71 months receiving supplementary food was higher than the national average

in all the north-eastern states except for Nagaland. In fourteen states, the proportion was lesser than the

national average.

Figure 7.2: Percentage of children aged 36-71 months who received supplementary food, by states

7.7 REGULARITY OF RECEIVING SUPPLEMENTARY FOOD

The mothers and currently pregnant women were further asked about the number of days they or their children

received supplementary food from AWCs in one month prior to the survey. The analysis is presented in Table

7.24. It shows that one-fifth of the lactating mothers, 21 percent of the children aged 6-35 months, 31 percent

children aged 36-71 months and 28 percent pregnant women reported receiving supplementary food for 21 or

more days. While the receipt of the supplementary food was reported by a slightly higher proportion of lactating

mothers in the rural areas (21 percent) as compared to the urban areas (19 percent). However, in case of

children in the age group 6-35 months and 36-71 months and currently pregnant women, it was more in the

urban areas than in the rural areas. The average number of days on which supplementary food was received

from AWCs also varies across different beneficiaries. It varied from 11 days for lactating mothers, 12 days for

mothers of children aged 6-35 months and 16 days in case of children aged 36-71 months. Pregnant women, on

an average, received supplementary food for 14 days. The details on these by select characteristics are

presented in Tables 7.25-7.28 given in Annexure-A.

78 73 71 70 70 69 67

63 61 61 60

52 52 48 47 44 43 42 42

36

29 27 27 24 23 22 21 18 14 14

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Table 7.24: Frequency of receiving supplementary food

Percentage of mothers of children aged 0-5 months, children aged 6-35 months, children aged 36-71 months and currently

pregnant women covered by an AWC reported to have received supplementary food from AWC for 21 days or more and

the average number of days of receipt in one month preceding the survey by place of residence, RSOC, 2013-14.

Residence

Mothers of child 0-5

months Child 6-35 months Child 36-71 months Pregnant women

Percentage Number Percentage Number Percentage Number Percentage Number

Received supplementary food for 21 or more days

Rural 20.5 3,011 20.5 16,256 30.9 17,325 27.0 1,778

Urban 18.9 580 24.3 3,999 31.7 3,816 31.4 359

Total 20.3 3,590 21.3 20,255 31.0 21,140 27.8 2,137

Average Number of days received Supplementary Food

Average Number Average Number Average Number Average Number

Rural 10.7 2,735 11.3 13,475 15.7 16,159 13.6 1,543

Urban 9.6 531 12.4 3,381 15.1 3,570 14.7 303

Total 10.5 3,266 11.5 16,856 15.6 19,729 13.8 1,847

7.8 SUPPLEMENTARY FOOD CONSUMPTION PATTERN

A question was asked to the mother receiving food from AWC about the quantum of food consumed by her or the child. There were four options to this question.

a. Entire stuff/quantity b. Shared with other siblings/family members c. He/she does not like the food and so does not consume at all d. Cannot say/Don’t remember

The question was asked with the intention to understand whether mothers, children and currently pregnant

women liked the food supplied from the AWC. However, the options to this question may have several

interpretations. Table 7.29 presents percentage distribution of mothers of children aged 0-5 months according

to consumption pattern of the supplementary food received from the AWCs and by select background

characteristics. Nearly one-third (32 percent) of the lactating mothers reported consuming the entire food

received and another 48 percent shared it with other family members and 12 percent did not like the taste,

hence, did not consume the food at all. An analysis by residence shows that the proportion of lactating mothers

reporting consumption of entire quantity was slightly higher in the urban areas (35 percent) as compared to

those in the rural areas (32 percent). On the other hand, a higher proportion of lactating mothers (49 percent) in

the rural areas reported the practice of sharing with other members in the family when compared with the

mothers (44 percent) in the urban areas. Analysis by different levels of wealth indices shows that the practice of

sharing supplementary food with other family members was more common among mothers belonging to the

lowest wealth index (56 percent) and it decreased with the increase in index value.



Table 7.29: Supplementary food consumed by mothers of children aged 0-5 months

Percentage distribution of mothers of children aged 0-5 months according to pattern of consumption of the foods received

from AWC by background characteristics, RSOC, 2013-14.

Characteristics

Consumption of supplementary food Number of mothers of children aged 0-5 months receiving

supplementary food from AWC

Entire stuff/quantity

Shared with other siblings/family

members

Does not like the food and so does not

consume at all

Can't say/Don’t remember

Mother of children 0-5 months

32.1 48.0 11.6 8.3 3,589

Residence Urban 34.9 44.3 11.4 9.4 580 Rural 31.5 48.7 11.7 8.1 3,009

Wealth index Lowest 28.5 55.7 7.4 8.4 1,014 Second 33.6 47.9 10.8 7.7 872 Middle 35.2 46.7 10.3 7.8 779 Fourth 33.0 39.2 17.9 9.9 568 Highest 30.2 42.9 18.7 8.1 355

Table 7.30: Supplementary food consumed by children aged 6-35 months

Percentage distribution of children aged 6-35 months according to pattern of consumption of the foods received from AWC

by background characteristics, RSOC, 2013-14.

Characteristics Consumption of supplementary food Number of mothers of children aged 6-35

months receiving supplementary food

from AWC

Entire stuff/qua

ntity

Shared with other

siblings/family members

Does not like the food and so does not

consume at all

Can't say/Don’t remember

Children aged 6-35 months 31.1 52.4 9.7 6.7 20,272 Residence

Urban 33.5 49.9 11.0 5.6 4,000 Rural 30.5 53.0 9.4 7.0 16,272




Table 7.30 presents percentage distribution of children aged 6-35 months according to consumption of the

supplementary food received from AWC by background characteristics. Around 31 percent children aged 6- 35

months reportedly consumed the entire quantity of supplementary food received from the AWC and 52 percent

shared the food with other siblings/family members in the house. There were 10 percent children who reported

that they did not like the taste of the supplementary food hence did not consume it at all. The proportion of

children consuming entire quantity of food was slightly higher in the urban areas (34 percent) as compared to

those in the rural areas (31 percent). Analysis across children belonging to different wealth indices shows that

the practice of sharing supplementary food with other family members or siblings was more common among

children belonging to the lowest wealth index (62 percent) and it gradually decreased with increase in wealth

indices.

Table 7.31 presents percentage distribution of children aged 36-71 months according to consumption pattern of

supplementary food received from AWC by background characteristics. While analysing the data, those children

who ate supplementary food at AWC were considered to be consuming the entire quantity of supplementary

food. Around 79 percent children aged 36-71 months reportedly consumed the entire quantity of

supplementary food given at the AWC. Such children were higher (80 percent) in the rural areas as compared to

that (72 percent) in the urban areas. Data disaggregated by wealth index revealed a higher proportion of

children in the lowest wealth index (80 percent) consuming entire quantity of supplementary food received

from AWC against 69 percent in the highest wealth index. Notably, the consumption pattern in this age group

was different from other categories of beneficiaries.

Table 7.31: Supplementary food consumed by children aged 36-71 months

Percentage distribution of children aged 36-71 months according to pattern of consumption of the foods received from

AWC by background characteristics, RSOC, 2013-14.

Characteristics

Consumption of supplementary food Number of children aged

36-71 months receiving

supplementary food from

AWC

Entire

stuff/quantity

Half Less than

Half

Did not

consume at

all

Children aged 36-71 months 78.8 12.7 5.7 2.8 21006

Residence

Urban 71.5 15.8 8.2 4.5 3,784

Rural 80.4 12.0 5.2 2.4 17,221

Wealth index

Lowest 80.3 12.5 5.2 2.1 5,748

Second 81.6 11.6 4.8 2.0 5,467

Middle 79.3 13.7 4.6 2.5 4,690

Fourth 75.9 11.8 8.1 4.1 3,354

Highest 69.4 15.9 9.1 5.7 1,747



The pregnant women receiving supplementary food from AWC were also asked about the portion of food

consumed by her. Table 7.32 presents the percentage distribution of currently pregnant women according to

the consumption of supplementary food received from AWC by background characteristics. Amongst the

pregnant women receiving supplementary food, around 47 percent reported consuming the entire portion

themselves; another 41 percent shared the food with other family members and around 6 percent did not like it

and so did not consume it at all. The proportion of currently pregnant women consuming the entire quantity

was higher in the rural areas (48 percent) as compared to those in the urban areas (41 percent). Analysis of the

data by different wealth indices showed that consumption of entire quantity was almost at the same level

among the pregnant women belonging to different wealth quintiles except for those in the highest index

wherein it was slightly lower.

Table 7.32: Supplementary food consumed by currently pregnant women

Percentage distribution of currently pregnant women according to pattern of consumption of the foods received from AWC

by background characteristics, RSOC, 2013-14.

Characteristics

Consumption of supplementary food Number of

currently pregnant

receiving

supplementary

food from AWC

Entire

stuff/quantity

Shared with

other

siblings/family

members

Does not like

the food and

so does not

consume at all

Can't

say/Don’t

remember

Pregnant Women 46.9 41.0 6.3 5.9 2,137

Residence

Urban 41.4 43.7 8.6 6.3 359

Rural 48.0 40.4 5.8 5.8 1,778

Wealth index

Lowest 46.1 42.6 5.6 5.7 501

Second 47.5 45.3 3.9 3.3 526

Middle 49.0 35.6 6.8 8.6 492

Fourth 48.9 38.1 7.5 5.5 393

Highest 38.9 44.1 9.9 7.1 225

7.9 PLACE OF CONSUMPTION AND LIKING OF SUPPLEMENTARY FOOD

Supplementary food for children aged 36-71 months is generally provided in the form of hot cooked meal to be

eaten at AWC. Mother was probed for the place of consumption of the food given to the child in the sense

whether s/he consumed at AWC, at home or partially at AWC. Another question was asked about mother’s

perception whether the child liked the taste of the food. Table 7.33 presents place of consumption of

supplementary food and mother’s perception about liking of the food for children aged 36-71 months. Among

the children aged 36-71 months who received supplementary food from the AWC, around 68 percent consumed

it at the AWC itself and 25 percent consumed it at home. The proportion of children consuming the

supplementary food at the AWC was higher in the rural areas (69 percent) as compared to those in the urban

areas (60 percent).



As regards the taste of the supplementary food, around 52 percent mothers of children 36-71 months old

reported that the child always liked the taste of the food, while about 17 percent said that the child liked it most

of the times, and another 21 percent mentioned that the child liked it sometimes. The perception of mothers

about child’s liking of supplementary food was almost similar in both rural and urban areas.

Table 7.33: Place of consumption and perception on taste of supplementary food consumed

Percent distribution of children aged 36-71 months receiving supplementary food from an AWC by place of consumption of food and whether child liked the taste of food, according to place of residence, RSOC, 2013-14.

Characteristics Residence

Total Urban Rural

Place of consumption of supplementary food

AWC 59.7 69.2 67.5

Home 28.8 24.1 25.0

Partly at AWC 8.0 4.8 5.4

Did not consume 3.6 1.9 2.2

Number of children receiving supplementary food from an AWC 3,816 17,323 21,139

Mother’s report on whether child likes the taste of the food received from AWC

Always likes 52.2 52.4 52.4

Likes most of the times 16.0 17.5 17.2

Likes sometimes 22.8 20.4 20.8

Indifferent 3.3 3.1 3.1

Does not like 3.7 3.3 3.3

Number of children who consumed supplementary food received from an AWC 3,680 16,993 20,673

7.10 GROWTH MONITORING

Mothers of children aged 0-35 months and 36-71 months were asked if the child has growth chart/card. Overall

19 percent children aged 0-35 months and 9 percent children aged 36-71 months reportedly had growth

chart/card. There are large variations between the states with respect to child having growth chart/card. The

state wise picture for children aged 0-35 months and 36-71 months is shown in Figures 7.3 and 7.4 respectively.

The percentage of children aged 0-35 months having growth chart ranged from 2 percent in Manipur to 50

percent in Goa exhibiting a variation of 25 times. The top five states reporting growth chart for children aged 0-

35 months are Goa (50 percent), West Bengal (43 percent), Karnataka (43 percent), Sikkim (42 percent) and

Odisha (41 percent) and the bottom five states are Manipur (2 percent), Jammu & Kashmir (3 percent),

Nagaland (4 percent), Uttar Pradesh (5 percent) and Arunachal Pradesh (5 percent). The percentage of children

aged 36-71 months having growth chart ranged from less than 1 percent in Manipur to 30 percent in Kerala, a

variation of more than 30 times. The situation in case of children aged 36-71 months in this regard seems to be

relatively bad as compared to children aged 0-35 months as there are seven states where the percentage of

children having growth chart is 2 percent or less. Similarly, the percentage of children having growth chart in the

best performing state for 36-71 months (Kerala-30 percent) is 20 percentage points less than for the best

performing state in case of 0-35 months (Goa- 50 percent).



Figure 7.3: Percentage of children aged 0-35 months covered by an AWC, reported to have growth chart/card by state

Figure 7.4: Percentage of children aged 36-71 months covered by an AWC, reported to have growth chart/card by state

50

43 43 42 41

36 33

30 26

23 21

19 19 17 13 13 12 12 11 11 10 10

7 7 6 5 5 4 3 2

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30

27 27 24

21 19

16 14 14 14

12 11

9 9 8 6 6 6

4 4 3 3 3 2 2 2 2 2 2

0

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Table 7.34: Weight monitoring of children 0-71 months Percentage of children aged 0-71 months for whom growth chart is available and percent distribution of those with growth chart by frequency of weighing in the 3 months

preceding the survey, by background characteristics

Characteristics


with growth

chart/card)

Number of

children 0-71

months

Frequency of weighing in the 3 months preceding the survey

Percentage of children 0-

35 months weighed at

least once in last 3 months


number of

children 0-35

months

Percentage of children 36-71

months weighed at least once in

3 months preceding the

survey

Number of

children 36-71

months who had growth

chart/card

1 2 3 or

more

Do not

know

Not weighted

Age of the child (months) 0-35 19.2 54,163 21.7 20.4 21.9 3.1 33.0 64.0 10,374 na na 36-71 9.2 55,694 18.3 21.2 26.6 4.7 29.2 na na 66.1 5,130

Sex of the Child Male 14.1 57,567 20.7 21.1 23.7 3.5 31.1 64.7 5,515 66.9 2,593

Female 14.1 52,290 20.4 20.3 23.1 3.8 32.4 63.1 4,859 65.2 2,537 Residence

Urban 14.8 33,434 25.2 20.4 20.2 3.2 31.0 67.2 3,118 63.5 1,824 Rural 13.8 76,423 18.4 20.8 24.9 3.8 32.1 62.6 7,255 67.5 3,306

Mother education No Education 8.4 38,358 13.9 19.8 21.4 5.3 39.6 51.6 2,153 62.1 1,070

Below Primary 15.4 5,523 20.4 19.5 21.5 2.7 35.9 63.0 630 57.0 220 Completed Primary 16.2 16,910 19.4 20.8 23.9 4.0 31.8 65.1 1,800 62.4 935 Completed Middle 16.0 16,390 19.8 19.4 21.8 4.3 34.7 60.6 1,861 62.1 758 Completed Secondary 18.2 14,692 23.5 21.4 25.3 2.8 27.0 70.6 1,724 69.5 950

Completed Higher Secondary and above 18.9 17,984 26.0 22.2 25.1 2.2 24.6 73.0 2,206 73.8 1,197 Religion

Hindu 14.6 85,854 20.3 21.7 24.5 3.6 29.9 66.1 8,291 67.2 4,206 Muslim 11.9 18,251 23.2 16.7 16.6 3 40.5 56.1 1,566 57.5 604 Christian 17.8 2,795 21.5 14.7 31.1 3.6 29.1 60.7 285 76.2 212 Sikh 11.8 1,611 7.7 10.6 3 3.3 75.5 18.3 128 27.3 62 Jain 3.2 174 * * * * * * 5 * 0 Buddhist 12.0 672 23.8 29 31.9 13.1 2.2 86.3 47 82.5 33 No religion 8.7 75 * * * * * * 5 * 2 Other 13.4 425 9.4 32.1 27.3 8.6 22.6 65.9 46 80.9 11

Social Group Scheduled Caste 13.9 22,309 19.0 20.7 22.8 3.7 33.9 62.1 2,219 63.3 872

Scheduled Tribe 13.4 12,501 18.7 21.2 31.2 5.1 23.7 67.7 1,090 77.8 582 OBC

14.0 44,273 20.1 19.3 23.7 3.5 33.3 62.5 3,851 64.3 2,367 Others 14.4 29,679 23.4 22.7 20.9 3.1 29.9 67.0 2,995 66.8 1,283 Do Not Know 22.4 1,095 14.4 16.9 14.2 5.0 49.6 48.6 219 19.3 27



Characteristics


with growth

chart/card)

Number of

children 0-71

months

Frequency of weighing in the 3 months preceding the survey

Percentage of children 0-

35 months weighed at

least once in last 3 months


number of

children 0-35

months



3 months preceding the

survey

Number of

children 36-71

months who had growth

chart/card

1 2 3 or

more

Do not

know

Not weighted

Wealth Index Lowest 10.0 22,672 18.3 20.2 26.4 4.4 30.7 61.8 1,626 72.7 646

Second 12.8 22,576 17.7 19.9 23.9 4.7 33.9 60.6 2,060 63.5 822

Middle 14.9 22,491 18.0 23.2 23.4 3.8 31.6 64.6 2,291 64.5 1,060 Fourth 16.4 22,027 22.2 19.9 23.5 2.9 31.5 65.2 2,327 66.3 1,289

Highest 16.8 20,091 25.2 20.1 20.9 2.8 30.9 66.8 2,069 65.4 1,313 Total 14.1 1,09,857 20.6 20.7 23.4 3.6 31.7 64.0 10,374 66.1 5,130

na: Not Applicable, *Percentage not shown; based on fewer than 25 unweighted cases.

Table 7.34 shows the proportion of children for whom growth chart is available and distribution of such children by frequency of weighing in

three months preceding the survey. Out of all the children aged 0-71 months, for 14 percent of the children mother reported of having a growth

chart. Among them 65 percent were weighed at least once in three months. Mothers of younger children are more likely to have growth chart

than mothers of older children. Almost one in five mothers (19%) of children aged 0-35 months reported to have growth chart, compared to

nine percent of mother of children aged 36-71 months. Though, there was a difference in the proportion having growth chart, about 64-66

percent of the children from both the age-groups were weighed at least once in three months prior to survey. The proportion of children with

growth card increased from the group of children whose mother had no education (8 percent) to those whose mother had below primary

education (15 percent). However, thereafter, with increase in mother’s education there was only a small increase in the proportion of children

with growth chart. For about one-fifth (19 percent) of the children whose mother had education of higher secondary or more, growth chart was

available. With increase in mother’s education, there was increase in the proportion of children aged 0-35 months and 36-71 months who were

weighed at least once in three months period prior to survey; though the increase was not uniform. The proportion of children with growth card

and the proportion of children aged 0-35 months who weighed at least once in three months preceding the survey, both hold positive

relationship with wealth quintile. However the proportion of children aged 36-71 months who weighed at least once in three months preceding

the survey holds negative relationship with wealth quintile.



35

5

16

39

4 2

76

2 9 10

1 2

62

3 11

20

2 2

AnganwadiCentre

At Home Govt. hospital/Health Centre

Private Hospital / Private Doctor’s

clinic

Others Don’t know

Urban Rural Total

The mothers who reported that their child was weighed at least once in the last three months were further

asked about the place where the child was weighed last. The data was analysed separately for children aged 0-

35 months and 36-71 months. Figure 7.5 shows that among the children aged 0-35 months, the maximum (58

percent) were weighed at an AWC, followed by private hospital/clinic (21 percent) and government

hospital/health centre (15 percent). Among the children aged 36- 71 months, 62 percent were weighed at AWC,

20 percent at private hospital/clinic and 11 percent at government hospital/health centre (Figure 7.6). The

figures 7.5 and 7.6 further show that more rural children were weighed at AWC whereas more urban children

were reportedly weighed at private hospital/clinic as well as at government hospital/health centre.

Figure 7.5: Place of taking weight last time for children aged 0-35 months

Figure 7.6: Place of taking weight last time for children aged 36-71 months

36

3

19

39

1 3

69

3

13 12

1 3

58

3

15 21

1 3

AnganwadiCentre

At Home Govt. hospital/Health Centre

Private Hospital / Private Doctor’s

clinic

Others Don’t know

Urban Rural Total



The mothers who reported that their child was weighed at any facility were further asked whether they are

aware of the present weight of the child. Table 7.35 shows that 83 percent mothers of children aged 0-35

months and 80 percent mothers of children aged 36-71 months were aware of the weight of the child. The table

further shows that there was a differential on mother’s awareness regarding weight of the child by educational

level of mothers. For example, 88 percent mothers of children aged 0-35 months having completed higher

secondary were aware of the weight of their child as compared to 76 percent illiterate mothers. Comparatively

less ST mothers of children aged 36-71 months (67 percent) were aware of weight of the child than mothers

belonging to SC (80 percent), OBC (82 percent) and other castes (84 percent). The analysis by wealth quintiles

shows that mothers from lowest wealth quintile were less aware of weight of their child than the mothers from

the higher quintiles. Awareness of mothers regarding child’s weight in various states is presented in Table 7.36

given in Annexure-A.

Table 7.35: Awareness of weight of the child

Percentage of mothers of children aged 0-35 months and 36-71 months aware of the present weight of the child by

selected background characteristics, RSOC, 2013-14.

Characteristics

Percent aware of weight of child aged 0-35 months

Number of Children aged 0-35 months

Percent aware of weight of child aged 36-71 months

Number of Children aged 36-71 months

Mother's education No education 75.8 1,112 73.1 664

Below Primary (Class - 1 to 4) 78.2 397 63.9 125

Completed Primary (Class 5-7) 80.4 1,172 80.5 584

Completed Middle (Class 8 -9) 79.9 1,127 79.8 471

Completed Secondary (Class 10-11) 87.3 1,218 82.4 660

Completed Higher Secondary (Class 12) 87.7 1,610 86.9 884

Social Group

Scheduled Caste 80.7 1,377 79.9 552

Scheduled Tribe 75.4 738 67.2 452

OBC 85.2 2,407 82.3 1,522

Other 83.1 2,006 84.3 857

Do Not Know 79.5 106 * 5

Wealth index

Lowest 74.1 1,006 64.8 470

Second 79.9 1,249 79.0 522

Middle 83.7 1,481 80.7 684

Fourth 82.6 1,518 81.9 854

Highest 89.4 1,382 88.0 859

Total 82.5 6,635 80.4 3,389

*Percentage not shown; based on fewer than 25 unweighted cases.

The mothers were further asked whether weight of the child was normal or the child was moderately

underweight or severely underweight. Figure 7.7 shows that more than three-fourth mothers of children aged 0-

35 months reported that the child’s weight was normal, 12 percent said that the child was moderately



underweight and 2 percent reported child as severely underweight. Comparatively more mothers of children

aged 0-35 months belonging to OBC (79 percent) and Other castes (84 percent) reported child’s weight as

normal than SC (73 percent) and ST (73 percent) mothers. Among the children aged 36-71 months, 84 percent

were reported to be normal, 8 percent moderately underweight and around one percent severely underweight

(Figure 7.8). Eight percent mothers of children aged 0-35 months and seven percent mothers of children aged

36-71 months did not know that in which category her child falls respectively.

Figure 7.7: Weight of children aged 0-35 months, by social group

Figure 7.8: Weight of children aged 36-71 months, by social group

All those mothers who reported that the child’s weight was taken were asked if anyone had previously discussed

her child’s nutritional status with her. This is a multiple response question and all those who discussed child’s

nutrition status with mother were recorded. Table 7.37 presents the analysis of responses received from

mothers of children aged 36-71 months. The table shows that half of the mothers (51 percent) reported that no

one discussed with her about her child’s nutrition status. Nearly one fourth (26 percent) mothers reported

AWW, 6 percent ANM and 12 percent reported doctor discussing the nutritional status of the child. The table

further shows that in rural areas it was mainly the AWW who did discuss the nutritional status whereas in urban

areas it was predominantly done by doctors.

73 73 79 84

55

78

15 11 12 9 19

12 3 2 2 1 1 2

9 14

7 6

26

8

ScheduledCaste

Scheduled Tribe OBC Other castes Do Not Know Total

Normal Moderately underweight Severely underweight Don’t know

85 76

84 90

72

84

7 9 8 6

20

8 1 2 2 1 0 1

8 13 6 3

8 7

ScheduledCaste

Scheduled Tribe OBC Other castes Do Not Know Total

Normal Moderately underweight Severely underweight Don’t know



Table 7.37: Persons who discussed about child’s nutrition status

Percentage of mothers of children aged 36-71 months reporting persons who discussed about child’s nutrition status by

background characteristics, RSOC, 2013-14.

Characteristics No one

discussed AWW ANM Doctor Others

Number of children aged 36-71 months

Mother’s age 15-19 * * * * * 7 20-24 49.2 26.9 7.8 10.7 5.4 766 25-29 49.8 27.1 5.7 10.8 6.5 1,478 30-34 52.3 23.0 3.1 13.9 7.7 755 35-39 56.1 21.8 3.9 14.0 4.2 283 40-44 51.4 32.6 4.1 8.9 3.0 73 45-49 (51.7) (27.6) (3.4) (6.9) (10.3) 26

Residence

Urban 51.8 17.7 3.1 20.1 7.2 1,158

Rural 50.4 30.0 6.7 7.3 5.7 2,231

Mother's education

No education 55.3 29.7 6.2 3.9 4.9 664

Below Primary (Class - 1 to 4) 57.7 23.3 5.0 3.6 10.5 125

Completed Primary (Class 5-7) 45.7 35.6 7.2 5.5 6.1 584

Completed Middle (Class 8 -9) 49.9 26.8 8.8 8.6 5.9 471

Completed Secondary (Class 10-11) 51.0 23.5 5.4 13.2 6.9 660

Completed Higher Secondary (Class 12) 50.4 17.9 2.1 23.2 6.4 884

Religion

Hindu 51.0 26.9 5.3 10.8 5.9 2,825

Muslim 46.5 20.2 4.9 17.9 10.5 347

Christian 54.5 18.8 11.0 13.7 2.0 161

Sikh * * * * * 17

Buddhist/Neo-Buddhist (50.2) (34.3) (0.2) (6.9) (8.5) 28

No Religion * * * * * 1

Other * * * * * 9

Social Group

Scheduled Caste 50.3 27.0 7.6 8.3 6.9 552

Scheduled Tribe 52.9 36.6 2.6 3.7 4.1 452

OBC 51.6 25.3 4.9 12.6 5.7 1,522

Other 48.9 20.4 6.6 16.2 8.0 857

Do Not Know * * * * * 5

Wealth index

Lowest 57.8 33.9 4.5 1.9 2.0 470

Second 46.1 33.8 7.4 4.8 7.8 522

Middle 49.0 31.9 7.0 4.5 7.6 684

Fourth 50.5 25.0 5.0 13.6 6.0 854

Highest 51.8 12.4 4.1 24.9 6.8 859

Total 50.9 25.8 5.5 11.7 6.2 3,389

*Percentage not shown; based on fewer than 25 unweighted cases. ( ) Percentage based on 25-49 unweighted cases.



7.11 QUANTITY OF FOOD GIVEN TO SEVERELY MALNOURISHED CHILDREN

Severely underweight children are given more quantity of food (24-25 gm of protein) than children with normal

weight (12-15 gm of protein). Mothers were asked a series of questions to know about the child’s nutritional

status. As shown in Figures 6.7 and 6.8 there were 1.8 percent children aged 0-35 month and 1.4 percent aged

36-71 months reported to be severely underweight. Mothers of such children were asked about the quantity of

food child received when he/she was severely underweight. Table 7.38 presents percentage of children who

received additional quantity of supplementary food. Among severely underweight category, nearly 33 percent

children aged 6-35 months received same quantity of supplementary food as they used to receive earlier and

another 32 percent received slightly more than the usual quantity and only 5 percent received double the

quantity that they used to receive earlier.

Table 7.38: Quantity of supplementary food received by severely underweight children

Percentage of severely underweight children aged 0-35 months and 36-71 months by quantity of supplementary

food received, RSOC, 2013-14.

Quantity of supplementary food received Children aged 0-35

months

Children aged 36-71

months Total

Same as earlier 33.3 (42.9) 33.8

Slightly more 31.8 (25.7) 33.7

Almost double of what received earlier 4.5 (0.0) 3.2

Don't remember 16.5 (2.9) 13.7

Not Applicable 13.8 (28.6) 15.6

Number of children severely underweight 103 45 148


( ) Percentage based on 25-49 unweighted cases



7.12 ATTENDANCE DURING PRE-SCHOOL EDUCATION AND AGE AT ATTENDING PRE-SCHOOL

EDUCATION

As per the national policy on Early Childhood Care and Education (ECCE) pre-school education is an

indispensable foundation for lifelong learning and development, and has critical impact on success at the

primary stage of education. Provision of pre-school education (PSE) for children aged 36-71 months is another

important component of the ICDS programme. This is a joyful playway daily activity, to be undertaken for 2-4

hours a day for all children 3-6 years, for all working days of the week. The information on attendance in the PSE

was collected for all children aged 36-71 months in areas covered by an AWC.

Mothers of children aged 36-71 months were asked to mention all the services that they avail for the child from

the AWC in their area. Their spontaneous as well as prompted responses regarding each of the specific services

reportedly availed from the AWC for the children aged 36-71 months were recorded. Table 7.39 presents the

percentage of the mothers who reported utilization of AWC for PSE by children aged 36-71 months according to

their background characteristics. Overall two-fifth of the children aged 36-71 months attended PSE at the AWCs.

The analysis of attendance in PSE at the AWC by background characteristics shows that more rural children (43

percent) attended PSE at AWC than their urban counterparts (27 percent). More children belonging to STs (51

percent) and SCs children (41 percent) received PSE at the AWC than children from OBC (35 percent) and

general castes (38 percent). It is also observed that more children from the lowest wealth quintile (47 percent)

attended PSE in the AWCs than those in the higher wealth quintiles. The attendance at the AWC did not vary

much according to the gender and religion of the child.

The information on age since when the child started attending PSE at the AWC as well as number of days the

child attended PSE in the last month and in the last three months preceding the survey was collected for all the

children from mother who reported attendance in the PSE at the AWC. The results have also been presented in

Table 7.39.

The mean age at which the child started attending the PSE was 39 months. The mean age at attending PSE at

AWC was slightly lower for children in rural areas and children belonging to the lowest and the second lowest

wealth quintiles.

Among the children who attended PSE at AWC, mean number of days of attendance in PSE in one and three months preceding the survey were 17 and 43 days, respectively with marginal variations across background characteristics of the children.



Table 7.39: Attendance at pre-school education (PSE) at AWCs

Percentage of children aged 36-71 months residing in the area covered by an AWC according to their attendance in PSE,

mean age at attendance and the average number of days attended PSE by background characteristics, RSOC, 2013-14.

Characteristics Percentage attending

PSE in AWC

Number of children

living in an area covered by an AWC

Mean age at which started

attending PSE

Average number of days attended PSE in one full month

prior to survey

Average number of days

attended in 3 months prior to

the survey

Age of Child (months)

36-47 42.5 16,402 39.1 17.0 41.4 48-59 40.5 16,695 38.8 17.3 44.1 60-71 32.4 14,776 38.7 16.1 42.2

Sex of Child

Male 37.5 24,682 38.8 16.7 42.5 Female 39.9 23,191 38.9 17.0 42.6

Residence Urban 26.9 12,268 39.7 16.3 38.3 Rural 42.7 35,605 38.7 17.0 43.5

EMW's education No Education 39.1 18,598 38.5 16.7 41.6 Below Primary (Class - 1 to 4) 55.2 2,691 38.4 16.8 44.7 Completed Primary (Class 5-7) 44.6 7,666 39.0 16.8 43.2 Completed Middle (Class 8 -9) 39.7 6,875 38.7 16.5 42.9 Completed Secondary (Class 10-11) 36.1 5,937 39.8 18.2 43.4 12+ (Class 12 and above) 24.0 6,105 39.6 16.5 41.9

Religion

Hindu 39.6 37,609 39.0 17.1 43.0 Muslim 34.9 7,787 38.1 16.1 41.8 Christian 38.7 1,342 38.6 16.3 35.9 Sikh 23.2 646 36.9 17.5 42.9 Jain (26.2) 45 * * * Buddhist/Neo-Buddhist 50.8 266 40.5 16.3 36.7 No Religion (26.2) 31 * * * Other 44.9 147 37.4 15.6 41.6

Social Group

Scheduled Caste 40.6 10,193 38.9 16.8 42.9 Scheduled Tribe 50.6 5,665 39.2 17.3 41.2 OBC 34.5 19,520 39.2 16.8 42.4 Other 37.8 11,994 38.2 16.9 43.5 Do not know 46.3 502 36.7 14.2 40.2

Wealth index

Lowest 46.6 10,749 38.3 16.7 42.9 Second 45.5 10,533 38.4 16.8 42.8 Middle 41.1 10,191 39.2 17.2 43.1 Fourth 33.2 9,046 39.6 17.0 42.0 Highest 20.7 7,353 39.7 16.4 40.8

Total 38.7 47,873 38.9 16.9 42.6




Table 7.40 shows the percentage of children who attended PSE for 16 or more days, average number of hours

attended PSE in one month prior to the survey and percentage of children who attended PSE for four hours or

more hours. At the national level, among the children attending PSE at the AWC, 58 percent attended the PSE

for more than 16 days. The frequency distribution of the number of days of PSE attended by the children among

those attending the PSE has been presented in Figure 7.9.

Figure7.9: Percentage distribution of children according to number of days attended PSE in one month prior to the survey by place of residence

Analysis of attendance at PSE for 16 or more days by residence shows that slightly higher proportion of children

in rural areas compared to their urban counterparts reportedly attended PSE for 16 days or more in one month

prior to the survey. The attendance at PSE for 16 or more days was slightly higher for girls than boys. Across the

social category, a relatively higher proportion of children from other castes general caste group reported

attendance in PSE for 16 or more days.

Table 7.40 further shows that in case of one-fourth of children attending PSE in AWCs, the number of hours

generally spent for PSE at the AWC was four hours or more. The percentage distribution of children attending

PSE according to number of hours spent for PSE at the AWC presented in Table 7.41 shows that 40 percent of

the children were attending PSE just for one to two hours in a day and another 28 percent attended PSE for two

to four hours per day. The analysis by background characteristics reveal that the children in urban areas,

children whose mothers have higher level of education, children belonging to two upper wealth quintiles and

children from OBC category are more likely to attend PSE at AWC for four or more hours.

The mean number of hours generally spent for PSE was 2.8 in both rural and urban areas. The mean number of

hours generally spent for PSE was relatively lower for children belonging to other caste groups and children from

the lowest wealth quintile.

8

23

59

6 4 8

21

56

10 5 8

22

58

7 4

1-6 7-15 16 or more Not at all Don't know

Rural Urban Total



The percentage of children whose mothers participated in parent’s meet in the three months prior to survey is

also presented in Table 7.40. Among the children attending PSE, the mothers of 28 percent children participated

in parent’s meet in the three months prior to the survey. The corresponding percentage was relatively lower for

children in the age group of 60-71 months. A higher percentage of mothers residing in urban areas as well as

mothers having secondary and above level education reported participation in parent's meet at the AWC for the

PSE of their child. The percentage of mothers participating in the parent's meet increased with the increase in

the wealth quintiles. Across social groups the participation in the parents meet was marginally higher in case of

mothers coming from general caste groups.

Table 7.40: Regularity and quality of attendance at pre-school education at AWC

Percentage of children aged 36-71 months who attended PSE at AWC for 16 or more days, and for 4 hours or more hours in

a day, average number of days attended PSE and percentage of children whose mothers participated in parent's meet by

background characteristics, RSOC, 2013-14.

Characteristics

Percentage of

children

attended PSE 16

days or more in

one month

prior to the

survey

Average

number of

hours attended

PSE in one

month prior to

the survey

Percentage of

children

attended PSE

for 4 hours or

more

Percentage of

children whose

mothers

participated in

parent's meet in

the 3 months

prior to survey

Number of

children living in

an area covered

by an AWC

attending PSE in

AWC

Age of Child (months)

36-47 57.8 2.8 26.0 29.5 6,965

48-59 59.5 2.8 24.9 28.3 6,763

60-71 56.5 2.8 24.3 24.7 4,782

Sex of Child

Male 57.2 2.8 24.1 28.1 9,247

Female 58.9 2.9 26.3 27.6 9,262

Residence

Urban 55.5 2.8 29.0 29.3 3,296

Rural 58.6 2.8 24.4 27.5 15,213

EMW's education

No Education 56.5 2.8 25.0 20.9 7,278

Below Primary (Class - 1 to 4) 60.2 2.5 14.7 21.8 1,487

Completed Primary (Class 5-7) 58.6 2.8 23.3 30.7 3,414

Completed Middle (Class 8 -9) 56.5 2.7 20.1 27.5 2,727

Completed Secondary (Class 10-11) 65.4 3.2 35.1 41.3 2,141

12+ (Class 12 and above) 54.5 3.1 36.3 42.5 1,463

Religion

Hindu 58.4 2.9 26.1 28.0 14,899

Muslim 55.9 2.5 19.2 23.8 2,717

Christian 57.6 3.2 33.8 44.0 520

Sikh 66.3 3.0 22.9 18.5 150

Jain * * * * 15

Buddhist/Neo-Buddhist 58.6 2.4 14.8 40.0 135

No Religion * * * * 6

Other 45.0 2.6 17.9 21.7 66



Characteristics

Percentage of

children

attended PSE 16

days or more in

one month

prior to the

survey

Average

number of

hours attended

PSE in one

month prior to

the survey

Percentage of

children

attended PSE

for 4 hours or

more

Percentage of

children whose

mothers

participated in

parent's meet in

the 3 months

prior to survey

Number of

children living in

an area covered

by an AWC

attending PSE in

AWC

Social Group

Scheduled Caste 57.2 2.9 26.1 26.9 4,142

Scheduled Tribe 58.0 2.7 19.1 27.8 2,864

OBC 58.5 3.0 32.0 28.1 6,734

Other 58.9 2.5 19.1 28.9 4,536

Do not know 46.2 2.0 4.9 16.7 232

Wealth index

Lowest 56.6 2.6 18.6 21.2 5,010

Second 57.1 2.7 22.4 23.0 4,795

Middle 60.4 3.0 29.6 32.1 4,185

Fourth 59.6 3.0 30.6 35.1 2,999

Highest 56.7 3.0 33.1 38.6 1,520

Total 58.1 2.8 25.2 27.8 18,509




Table 7.41: Pre-school education —time spent by children on PSE activities in a day at AWC

Percentage of children aged 36-71 months residing in area covered by AWC, by time spent by children on PSE activities in a

day at AWC, according to background characteristics, RSOC, 2013-14.

Characteristics

Time spent by children on PSE activities in a day at AWC Number of children

living in an area

attending ICDS run PSE

Less than

1 hour 1-2 hours 2-4 hours 4 hours or more

Age of child (months)

36-47 2.1 41.4 26.5 26.0 6,967

48-59 2.0 40.0 28.5 24.9 6,763

60-71 3.1 39.3 29.3 24.3 4,782

Sex of child

Male 2.4 41.4 27.8 24.1 9,249

Female 2.2 39.3 28.1 26.3 9,262

Residence

Urban 3.5 41.6 21.4 29.0 3,296

Rural 2.1 40.1 29.4 24.4 15,215

Mother's education

No Education 1.8 41.3 28.1 25.0 7,278





Completed Higher Secondary and above 4.3 28.6 25.1 36.3 1,463

Religion

Hindu 2.4 38.0 29.3 26.1 14,899

Muslim 1.8 55.0 20.2 19.2 2,719

Christian 3.8 32.9 23.7 33.8 520

Sikh 1.7 19.5 48.9 22.9 150

Jain * * * * 15

Buddhist/Neo-Buddhist 4.4 50.7 22.3 14.8 135

No religion * * * * 6

Other 0.0 46.9 29.1 17.9 66

Social Group

Scheduled Caste 1.7 39.4 28.2 26.1 4,142

Scheduled Tribe 1.7 47.3 28.5 19.1 2,864

OBC 2.5 30.2 30.6 32.0 6,737

Other 3.0 50.3 24.1 19.1 4,536

No Response 1.0 72.4 14.6 4.9 232

Wealth Index

Lowest 1.4 46.2 29.9 18.6 5,010

Second 1.8 43.3 27.7 22.4 4,795

Middle 2.2 36.5 28.0 29.6 4,185

Fourth 3.3 36.2 26.0 30.6 2,999

Highest 5.3 30.9 26.1 33.1 1,522

Total 2.3 40.4 27.9 25.2 18,511




The children who reportedly received at least one service from AWC but did not receive PSE were asked the

reasons for the same. Table 7.42 shows, in both rural and urban areas, the reason cited for not attending PSE at

the AWC by almost one-fifth of the children was ‘AWC is far off’. Another 14 percent of the children did not

attend PSE at AWC as no PSE sessions were organized at the AWC. The corresponding percentage was higher in

rural than the urban areas. The other reasons mentioned by 5 to 8 percent of the children for not attending PSE

at the AWC included ‘AWW not qualified or trained’, ‘AWW not coming to AWC regularly’, ‘Not aware about PSE

in AWC’, ‘Not aware PSE is conducted in AWC’.

Table 7.42: Reasons for not attending PSE at the AWC

Percentage of mothers of children aged 36-71 months covered by an AWC, who reported not attending PSE at the AWC by

reasons for not attending PSE, RSOC, 2013-14.

Reasons Residence

Total Urban Rural

Percentage not attending PSE at AWC 73.1 57.3 61.3

Base* 12,268 35,605 47,873

Reasons for not taking supplementary food

AWW not qualified or trained 5.3 4.8 4.9

PSE curriculum is not relevant or appropriate 8.9 8.0 8.2

PSE not conducted in AWC 8.9 15.4 13.9

AWW not coming to AWC regularly 2.7 5.9 5.2

AWC remains closed/not regularly opened 1.8 3.9 3.4

Not aware about PSE in AWC 5.9 6.3 6.2

I feel my child is discriminated 2.2 2.1 2.1

AWC is too far away 19.5 19.0 19.1

Not aware PSE is conducted in AWC 5.4 7.8 7.3

Base** 983 3,264 4,247

*All children aged 36-71 months residing in the area covered by AWC

**Those who received at least one service from AWC but did not receive PSE at AWC

Figure 7.10 shows state-wise proportion of children aged 36-71 months who reportedly attended PSE at AWC.

Percentage of children attending PSE at AWCs ranges from 74 percent in Tripura to as low as 1 percent in

Nagaland. In 14 states the proportion of children attending PSE was higher than national average of 39 percent.

Percentage of children attending PSE in AWC was below 20 percent in most of the Northern states (Punjab-18

percent, Rajasthan-17 percent, Uttar Pradesh-16 percent, Jammu and Kashmir-15 percent, Haryana-15 percent

and Delhi-11 percent).



Figure 7.10: State wise percentage of children aged 36-71 months who attended PSE in AWC

The state wise percentage of children 36 to 71 months who attended PSE for 16 or more days is given in Figure

7.11. The attendance at PSE for 16 or more days was much lower in the states of Nagaland (3), Manipur (24),

Meghalaya (26), Uttar Pradesh (34), Jammu & Kashmir (36) and Madhya Pradesh (37). The corresponding

percentages were much better than the national average for the states of Goa (82), Karnataka (78), Sikkim (75),

Bihar (72) and Tripura (70).

Figure 7.11: State wise percentage of children aged 36-71 months who attended PSE in AWC for 16 or more days

The state wise analysis on age since when the child was attending PSE at the AWC, number of days attended PSE

in the last month and in the last three months, number of hours for which generally attended PSE at the AWC

74

65 63 63 61 58 57 57 57

54 51

45 45 42

39 37 35 35 32 30

25 25 23 18 17 16 15 15

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and participation of the mothers at the parents meet at the AWC in the last three months is presented in Tables

7.43-7.45 given in Annexure-A.

7.13 OTHER SERVICES AT AWC

The Village Health and Nutrition Day (VHND) is to be organized once a month on a fixed day at the AWCs in the

villages. AWC is identified as the hub for service provision under National Health Mission and also as a platform

for inter-sectoral convergence. VHND also acts as a platform for interfacing between the community and the

health system. On the appointed day, ASHAs, AWWs, and other health workers mobilize the villagers, especially

women and children, to assemble at the nearest AWC. The ANM and other health personnel are also to be

present on time. On the VHND, the villagers interact with the health personnel and obtain basic services and

information. They also would learn about the preventive and promotional aspects of health care to encourage

them to seek health care at proper facilities.

Table 7.46 presents the awareness among ever married women with regards to VHND and their participation in

the past three months according to background characteristics. The table shows that 23 percent of the rural

ever married women were aware of the VHND conducted at AWC and out of them close to 43 percent reported

participating in at least one VHND in the past three months. Mothers’ education plays a role in the awareness

and attendance at VHND. For instance 27 percent mothers who passed at least higher secondary were aware of

VHND as compared to 16 percent illiterate women. Comparatively more educated women reported to have

participated in VHND than illiterate women.

Across the social category, a slightly higher proportion of women belonging to ST (25 percent) and those

belonging to SC (25 percent) reported their awareness of VHND than that of OBCs (21 percent). Analysis across

different wealth indices show that the awareness regarding VHND was relatively lower (21 percent) among ever

married women belonging to the lowest wealth index as compared to the women from highest wealth index (23

percent). Participation in the VHND was almost similar among women from different wealth quintiles.



Table 7.46: Village Health and Nutrition Day

Percentage of ever married women (EMW) in rural areas who were aware of VHND or Mother's day held at AWC and

percentage attended any such meeting in the last 3 months prior to survey, according to background characteristics, RSOC,

2013-14.

Characteristics

Percentage of

EMW aware of

VHND or

Mother's day

held at AWC

Number of

EMW in rural

area

Percentage of

EMW attended

any VHND or

Mother's day in

the 3 months prior

to survey

Number of EMW

aware of VHND

or Mother's day

EMW's education

No Education 16.2 29,443 41.2 4,760

Below Primary (Class - 1 to 4) 27.8 4,030 36.0 1,120

Completed Primary (Class 5-7) 26.6 11,157 42.6 2,963

Completed Middle (Class 8 -9) 26.3 10,275 43.1 2703

Completed Secondary (Class 10-11) 30.6 8,321 48.1 2,550

12+ (Class 12 and above) 27.3 7,960 46.3 2,175

Social Group

Scheduled Caste 24.5 15,196 46.2 3,727

Scheduled Tribe 25.0 9,523 50.4 2,384

OBC 20.6 28,657 41.9 5,913

Other 23.5 17,109 39.4 4,018

No Response 32.9 700 20.2 230

Wealth index

Lowest 20.5 17,839 43.7 3,663

Second 22.8 17,557 43.7 3,999

Middle 24.5 15,910 42.7 3,900

Fourth 24.5 12,004 45.6 2,935

Highest 22.5 7,874 38.1 1,776

Total 22.9 71,185 43.2 16,273

One of the roles and responsibilities of the AWWs is to make home visits for educating parents and to enable

mothers to plan an effective role in the child’s growth and development with special emphasis on the new born

child. Table 7.47 presents the details of the visits made by AWW as reported by the EMW. Overall 35 percent of

the EMW reported that the AWW had visited them least once in the three months preceding the survey. The

average number of visits reported by the EMW was 2.6.

Analysis by social categories shows that comparatively higher proportion of women belonging to STs (38

percent) reported visit by AWW in the last three months prior to the survey than women belonging to other

castes (34 percent). The average number of visits reported by women from different social categories was more

or less similar ranging from 2.5 to 2.7. Analysis by wealth indices shows that average number of visits reported

by the women belonging to the lowest wealth index was 2.4 while it was 2.5 visits reported by women from the

highest wealth quintile.



Table 7.48 presents the awareness of VHND and participation in VHND in three months prior to the survey.

Overall 23 percent of the EMW reported their awareness of the VHND. These were ranged state variations in the

awareness of VHND. In states like Tripura and Sikkim more than 60 percent women were aware of the VHND

followed by Gujarat (51 percent), Goa (50 percent) and Odisha (49 percent). The states where the awareness

regarding VHND was the lowest are Nagaland (1 percent), Delhi (6 percent), Haryana (6 percent), Uttar Pradesh

(8 percent), Jammu and Kashmir (8 percent), Chhattisgarh (8 percent) and Punjab (9 percent). Therefore any

subsequent analysis of these states should be done with caution.

Among the women who were aware of VHND, close to 44 percent reported having attended the event at least

once in the past three months of RSOC. However, there were wide state-wise variations with more than 50

percent of women who were aware attended the VHND in states like Sikkim (64 percent), Andhra Pradesh (60

percent), Himachal Pradesh (59 percent), Maharashtra (57 percent), Tamil Nadu (59 percent) and Jharkhand (54

percent). A much lower proportion of women reported attending such events in states like Delhi (26 percent)

and Arunachal Pradesh (17 percent).

Table 7.47: Home visits by AWW

Percentage of EMW in rural area who were visited at home by AWW at least once in last 3 months prior to the survey and

the average number of visits made in three months, according to selected background characteristics, RSOC, 2013-14.

Characteristics

Percentage of

EMW visited at

home by AWW in

last 3 months

Number of

EMWs in rural

areas

Average number

of visits made by

AWW

Number of EMW

visited by AWW

EMW's education

No Education 30.5 29,443 2.7 8,978

Below Primary (Class - 1 to 4) 33.8 4,030 2.6 1,361

Completed Primary (Class 5-7) 35.4 11,157 2.6 3,953

Completed Middle (Class 8 -9) 36.3 10,275 2.5 3,726

Completed Secondary (Class 10-11) 41.2 8,321 2.7 3,426

12+ (Class 12 and above) 39.9 7,960 2.7 3,175

Social Group

Scheduled Caste 35.7 15,196 2.7 5,423

Scheduled Tribe 37.7 9,523 2.6 3,596

OBC 33.4 28,657 2.7 9,568

Other Castes 33.9 17,109 2.5 5,808

No Response 32.3 700 2.1 226

Wealth index

Lowest 29.9 17,839 2.4 5,342

Second 34.3 17,557 2.7 6,020

Middle 37.9 15,910 2.7 6,038

Fourth 37.6 12,004 2.8 4,514

Highest 34.3 7,874 2.5 2,707

Total 34.6 71,185 2.6 24,621



With regard to the home visits undertaken by AWW, an overall 35 percent of the women reported been visited

by an AWW in the past three months (Table 7.48). State-wise variations showed that more than 50 percent of

the women reported been visited by AWW in states like Manipur (78 percent), Himachal Pradesh (59 percent),

Gujarat (60 percent), Andhra Pradesh (52 percent) and Sikkim (50 percent). The proportion of mothers

reporting visits by AWW were around or less than a fifth in States like Madhya Pradesh (22 percent), Jammu &

Kashmir (17 percent), Mizoram (14 percent) and Nagaland (1 percent).

Table 7.48: Other services provided at AWC by state

Percentage of rural EMW who reported their awareness of VHND day or mother day's held at AWC and number of VHNDs

or mother’s day attended in the last 3 months prior to the survey, percent of EMWs reporting AWW’s visit to their home at

least once in the last 3 months prior to the survey and average number of times visited at home in last 3 months prior to

the survey across states, RSOC, 2013-14.

State

Village Health and Nutrition Day Home Visits by AWW

Percentage of

EMW aware of

VHND or Mother's

day held at AWC

Percentage of EMW

attended any VHND or

Mother's day in 3

months prior to survey

Percentage of EMW

visited at home by

AWW in 3 months

prior to survey

Average number of

times visited at home

in 3 months prior to

survey

India 22.9 43.2 34.6 2.6

North

Delhi 6.2 25.6 25.0 2.5

Haryana 5.8 30.0 23.8 2.5

Himachal Pradesh 37.3 58.6 58.8 2.5

Jammu & Kashmir 7.5 40.0 16.8 2.6

Punjab 8.6 38.7 24.6 2.4

Uttar Pradesh 7.8 35.1 26.8 3.1

Uttarakhand 9.2 45.8 27.0 2.3

Central

Madhya Pradesh 26.2 35.3 22.0 2.9

Chhattisgarh 8.1 48.4 27.6 2.2

East

Bihar 20.7 36.4 32.0 2.2

Jharkhand 22.2 53.5 27.8 2.3

Odisha 48.5 34.9 36.6 2.2

West Bengal 34.9 24.1 27.5 1.9

North east

Arunachal Pradesh 14.7 16.5 45.5 2.2

Assam 14.2 36.0 30.0 1.7

Manipur 27.3 50.3 77.7 2.6

Meghalaya 16.3 29.7 22.5 1.9

Mizoram 38.5 36.1 14.1 1.4

Nagaland 0.6 41.1 0.7 1.8

Sikkim 60.5 64.1 49.9 1.9

Tripura 63.8 47.5 33.5 2.4



State

Village Health and Nutrition Day Home Visits by AWW

Percentage of

EMW aware of

VHND or Mother's

day held at AWC

Percentage of EMW

attended any VHND or

Mother's day in 3

months prior to survey

Percentage of EMW

visited at home by

AWW in 3 months

prior to survey

Average number of

times visited at home

in 3 months prior to

survey

West

Rajasthan 13.6 26.0 27.7 2.5

Goa 49.5 50.5 47.5 1.9

Gujarat 50.9 46.7 60.4 2.7

Maharashtra 28.5 57.4 48.0 2.9

South

Andhra Pradesh 34.5 59.6 52.2 3.2

Karnataka 30.5 43.6 33.1 2.5

Kerala 28.8 47.3 40.6 2.2

Tamil Nadu 21.8 58.8 41.8 3.0


RAPID SURVEY ON CHILDREN 2013-14 ANNEXURE | 278

ANNEXURE A:

SAMPLE SIZE DETERMINATION The sample size in terms of children has been worked out for each state on the basis of the following formula:

Where,

N = required sample size

P = Percent of children aged 12-23 months covered under full Immunization (as per CES

2009)

Q = 1-P

D = design effect*

d = permissible margin of error (5%)

Kα/2 = Z score at 95 percent level of confidence

C = adjustment factor for non-response (taken as 1.1)

*Design effect was taken as 1.5 as per other DHS surveys (NFHS 2005-06 survey also used similar design effect)

The state sample so estimated was deflated (using proportion of ever married women aged 15-34 per household

as revealed from DLHS 2007-08) to arrive at the requisite number of sample households. The state wise number

of sample of households and PSUs in RSOC is given in Table 1.1.



ANNEXURE A TABLES CHAPTER 1 Table 1.2: State wise number of regions formed in RSOC for sampling of rural and urban PSUs

State Regions formed

for RSOC Name of the districts in the region as per census 2011

Andhra Pradesh

I Srikakulam, Vizianagaram, Visakhapatnam

II East Godavari, West Godavari, Krishna, Guntur

III Prakasam, Nellore

IV Chittoor, Cuddapah, Anantapur, Kurnool

V Mahbubnagar, Rangareddi, Hyderabad, Medak, Nizamabad, Adilabad, Nalgonda

VI Karimnagar, Warangal, Khammam

Arunachal Pradesh

I Tawang, West Kameng, East Kameng

II Papumpare, Lower Subansiri, Upper Subansiri

III West Siang, East Siang, Upper Siang

IV Darrang, Lohit

V Tirap, Changlang

Assam

I Goalpara, Kamrup, Marigaon, Nagaon, Darrang

II Dhubri, Bongaigaon, Barpeta, Nalbari, Sonitpur

III Golaghat, Jorhat, Sibsagar, Dibrugarh, Tinsukia, Karimganj, Hailakandi, Cachar

IV Lakhimpur, Dhemaji

V Karbi Anglong

Bihar

I Saran, Siwan, Gopalganj, Pashchim Champaran, Purba Champaran

II Sitamarhi, Vaishali, Darbhanga, Madhubani, Samastipur, Muzaffarpur, Saharsa, Sheohar, Supaul

III Purnia, Araria, Katihar, Madhepura

IV Patna, Bhojpur, Rohtas, Buxor, Kaimur (Bhabua)

V Munger, Khagaria, Bhagalpur, Banka, Jamui, Lakhisarai, Sheikhpura

VI Nalanda, Gaya, Jehanabad, Aurangabad, Nawada, Begusarai

VII Kishanganj

Chhattisgarh

I Koriya, Surguja, Bilaspur, Korba, Janjgir-champa, Jashpur, Raigarh

II Kawaedha, rajnandgao, Durg, Raipur, Mahasamund, Dhamtari

III Kanker, Bastar, Dantewada

Goa I and II Each district in Goa is considered as a region.

Gujarat

I Jamnagar, Rajkot

II Surendranagar, Bhavnagar, Amreli

III Junagadh, Porbandar

IV Kachchh, Banaskantha

V Sabarkantha, Mahesana, Patan

VI Gandhinagar, Ahmedabad

VII Kheda, Anand

VIII Panch Mahals, Vadodara, Dohad

IX Bharuch, Surat, Valsad, The Dangs, Narmada, Navsari





Haryana

I Faridabad, Gurgaon, Sonipat

II Ambala, Kaithal, Karnal, Kurukshetra, Panipat, Yamunanagar, Panchkula

III Bhiwani, Mahendragarh, Rewari, Sirsa

IV Hissar, Jind, Rohtak, Fatehbad, Jhajjar

Himachal Pradesh

I Chamba, Lahaul-Spiti, Kinnaur

II Kangra, Hamirpur, Una, Mandi, Kullu

III Bilaspur, Shimla, Solan, Sirmaur

Jammu & Kashmir

I Kargil, Leh

II Anantnag, Pulwama, Srinagar, Badgam, Baramulla

III Kupwara, Rajouri, Poonch

IV Doda, Udhampur, Kathua, Jammu

Jharkhand16

I Deogarh, Godda, Sahibganj, Pakaur, Dumka

II Chatra, Hazaribagh, Kodarma, Giridh, Bokaro, Dhanbad

III Garhwa, Palamu, Lohardagga, Gumla, Ranchi, Pashchim Singhbhum, Purbi Singhbhum

Karnataka

I Bidar, Bijapur, Gulbarga, Raichur, Bagalkot, Koppal

II Belgaum, Dharwad, Gadag, Haveri

III Dakshina Kannada, Kodagu, Uttara Kannada, Udupi

IV Chikmagalur, Shimoga

V Bangalore rural, Bellary, Chitradurga, Kolar, Tumkur, Davangere

VI Hassan, Mandya, Mysore, Chamrajnagar

Kerala I to XIV Each district in Kerala is considered as a region.

Madhya Pradesh

I Panna, Rewa, Satna, Sidhi, Shahdol, Chhatarpur, Tikamgarh, Umaria

II Raisen, Sagar, Damoh, Vidisha, Bhopal, Sehore

III Dewas, Dhar, Indore, Jhabua, Ujjain, Rajgarh, Ratlam, Mandsaur, Shajapur, Neemuch

IV Mandla, Jabalpur, Seoni, Narsimhapur, Chhindwara, Balaghat, Dindori, Katni

V Betul, Hoshangabad, East Nimar, West Nimar, Barwani, Harda

VI Gwalior, Bhind, Morena, Datia, Guna, Shivpuri, Sheopur

Maharashtra

I Thane, Raigad, Ratnagiri, Sindhudurg

II Nasik, Jalgaon

III Ahmednagar, Pune, Satara, Sangli, Solapur, Kolhapur

IV Aurangabad, Jalna, Parbhani, Bid, Latur, Osmanabad, Buldhana, Akola, Amaravati, Washim, Hingoli

V Yeotmal, Wardha, Nagpur, Nanded

VI Bhandara, Chandrapur, Gadchiroli, Gondiya

VII Dhule and Nandurbar

Manipur

I Senapati, Tamenglang, Ukhrul

II Churchandpur, Chandel

III Bishnupur , Imphal West, Imphal East, Toubal

Meghalaya

I West Garo Hills

II East Garo Hills, South Garo Hills

III West Khasi Hills

IV Ri Bhoi, East Khasi Hills





V Jantia Hills

Mizoram

I Kolasib, Mamit, Aizwal, Champhal, Serchip

II Lunglei

III Lawangttai, Saita

Nagaland

I Tuensang, Mon

II Mokakchung, Zunhebota

III Wokha , Dimapur

IV Kohima , Phek

NCT of Delhi I to XI Each district in NCT of Delhi is considered as a region.

Odisha

I Sundargarh, Kendujhar, Mayurbhanj

II Phulabani, Koraput, Baudh, Malkangiri, Navarangapur, Rayagada

III Sambalpur, Balangir, Kalahandi, Bargarh, Debagarh, Jharsuguda, Nuapada, Sonapur

IV Baleshwar, Cuttack, Ganjam, Puri, Dhenkanal, Anugul, Bhadrak, Gajapati, Jagatsinghpur, Jajapur, Kendrapara, Khordha, Nayagarh

Punjab

I Gurdaspur, Amritsar, Firozpur

II Jalandhar, Kapurthala, Hoshiarpur, Rupnagar, Nawashahr

III Ludhiana, Patiala, Sangrur, Fatehgarh Sahib

IV Bhatinda, Faridkot, Mansa, Moga, Muktsar

Rajasthan

I Ganganagar, Bikaner, Churu, Jaisalmer, Jodhpur, Nagaur,Barmer, Sirohi, Hanumangarh

II Jhunjhunun, Alwar, Bharatpur, Dhaulpur, Sawai Madhopur, Jaipur, Sikar, Ajmer, Tonk, Dausa, Karauli

III Dungarpur, Banswara, Udaipur

IV Chhitaurgarh, Bundi, Kota, Jhalawar, Baran

V Bhilwara, Rajasamand, Jalor and Pali

Sikkim I to IV Each district in Sikkim is considered as a region.

Tripura

I Dhalai

II North Tripura

III South Tripura

IV West Tripura

Tamil Nadu

I Coimbatore, Dindigul Anna (Dindigul), Madurai (Madura and Theni), Periyar (Erode), Nilgiri

II North Arcot-Ambedkar (Vellore), Dharmapuri, Tiruvannamalai-Sambuvarayan, Salem (Salem and Namakal), Tiruchirappalli (Tiruchirapalli, Karur and Perambalur), Ariyalur

III Kanniyakumari

IV Chengalpattu-MGR (Kanchipuram and Tiruvallur), South Arcot (Cuddalore and Villupuram),Thanjavur, (Thanjavur, Nagappattinam and Tiruvarur), ChennaI

V Pudukkottai, Pasumpon, Muthuramalinga Thevar (Sivagangai), Kamarajar (Virudhunagar),Ramanathapuram, Chidambaranar (Thootukudi), Tirunelveli Kattabomman (Tirunelveli)

Uttarakhand I Dehradun, Haridwar, Udham Singh Nagar





II UttarkKashi, Tehri Garhwal, Rudra Prayag, Pauri Garhwal

III Chamoli, Bageshwar, Pitorgarh, Almora, Nainital, Champawat

Uttar Pradesh

I Bijnor, Ghaziabad, Meerut, Moradabad, Rampur, Saharanpur, Muzzafarnagar, Agra, Aligarh, Bareilly, Budaun, Bulandshahr, Etah, Farrukhabad, Firozabad, Mainpuri, Pilibhit, Shahjahanpur, Etawah, Mathura, Auraiya, Baghpat, Goutam Buddha Nagar, Hathras, Jyotiba Phule Nagar, Kannauj

II Kheri, Hardoi, Rae Bareli, Sitapur, Barabanki, Fatehpur, Kanpur Dehat, Kanpur Nagar, Lucknow, Unnao

III Allahabad, Gonda, Pratapgarh, Sultanpur, Bahraich, Faizabad, Azamgarh, Basti, Deoria, Gorakhpur, Jaunpur, Maharajganj, Mau, Siddharthnagar, Ballia, Gazipur, Varanasi, Mirzapur, Sonbhadra, Ambedkar Nagar, Balrampur, Chandauli, Kaushambi, Kushinagar, Sant Kabir Nagar, Sant Ravidas Nagar, Shrawasti

IV Banda, Lalitpur, Hamirpur, Jalaun, Jhansi, Chitrakoot, Mahoba

West Bengal

I Jalpaiguri, Darjeeling

II Koch Bihar, West Dinajpur (Dakshin Dinajpur)

III Nadia, Haora, Hugli, North Twenty-Four Parganas, South Twenty-Four Parganas, Barddhaman

IV Medinipur, Bankura, Birbhum

V Puruliya

VI Maldah, Murshidabad and Uttar Dinajpur 16 In Jharkhand the regions were not considered for sampling of rural PSUs.



Table 1.3: State wise sampling model selected for sampling of rural PSUs

State Region Explicit variable Implicit variable

Any modifications in NFHS Regions

Andhra Pradesh NFHS regions Village Size (3 levels - <=250, 250-1000 & 1000+ HH)

Female Literacy

None

Arunachal Pradesh NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Assam NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Bihar NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

Kishanganj District was removed from Region III

and formed as Region VII.

Chhattisgarh NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Delhi Each district is considered as a

region

NA Female Literacy

Each district in Delhi is considered as a region

sorted according to female literacy and

sampling is taken up according to PPS

Goa NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Gujarat NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Haryana NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Himachal Pradesh NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Jammu & Kashmir NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Jharkhand Village Size (3 levels - <=250,

251-499 &500+ HH)

Percentage of Non-SC/ST (3 levels - 33%, 34% and 33%)

Female Literacy

None

Karnataka NFHS regions Village Size (3 levels - <=250, 250-1000 & 1000+ HH)

Female Literacy

None

Kerala NFHS regions None Female Literacy

None

Madhya Pradesh NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Maharashtra NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

Dhule and Nandurbar were removed from Region II and a new

Region VII was created

Manipur Each district is considered as a

region

None Female Literacy

None



State Region Explicit variable Implicit variable

Any modifications in NFHS Regions

Meghalaya Each district is considered as a

region

None Female Literacy

None

Mizoram NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Nagaland NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Odisha NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Punjab NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Rajasthan NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

Bhilwara, Rajasamand, Jalor and Pali have been

removed and put in a new Region - Region V

Sikkim NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Tamil Nadu NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Tripura NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

Uttar Pradesh NFHS regions Village Size (3 levels - <=250, 250-1000 & 1000+ HH)

Female Literacy

None

Uttarakhand NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

None

West Bengal NFHS regions Village Size (2 levels - <=250, 250+ HH)

Female Literacy

Maldah, Uttar Dinajpur and Murshidabad were removed from Region II

and a new Region VI was created.



Table 1.4: Comparison of proportions of populations in the RSOC sample villages and Census 2011 by various stratification variables

State

%Effective Female Literacy

% Non-SC/ST % Non-Agricultural

Workers % of villages with

<250 HHs Number of

districts covered

RSOC sample villages

Census 2011


Census 2011


Census 2011


Census 2011


Census 2011

Delhi 71.7 73.1 81.1 80.4 89.8 85.3 7.9 17.5 7 7

Haryana 59.3 60.0 75.5 77.5 43.8 39.6 36.9 37.7 21 21

Himachal Pradesh 74.6 74.6 62.0 67.9 53.7 55.5 94.9 95.5 11 12

Jammu & Kashmir 49.1 51.6 70.0 76.3 62.1 59.3 67.2 66.3 19 22

Punjab 66.5 65.7 60.8 62.5 40.1 42.3 62.5 61.4 18 20

Uttar Pradesh 53.8 53.7 78.3 76.3 26.1 26.3 62.6 62.6 70 71

Uttarakhand 64.8 66.2 78.5 75.0 53.2 46.3 91.9 92. 9 13 13

Chhattisgarh 56.5 55.6 48.7 50.3 25.3 19.2 68.4 67.9 17 18

Madhya Pradesh 53.3 52.4 58.1 57.1 17.9 16.7 71.5 71.6 48 50

Bihar 49.2 49.0 82.2 82.0 21.6 22.2 49.5 49.9 36 38

Jharkhand 49.6 48.9 50.2 56.0 34.6 37.9 80.5 81.5 23 24

Odisha 60.8 60.7 53.9 56.5 32.4 35.2 79.0 78.6 28 30

West Bengal 65.4 65.5 66.9 64.7 47.1 38.8 54.7 54.9 18 19

Arunachal Pradesh 58.7 52.1 40.6 26.1 56.0 38.0 92.7 98.3 16 16

Assam 62.5 63.0 78.6 79.5 49.7 42.8 69.9 70.4 25 27

Manipur 74.5 68.9 44.0 51.7 52.2 41.8 35.6 14.1 9 9

Meghalaya 69.8 68.4 13.8 9.4 31.7 32.4 83.8 97.2 7 7

Mizoram 81.3 79.8 2.2 3.4 20.0 18.8 82.9 85.3 8 8

Nagaland 71.1 71.5 12.6 7.2 46.0 32.4 78.3 76.7 11 11

Sikkim 72.7 72.4 58.6 59.0 54.4 52.0 71.9 70.5 4 4

Tripura 81.0 79.5 50.4 42.6 45.4 45.0 19.1 19.7 4 4

Rajasthan 45.6 45.8 57.7 64.6 29.6 33.1 71.5 71.6 31 33

Goa 82.6 81.6 81.3 82.4 85.7 86.0 46.9 46.2 2 2

Gujarat 63.1 61.4 77.3 70.3 20.1 26.5 46.5 46.3 24 26

Maharashtra 71.0 68.5 75.5 73.2 32.5 23.5 55.2 55.6 32 35

Andhra Pradesh 52.3 51.5 73.2 71.5 31.4 28.4 8.4 8.1 22 23

Karnataka 59.8 59.7 68.4 70.8 34.1 31.9 25.3 25.1 26 30

Kerala 91.2 90.8 87.9 87.1 75.9 75.4 0.0 0.6 14 14

Tamil Nadu 66.9 65.0 76.5 72.8 48.0 42.2 27.6 26.0 28 31



Table 1.5: Comparison of proportions of populations in the RSOC sample urban wards and Census 2011 by various stratification variables

State

% Effective Female Literacy

% Non-SC/ST % Non-Agricultural Workers

Number of districts covered

RSOC sample wards

Census 2011

RSOC sample wards

Census 2011

RSOC sample wards

Census 2011

RSOC sample wards

Census 2011

Delhi 79.9 80.9 81.6 83.3 99.3 99.2 9 9

Haryana 76.3 76. 9 88.3 84.2 95.4 93.9 18 21

Himachal Pradesh 88.6 88.4 81.3 79.6 97.2 97.0 10 11

Jammu & Kashmir 63.9 69.0 94.4 92.4 96.0 95.5 10 22

Punjab 79.3 79.2 80.6 77.3 97.6 94.5 16 20

Uttar Pradesh 75.3 69.2 86.9 87.0 94.8 89.6 56 71

Uttarakhand 77.5 79.3 87.9 86.1 97.3 95.8 7 13

Chhattisgarh 78.5 77.2 82.0 77.2 96.5 91.5 12 18

Madhya Pradesh 75.6 76.5 86.1 79.5 96.6 89.9 25 50

Bihar 75.1 70.5 89.5 89.0 89.9 82.6 30 38

Jharkhand 75.5 75.5 79.3 79.7 97.4 96.3 13 24

Odisha 82.3 80.4 79.0 77.6 96.8 94.1 18 30

West Bengal 80.9 81.0 82.9 83.5 96.3 96.0 17 19

Arunachal Pradesh 76.7 76.7 49.0 49.0 96.1 96.1 16 16

Assam 85.2 84.4 86.7 85.8 97.5 96.4 15 27

Manipur 82.6 79.3 72.7 80.7 90.2 80.5 7 9

Meghalaya 89.2 89.1 31.1 28.7 95.4 95.1 7 7

Mizoram 97.6 97.3 8.0 7.4 77.1 77.6 8 8

Nagaland 86.5 87.4 36.2 29.2 96.6 94.3 9 11

Sikkim 85.2 84.7 67.8 69.3 98.8 98.4 4 4

Tripura 90.6 91.4 69.4 72.3 95.0 93.5 4 4

Rajasthan 75.5 70.7 82.4 81.1 96.8 94.2 26 33

Goa 85.5 86.6 89.8 91.4 98.2 98.2 2 2

Gujarat 84.9 81.0 92.9 89.6 98.7 95.1 17 26

Maharashtra 85.0 84.9 90.2 85.7 98.9 95.4 23 36

Andhra Pradesh 75.9 74.4 87.0 86.8 95.6 92.3 20 23

Karnataka 84.8 81.4 88.4 83.9 97.8 94.2 22 30

Kerala 92.8 93.4 91.9 92.0 95.0 94.9 14 14

Tamil Nadu 85.0 82.3 85.7 85.4 97.2 91.5 24 32



CHAPTER 3

Table 3.1a: Social-group of respondents by states

Percent distribution of ever-married women aged 15-49 by social-group, according to state, RSOC, 2013-14.

States

Social Group

Scheduled

Caste

Scheduled

Tribe

Other Backward

Classes Other

No

Response Total

India 19.3 10.9 40.0 29.1 0.8 100.0

North

Delhi 20.9 2.8 28.1 48.0 0.2 100.0

Haryana 23.7 8.8 28.4 38.8 0.3 100.0

Himachal Pradesh 27.3 4.9 15.9 51.8 0.1 100.0

Jammu & Kashmir 8.1 10.1 16.4 64.5 1.0 100.0

Punjab 26.9 6.4 19.9 46.5 0.3 100.0

Uttar Pradesh 23.1 2.7 52.4 21.6 0.1 100.0

Uttarakhand 14.1 5.8 20.9 58.1 1.1 100.0

Central

Chhattisgarh 17.9 32.7 42.0 7.0 0.4 100.0

Madhya Pradesh 17.2 21.1 45.7 15.9 0.1 100.0

East

Bihar 24.0 2.0 55.7 18.2 0.1 100.0

Jharkhand 13.8 29.6 45.3 10.8 0.5 100.0

Odisha 18.1 23.0 27.8 31.1 0.0 100.0

West Bengal 26.1 5.9 8.0 54.5 5.5 100.0

Northeast

Arunachal Pradesh 3.9 79.2 3.5 13.3 0.0 100.0

Assam 11.2 17.8 20.0 50.3 0.7 100.0

Manipur 0.5 30.9 25.7 41.7 1.2 100.0

Meghalaya 5.2 84.1 0.9 9.7 0.1 100.0

Mizoram 0.7 96.3 2.9 0.0 0.0 100.0

Nagaland 5.8 86.4 5.3 1.9 0.6 100.0

Sikkim 9.8 35.3 35.2 12.5 7.2 100.0

Tripura 27.8 25.6 16.0 30.4 0.3 100.0

West

Rajasthan 18.4 11.8 49.8 19.7 0.3 100.0

Goa 2.9 8.7 30.3 57.2 0.8 100.0

Gujarat 10.8 21.0 30.8 36.7 0.7 100.0

Maharashtra 14.1 10.7 33.3 41.5 0.4 100.0

South

Andhra Pradesh 22.0 9.9 49.2 18.4 0.4 100.0

Karnataka 11.8 10.0 37.7 39.4 1.2 100.0

Kerala 7.6 3.7 67.5 21.0 0.2 100.0

Tamil Nadu 26.0 6.3 57.1 10.4 0.1 100.0



Table 3.2a: Literacy and educational attainment of respondents by states

Percent distribution of ever-married women aged 15-49 by educational attainment, according to state, RSOC, 2013-14.

States

Years of education completed

Percentage

literate No

education

Below

Primary

(<5 years)

Primary

(5-7

years)

Middle (8

-9 years)

Secondary

(10-11

years)

Higher

Secondary and

above (12 or

more years )

India 39.3 5.8 15.0 13.4 12.3 14.2 61.2

North

Delhi 24.6 1.0 8.8 12.8 16.5 36.4 76.4

Haryana 33.5 3.1 15.0 11.7 14.1 22.6 65.9

Himachal Pradesh 15.6 3.2 17.6 14.1 20.4 29.1 85.6

Jammu & Kashmir 53.3 1.5 6.4 14.5 10.0 14.4 47.4

Punjab 25.5 2.0 14.3 13.5 21.6 23.1 74.8

Uttar Pradesh 55.2 1.6 9.9 12.1 7.4 13.9 45.0

Uttarakhand 31.3 0.9 12.2 18.2 11.6 25.8 70.8

Central

Chhattisgarh 44.4 8.3 16.8 16.9 5.9 7.8 56.1

Madhya Pradesh 47.0 5.0 15.6 14.8 6.8 10.9 53.1

East

Bihar 62.0 4.9 11.0 9.1 7.3 5.8 38.8

Jharkhand 53.7 6.4 11.0 11.0 7.0 10.9 47.5

Odisha 37.9 10.1 19.4 15.7 9.5 7.4 63.5

West Bengal 29.7 14.5 18.4 18.5 10.4 8.4 70.4

Northeast

Arunachal Pradesh 28.7 17.0 22.3 15.8 9.1 7.0 72.2

Assam 32.1 15.1 14.2 21.8 8.2 8.7 68.2

Manipur 14.9 5.3 13.8 24.8 16.5 24.6 83.9

Meghalaya 18.5 15.3 20.6 18.5 15.0 12.1 83.5

Mizoram 3.1 5.8 17.9 21.5 32.1 19.7 98.2

Nagaland 19.2 3.7 12.0 23.1 20.1 21.9 88.0

Sikkim 24.2 13.5 21.6 16.0 12.2 12.5 76.7

Tripura 14.2 15.5 20.9 30.9 10.6 7.8 88.2

West

Rajasthan 54.7 3.2 15.2 11.5 5.5 9.9 46.0

Goa 9.7 7.8 15.2 17.8 24.0 25.6 89.9

Gujarat 35.7 7.1 19.6 12.6 11.0 13.9 63.6

Maharashtra 23.9 6.7 17.3 15.8 19.3 17.0 78.3

South

Andhra Pradesh 48.8 1.9 15.8 6.0 15.2 12.3 53.4

Karnataka 31.1 6.1 16.7 8.8 21.1 16.3 67.2

Kerala 2.2 3.1 9.3 9.9 32.7 42.7 97.2

Tamil Nadu 19.5 6.8 20.4 19.3 14.8 19.2 79.5



Table3.3a: Current educational status of adolescent girls age 10-19 during 2012-13 by state

Percent distribution of adolescent girls age 10-19 by the grade they were attending during the school year 2012-13

according to state, RSOC, 2013-14.

States

Never

attended

school

Did not

attend

school in

2012-13

Attending

Total Primary

(1-4)

Middle

(5-8)

Secondary

(9-10)

Higher secondary or

higher (11th

or higher

grade)

India 7.8 14.7 12.4 35.0 16.6 13.5 100.0

North

Delhi 3.0 5.6 11.5 43.7 19.4 17.0 100.0

Haryana 6.5 12.9 10.5 34.7 17.6 17.8 100.0

Himachal Pradesh 0.6 5.5 4.7 39.1 25.7 24.4 100.0

Jammu & Kashmir 6.1 9.8 11.0 41.0 21.8 10.3 100.0

Punjab 7.5 9.7 12.7 32.7 22.2 15.2 100.0

Uttar Pradesh 13.6 13.4 16.8 31.2 12.5 12.7 100.0

Uttarakhand 2.7 8.5 13.3 33.6 22.7 19.2 100.0

Central

Chhattisgarh 3.6 14.5 11.3 43.9 15.0 11.8 100.0

Madhya Pradesh 6.3 16.4 11.4 37.9 16.9 11.1 100.0

East

Bihar 13.6 8.0 23.9 34.7 13.1 6.7 100.0

Jharkhand 9.0 9.1 16.9 40.0 17.6 7.3 100.0

Odisha 5.8 26.8 7.8 32.0 18.8 8.8 100.0

West Bengal 2.5 20.5 12.1 35.2 19.8 9.9 100.0

Northeast

Arunachal Pradesh 2.5 10.4 12.5 42.1 18.6 14.0 100.0

Assam 4.2 21.2 9.6 42.6 16.9 5.6 100.0

Manipur 1.4 12.6 17.0 39.8 17.9 11.2 100.0

Meghalaya 2.1 12.7 14.7 39.1 20.6 10.8 100.0

Mizoram 0.3 12.4 6.3 33.6 24.9 22.5 100.0

Nagaland 12.0 30.7 5.3 15.0 18.1 18.8 100.0

Sikkim 0.9 7.7 10.8 50.7 20.3 9.7 100.0

Tripura 2.0 16.0 12.2 45.6 19.1 5.0 100.0

West

Rajasthan 11.5 15.4 14.7 33.5 12.0 12.9 100.0

Goa 0.9 6.9 10.5 46.6 19.0 15.9 100.0

Gujarat 8.0 25.8 6.9 35.7 12.9 10.6 100.0

Maharashtra 3.0 16.2 10.5 35.8 17.0 17.6 100.0

South

Andhra Pradesh 9.2 14.9 3.6 28.2 21.5 22.6 100.0

Karnataka 5.6 15.1 8.5 37.5 18.2 15.1 100.0

Kerala 1.4 5.2 8.9 38.3 19.8 26.4 100.0

Tamil Nadu 0.3 12.9 3.0 39.4 23.5 21.0 100.0



Table 3.4a: Percent ever-pregnant and pregnant before age across states

Percentage of ever-married women aged 15-49 who were ever-pregnant and percentage who had their first pregnancy by

age 18 across states, RSOC, 2013-14.

States

Percentage

Ever pregnant Pregnant before

age 18

India 92.5 21.6

North

Delhi 91.1 15.7

Haryana 93.0 13.8

Himachal Pradesh 95.1 7.8

Jammu & Kashmir 94.4 15.1

Punjab 93.6 9.3

Uttar Pradesh 92.3 18.4

Uttarakhand 92.2 14.7

Central

Chhattisgarh 91.8 26.5

Madhya Pradesh 94.2 19.3

East

Bihar 94.8 34.1

Jharkhand 91.3 23.4

Odisha 93.3 23.9

West Bengal 92.3 38.4

Northeast

Arunachal Pradesh 96.3 24.5

Assam 93.4 25.3

Manipur 94.3 12.5

Meghalaya 94.6 16.9

Mizoram 95.2 6.4

Nagaland 76.6 3.1

Sikkim 94.7 20.7

Tripura 92.8 32.0

West

Rajasthan 92.5 25.6

Goa 93.2 5.6

Gujarat 92.6 11.2

Maharashtra 90.1 17.5

South

Andhra Pradesh 93.5 23.8

Karnataka 92.4 15.8

Kerala 93.2 8.0

Tamil Nadu 90.1 18.3



Table 3.5a: Teenage pregnancy and motherhood by states

Percentage of women aged 15-19 who have had a live birth or who are pregnant with their first child and percentage who

have begun childbearing, by background characteristics, RSOC, 2013-14.

States

Percentage of women

Who have had a live birth Pregnant with first child Who have begun

childbearing

India 3.3 2.1 5.3

North

Delhi 1.6 0.0 1.6

Haryana 2.4 1.9 4.3


Jammu & Kashmir 1.7 0.2 2.0

Punjab 0.7 1.0 1.7



Central



East

Bihar 4.8 2.0 6.7

Jharkhand 3.8 4.3 8.1

Odisha 4.1 2.2 6.4


Northeast

Arunachal Pradesh 6.6 0.5 7.1

Assam 4.8 2.7 7.5

Manipur 6.0 2.2 8.2


Mizoram 1.7 0.2 1.8

Nagaland 0.5 0.0 0.5

Sikkim 4.3 1.2 5.5

Tripura 15.4 3.3 18.7

West

Rajasthan 3.4 1.6 5.1

Goa 1.5 1.0 2.5

Gujarat 2.8 0.9 3.7


South


Karnataka 3.2 2.8 6.0

Kerala 2.5 0.9 3.4

Tamil Nadu 2.4 0.5 2.9



Table 3.6a: Number of children ever born and surviving across states

Percentage of ever married women aged 15-49 who ever had a live birth and mean number of ever born and living children

by state, RSOC, 2013-14.

States Percentage who ever had

live birth

Mean number of

children ever born

Mean number of

children survived

India 90.0 2.4 2.3

North

Delhi 90.2 2.1 2.0

Haryana 90.8 2.3 2.2



Punjab 92.1 2.2 2.1



Central



East

Bihar 92.6 3.3 3.0


Odisha 89.5 2.3 2.1


Northeast


Assam 89.8 2.4 2.3

Manipur 91.2 2.3 2.2


Mizoram 94.2 2.1 2.0

Nagaland 76.4 1.6 1.6

Sikkim 93.1 2.3 2.1

Tripura 90.1 1.8 1.8

West


Goa 91.6 1.8 1.7

Gujarat 89.9 2.2 2.1


South



Kerala 91.8 1.7 1.7

Tamil Nadu 87.5 1.9 1.8



Table 3.7a: Number of children ever born and surviving across states

Percentage of ever married women age 35-49 who ever had a live birth and mean number of ever born and living children

by state, RSOC, 2013-14.

States Percentage who ever had a

live birth

Mean number of ever

born children

Mean number of living

children

India 95.5 3.2 2.9

North

Delhi 96.2 2.7 2.6

Haryana 97.3 3.1 2.9



Punjab 98.2 2.8 2.6



Central



East

Bihar 97.5 4.6 4.1


Odisha 94.8 3.0 2.8


Northeast


Assam 96.7 3.3 3.1

Manipur 95.5 3.0 2.8


Mizoram 93.7 2.3 2.3

Nagaland 97.0 2.4 2.4

Sikkim 98.3 3.0 2.8

Tripura 96.1 2.4 2.3

West


Goa 91.9 2.0 1.9

Gujarat 95.8 2.7 2.6


South



Kerala 95.9 2.0 2.0

Tamil Nadu 91.4 2.3 2.2



Table 3.8a: Birth order by states

Percent distribution of live-births in the three years preceding the survey by order of birth by state, RSOC, 2013-14.

States Birth order

1 2 3+

India 46.9 30.2 22.9

North

Delhi 60.7 27.6 11.7

Haryana 54.5 27.4 18.0



Punjab 50.8 33.1 16.2



Central



East

Bihar 22.9 32.0 45.1

Jharkhand 40.3 23.4 36.3

Odisha 39.5 37.6 22.9

West Bengal 46.0 33.9 20.0

Northeast


Assam 40.8 32.1 27.1

Manipur 38.3 35.9 25.9

Meghalaya 29.5 39.0 31.5

Mizoram 38.6 38.0 23.4

Nagaland 23.0 49.0 28.0

Sikkim 47.5 35.2 17.3

Tripura 53.8 33.5 12.6

West

Rajasthan 40.5 29.0 30.5

Goa 64.1 26.1 9.8

Gujarat 49.2 30.3 20.5


South


Karnataka 61.0 28.1 10.9

Kerala 70.3 24.4 5.3

Tamil Nadu 57.1 34.6 8.3



Table 3.9a: Current use of family planning by states

Percentage of currently married women aged 15-49 using any method and any modern method by residence, according to

states, RSOC, 2013-14.

States

Residence Total

Urban Rural

Any method Any modern

method Any method

Any modern method

Any method

Any modern method

India 59.8 54.3 56.8 49.5 57.8 51.1 North

Delhi 50.5 48.8 50.8 48.7 50.5 48.8 Haryana 56.4 51.6 54.3 48.3 55.0 49.4 Himachal Pradesh 62.7 61.7 63.4 59.8 63.4 60.0 Jammu & Kashmir 61.0 52.1 55.9 42.4 57.2 44.9 Punjab 69.9 60.2 63.8 58.3 66.1 59.0 Uttar Pradesh 51.6 43.6 48.5 35.4 49.2 37.3 Uttarakhand 64.2 57.5 60.9 55.3 62.0 56.0

Central

Chhattisgarh 55.5 52.0 54.1 50.5 54.4 50.8 Madhya Pradesh 54.7 50.4 58.4 53.8 57.3 52.8

East

Bihar 49.6 45.4 39.8 35.8 40.9 37.0 Jharkhand 45.3 41.3 40.8 36.5 41.8 37.6 Odisha 59.1 49.3 45.3 37.3 47.6 39.3 West Bengal 76.6 51.7 76.0 60.6 76.2 57.7

Northeast Arunachal Pradesh 71.4 55.8 69.8 49.7 70.3 51.3 Assam 74.7 44.4 71.5 36.0 71.9 37.2 Manipur 29.9 13.9 23.0 14.2 25.5 14.1 Meghalaya 34.6 29.8 33.3 23.9 33.6 25.2 Mizoram 85.8 83.5 53.8 53.7 71.2 69.9 Nagaland 28.2 25.9 19.9 18.4 22.9 21.1 Sikkim 76.6 49.0 70.3 55.6 72.2 53.6 Tripura 67.9 57.1 57.8 52.3 60.6 53.6

West Rajasthan 67.2 60.0 66.0 58.6 66.3 59.0 Goa 47.4 41.7 43.9 38.5 46.2 40.6 Gujarat 57.0 52.2 54.5 50.8 55.7 51.5 Maharashtra 63.8 63.2 61.2 59.6 62.4 61.4

South Andhra Pradesh 61.4 61.4 66.2 66.2 64.6 64.6 Karnataka 62.7 61.9 66.2 64.9 64.7 63.7 Kerala 56.6 55.5 50.0 48.9 53.2 52.1 Tamil Nadu 54.3 54.0 55.4 55.4 54.8 54.7



Table 3.10a: Age distribution and sex ratio of children by states

Percent distribution of children age 0-5 by single year of age and sex ratio according to state, RSOC, 2013-14.

States

Age

Total

Sex ratio

(females per

1,000

males)

0 1 2 3 4 5

India 16.3 16.3 17.6 17.0 15.8 17.0 100.0 933

North

Delhi 17.5 15.8 17.4 14.6 14.8 19.9 100.0 858

Haryana 18.6 17.2 18.2 16.0 16.3 13.6 100.0 838

Himachal Pradesh 14.8 16.6 18.7 16.2 16.6 17.2 100.0 985

Jammu & Kashmir 16.5 16.5 17.7 16.0 16.5 16.9 100.0 841

Punjab 15.3 17.6 17.3 15.5 15.0 19.2 100.0 891

Uttar Pradesh 16.1 15.6 17.3 16.2 15.7 19.1 100.0 913

Uttarakhand 15.1 15.5 17.3 18.6 18.7 14.8 100.0 887

Central

Chhattisgarh 18.3 15.2 17.9 16.7 16.2 15.7 100.0 1,002

Madhya Pradesh 16.7 17.2 16.8 16.6 15.4 17.4 100.0 908

East

Bihar 15.5 16.3 16.8 17.1 15.6 18.8 100.0 902

Jharkhand 16.9 15.4 18.4 18.0 14.8 16.5 100.0 1092

Odisha 15.7 16.6 16.7 16.1 17.4 17.5 100.0 931

West Bengal 16.4 16.5 17.5 17.1 15.5 16.9 100.0 1,024

Northeast

Arunachal Pradesh 10.2 12.7 22.5 12.5 20.1 22.1 100.0 866

Assam 15.3 15.3 15.8 17.9 15.6 20.1 100.0 908

Manipur 16.7 14.2 16.8 16.8 15.5 20.0 100.0 909

Meghalaya 14.5 12.4 22.3 13.6 14.9 22.2 100.0 883

Mizoram 15.5 12.4 17.4 15.7 17.6 21.5 100.0 865

Nagaland 15.9 7.6 22.9 16.6 20.4 16.6 100.0 849

Sikkim 18.2 18.2 17.8 16.8 14.3 14.7 100.0 931

Tripura 14.4 18.0 20.4 14.0 15.7 17.3 100.0 975

West

Rajasthan 17.6 16.4 17.1 16.0 15.2 17.7 100.0 872

Goa 15.6 17.7 18.7 15.7 16.1 16.2 100.0 941

Gujarat 17.8 16.9 19.2 17.0 15.5 13.6 100.0 916

Maharashtra 15.8 16.7 18.3 17.0 16.6 15.6 100.0 863

South

Andhra Pradesh 16.5 16.0 17.2 20.2 15.5 14.6 100.0 1,009

Karnataka 17.1 17.8 17.6 18.4 14.5 14.7 100.0 1,010

Kerala 13.8 14.4 17.5 17.1 16.7 20.5 100.0 995

Tamil Nadu 15.4 16.8 18.5 16.2 16.7 16.4 100.0 964



CHAPTER 5

Table 5.9: Prevalence and management of diarrhoea and fever by state

Percentage of children aged 0-5 years, who had diarrhoea in 15 days preceding the survey, percentage with diarrhoea who received

treatment and ORS, percentage who had fever in the last 15 days preceding the survey, percentage with fever for whom blood was taken

from his/her finger for testing and who took anti-malarial drugs, by state.

States

Percentage suffered from

diarrhoea in 15 days preceding

the date of survey

Percentage received

treatment for the

diarrhoea

Percentage received

ORS/HAF any time during

the diarrhoea

Percentage of children with fever in the last 15 days




for testing

Percentage who took

anti-malarial drugs

India 6.5 77.9 54.4 13.6 15.3 18.4 North

Delhi 4.5 66.7 55.3 7.1 18.1 18.5 Haryana 8.5 73.8 44.5 11.9 19.0 13.0 Himachal Pradesh 5.5 76.3 74.7 13.6 11.2 8.4 Jammu & Kashmir 4.4 79.7 68.8 12.2 9.2 14.8 Punjab 2.6 74.4 26.4 11.5 6.8 6.3 Uttar Pradesh 5.2 75.4 31.7 11.3 8.2 12.9 Uttarakhand 3.2 73.2 39.1 9.3 6.6 3.5

Central Chhattisgarh 6.8 80.2 35.1 16.1 14.4 13.1 Madhya Pradesh 5.6 74.6 39.8 10.0 11.0 11.6

East Bihar 4.5 86.4 38.5 16.3 6.2 14.4 Jharkhand 5.5 74.8 74.0 16.1 17.5 17.2 Odisha 9.2 83.5 70.9 13.7 33.6 33.9 West Bengal 3.5 85.8 76.8 17.0 5.0 9.3

Northeast Arunachal Pradesh 4.2 71.7 87.8 9.3 5.6 2.0 Assam 2.1 79.9 75.2 10.4 5.8 1.2 Manipur 16.5 56.6 73.3 15.0 6.3 23.8 Meghalaya 3.1 76.0 79.2 8.1 2.5 8.1 Mizoram 4.6 54.6 83.6 6.3 17.3 72.4 Nagaland 0.4 30.5 40.4 0.5 * * Sikkim 7.1 76.9 76.4 8.8 8.0 26.9 Tripura 3.0 75.3 84.4 9.8 40.0 51.4

West Rajasthan 5.6 76.2 37.3 16.0 7.6 14.6 Goa 5.8 82.2 78.0 12.3 23.1 13.3 Gujarat 8.8 82.5 56.5 12.7 17.5 25.0 Maharashtra 12.5 78.6 51.6 17.5 17.9 16.2

South Andhra Pradesh 8.0 74.0 73.7 13.6 41.5 51.6 Karnataka 9.3 83.9 64.8 14.6 18.4 21.8 Kerala 3.6 72.1 76.4 9.8 15.4 23.2 Tamil Nadu 5.1 65.1 68.7 12.7 18.8 13.2


Table 5.10: Prevalence and management of ARI by state

Among children aged 0-5 years, percentage who had fever in the last 15 days preceding the survey, percentage who had symptoms of acute respiratory infection (ARI) in the last

15 days preceding the survey, sought advice or treatment for the illness, by state.

State

Residence Total

Urban Rural

Percentage of

children who

had cough in

the last 15 days

preceding the

survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

Percentage of

children who

had cough in

the last 15

days preceding

the survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

Percentage of

children who

had cough in

the last 15 days

preceding the

survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

India 14.9 7.6 79.9 16.6 9.1 75.8 16.1 8.6 76.9

North

Delhi 9.0 4.9 89.0 15.6 7.9 84.1 9.2 5.0 88.8

Haryana 13.1 7.3 79.4 17.4 11.9 79.0 16.0 10.4 79.1

Himachal Pradesh 10.1 5.3 * 15.2 7.2 93.2 14.7 7.1 92.1

Jammu & Kashmir 16.4 13.0 85.0 13.0 9.8 86.9 13.9 10.6 86.3

Punjab 12.6 7.4 89.6 10.4 6.4 76.7 11.2 6.7 81.7

Uttar Pradesh 10.3 5.1 78.4 11.3 6.7 78.6 11.1 6.3 78.6

Uttarakhand 16.5 8.7 86.5 9.0 5.0 86.4 11.2 6.1 86.5

Central

Chhattisgarh 24.6 8.2 78.4 22.4 11.8 76.5 22.9 11.0 76.8

Madhya Pradesh 20.8 12.4 89.8 18.9 9.7 80.8 19.4 10.4 83.6

East

Bihar 17.0 9.5 92.6 22.7 12.4 86.9 22.0 12.0 87.4

Jharkhand 20.0 12.3 67.6 21.0 13.8 51.0 20.8 13.4 54.3

Odisha 16.0 10.3 92.0 13.9 8.7 69.7 14.3 9.0 73.9

West Bengal 26.4 10.7 67.5 27.4 15.2 66.9 27.1 13.8 67.1

Northeast

Arunachal Pradesh 7.0 3.7 * 7.0 2.9 (53.1) 7.0 3.1 63.0

Assam 15.0 7.6 * 6.8 3.8 54.5 7.9 4.3 61.4

Manipur 26.1 8.1 (51.8) 16.6 6.1 58.1 19.4 6.7 55.9

Meghalaya 11.3 3.1 * 4.9 1.6 * 6.1 1.9 (79.3)

Mizoram 8.2 3.3 (70.9) 2.1 0.6 * 5.3 2.0 (75.1)

Nagaland 2.2 0.8 * 0.4 0.1 * 0.9 0.3 *

Sikkim 12.8 6.6 (87.7) 7.8 4.2 83.5 9.0 4.8 84.8

Tripura 17.5 10.4 (82.9) 13.1 6.0 46.0 14.2 7.0 59.0

West


State

Residence Total

Urban Rural

Percentage of

children who

had cough in

the last 15 days

preceding the

survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

Percentage of

children who

had cough in

the last 15

days preceding

the survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

Percentage of

children who

had cough in

the last 15 days

preceding the

survey

Percentage

of children

with

symptoms

of ARI**

Percentage of

children with

symptoms of ARI

sought

advise/treatment

Rajasthan 18.0 8.7 90.1 18.1 9.5 80.5 18.1 9.3 82.8

Goa 12.0 4.5 (88.1) 15.1 5.6 94.4 13.2 4.9 90.7

Gujarat 15.9 9.5 74.7 17.6 11.0 74.4 17.0 10.4 74.5

Maharashtra 16.3 9.5 82.2 17.3 10.5 80.3 16.8 10.1 81.1

South

Andhra Pradesh 7.7 5.3 63.6 15.1 7.7 71.6 12.6 6.9 69.6

Karnataka 14.1 5.4 89.2 13.9 5.9 78.7 13.9 5.7 82.3

Kerala 7.9 3.3 (76.3) 6.5 1.8 * 7.1 2.5 (82.1)

Tamil Nadu 13.6 4.7 75.1 15.8 5.0 63.0 14.8 4.8 68.5


Table 5.12: Health check-up of children aged 0-71 months by state

Percentage of children aged 0-6 years who had health check-up in the three months preceding the survey, by

state.

State

Percentage whose health was checked up at

least once in 3 months preceding the survey

Residence Total

Urban Rural

India 21.9 19.5 20.2

North

Delhi 13.9 14.6 13.9

Haryana 14.0 15.8 15.2



Punjab 16.6 11.9 13.6



Central



East

Bihar 13.2 18.3 17.7

Jharkhand 16.1 12.8 13.5

Odisha 17.2 14.5 14.9

West Bengal 20.9 18.6 19.3

Northeast


Assam 19.6 7.0 8.7

Manipur 26.5 15.3 18.5

Meghalaya 20.1 9.8 11.7

Mizoram 15.5 6.0 10.8


Sikkim 21.7 26.4 25.3

Tripura 17.2 9.0 10.9

West

Rajasthan 21.9 20.1 20.6

Goa 35.0 45.7 38.9

Gujarat 23.8 28.4 26.5


South


Karnataka 33.6 33.0 33.2

Kerala 29.4 26.4 27.8

Tamil Nadu 17.7 15.1 16.3


CHAPTER 6

Table 6.7: Exclusive breastfeeding, continued breastfeeding by age one and two and complementary feeding at age 6-8 months by states

Percentage of children aged 0-5 months who are currently breastfed and who are currently exclusively breastfed,

percentage of children aged 12-15 months and 20-23 months who are currently breastfed and percentage of

children aged 6-8 months who were fed complementary food, by state.

States

Children aged 0-5 months* Children aged 12-

15 months* Children aged

20-23 months* Children aged 6-8

months

Currently breastfed

Exclusive breast feeding

Currently breastfed

Currently breastfed

Fed complementary food

India 95.6 64.9 84.8 67.5 50.5 North


Central Chhattisgarh 98.7 82.3 89.5 79.8 59.9 Madhya Pradesh 97.7 74.8 91.5 71.9 46.3

East Bihar 97.9 70.8 87.6 72.9 45.7 Jharkhand 98.4 64.3 95.7 90.6 53.7 Odisha 99.7 68.5 97.0 96.4 55.5 West Bengal 99.5 59.4 94.6 84.3 67.7

Northeast Arunachal Pradesh 100.0 59.8 98.4 86.9 64.9 Assam 99.6 64.7 99.6 90.9 76.1 Manipur 98.3 66.8 87 77.5 83.0 Meghalaya 97.9 54.9 79.4 59.1 65.2 Mizoram 99.4 44.5 79.6 58.4 60.9 Nagaland 98.0 58.1 36.9 25.4 18.7

Sikkim 98.0 57.7 70.6 65.2 68.8 Tripura 97.6 63.0 97.1 87.9 60.8

West Rajasthan 85.8 49.9 79.3 66.2 45.9 Goa 98.4 62.6 79.9 71.6 75.6 Gujarat 96.1 74.4 83.4 60.4 43.4 Maharashtra 95.1 73.4 87.2 68.0 53.4

South Andhra Pradesh 96.5 69.2 85.7 64.9 40.1 Karnataka 98.0 55.1 78.7 50.4 63.4 Kerala 99.4 58.6 74.1 65.8 72.6 Tamil Nadu 91.9 57.0 61.9 30.0 64.0


Table 6.11: Infant and young child feeding (IYCF) practices by state

Percentage of children 6-23 months of age, fed with appropriate feeding practices based upon number of food groups and times they are fed during the day or

night preceding the survey by breastfeeding status and by state.

State

Among breastfed children, percentage fed: Among non-breastfed children, percentage fed: Among all (both breastfed or non-breastfed)

children, percentage fed:

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

India 36.3 19.9 10.7 63.3 33.4 12.4 41.1 22.3 11.0

North

Delhi 31.6 19.5 11.3 55.9 26.3 13.6 37.8 21.2 11.9

Haryana 18.8 9.2 3.1 61.2 22.7 9.8 29.9 12.7 4.8

Himachal Pradesh 46.4 20.8 10.4 76.6 32.4 14.6 54.8 24.0 11.6

Jammu & Kashmir 41.0 16.9 8.0 76.2 44.2 25.3 46.8 21.5 10.9

Punjab 35.2 19.1 11.4 67.0 13.3 5.0 41.2 18.0 10.2

Uttar Pradesh 30.2 15.1 9.2 64.2 29.4 10.3 36.5 17.8 9.4

Uttarakhand 47.7 21.4 13.3 75.7 26.3 8.9 53.7 22.4 12.4

Central

Chhattisgarh 57.5 8.6 6.5 72.4 25.0 5.6 59.1 10.3 6.4

Madhya Pradesh 37.8 20.9 13.4 64.7 31.9 10.4 41.4 22.4 13.0

East

Bihar 45.7 16.1 11.0 81.4 26.9 5.8 50.2 17.4 10.4

Jharkhand 35.7 17.8 9.0 70.1 43.0 22.1 37.2 18.9 9.6

Odisha 41.9 25.8 10.7 * * * 42.5 26.6 10.6

West Bengal 41.6 33.7 16.6 79.7 42.6 21.8 44.3 34.3 16.9

Northeast

Arunachal Pradesh 41.2 34.7 16.3 * * * 40.6 34.4 15.8

Assam 25.6 17.8 5.6 * * * 25.6 17.9 5.7

Manipur 29.7 22.5 8.3 49.6 33.3 17.1 32.4 24.0 9.5

Meghalaya 36.3 28.7 12.0 46.6 32.7 8.7 38.6 29.6 11.3

Mizoram 20.0 10.5 3.5 34.8 23.3 2.8 23.4 13.5 3.4

Nagaland 12.6 2.6 1.1 49.2 15.9 1.5 27.1 7.9 1.2

Sikkim 55.3 46.5 24.8 (60.7) (57.1) (21.4) 55.6 46.1 24.3

Tripura 51.9 21.0 13.8 61.7 33.5 8.8 54.4 24.2 12.5


State

Among breastfed children, percentage fed: Among non-breastfed children, percentage fed: Among all (both breastfed or non-breastfed)

children, percentage fed:

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

Minimum

number of

times

Minimum

dietary

diversity

Minimum

acceptable

diet

West

Rajasthan 45.8 14.5 10.1 71.1 28.0 10.0 50.8 17.2 10.1

Goa 38.5 38.0 15.7 71.5 53.5 23.6 45.1 41.1 17.3

Gujarat 30.4 20.2 11.1 49.5 37.7 10.6 34.6 24.1 10.9

Maharashtra 34.0 19.2 8.6 59.1 49.9 16.5 37.8 23.8 9.8

South

Andhra Pradesh 24.1 17.8 7.2 49.2 27.3 12.7 29.4 19.8 8.3

Karnataka 44.3 21.8 14.4 67.3 37.9 10.2 50.3 26.0 13.3

Kerala 38.1 36.6 22.2 49.3 38.7 23.2 40.3 37.0 22.4

Tamil Nadu 30.0 21.4 9.4 64.5 36.3 16.1 44.0 27.4 12.1



Table 6.13: Micro-nutrient supplementation by state

Percentage distribution of children 6-23 months who consumed Vitamin A rich and iron rich foods in the day or

night preceding the survey, percentage of children 6-59 months given Vitamin A and Iron Folic acid

supplements in the last six months and percentage given deworming medication in the last six months

preceding the survey, by State

State


Consumed foods

rich in vitamin A in

last 24 hours

Consumed foods

rich in iron in last 24

hours

Given Vitamin A

dose in last 6

months

Given IFA

supplements in

last 6 months

Given deworming

medicine in last 6

months

India 36.4 42.7 45.2 13.4 27.6

North

Delhi 27.0 48.6 48.0 15.5 28.2

Haryana 21.5 34.2 21.1 5.4 5.9

Himachal Pradesh 35.6 43.5 57.0 8.3 28.0

Jammu & Kashmir 31.9 42.0 38.8 4.8 15.7

Punjab 30.5 36.5 39.6 5.2 10.8

Uttar Pradesh 29.6 30.2 26.6 2.5 7.5

Uttarakhand 28.6 35.6 16.3 5.3 8.7

Central

Chhattisgarh 36.0 32.9 44.7 10.7 23.3

Madhya Pradesh 30.9 31.9 45.3 10.7 31.7

East

Bihar 37.3 37.8 46.0 4.4 16.0

Jharkhand 33.2 41.5 18.7 6.3 11.7

Odisha 49.0 56.5 57.2 14.7 57.8

West Bengal 58.5 60.7 21.7 1.7 29.5

Northeast

Arunachal Pradesh 51.3 75.6 51.4 2.9 16.4

Assam 34.7 53.2 50.3 4.5 24.6

Manipur 49.9 69.9 23.9 3.4 15.6

Meghalaya 53.4 58.8 46.2 12.1 24.7

Mizoram 27.2 77.7 75.5 42.3 55.1

Nagaland 30.0 47.3 7.9 0.6 17.8

Sikkim 69.1 61.5 43.5 9.8 29.8

Tripura 38.4 67.0 51.2 5.3 33.0

West

Rajasthan 26.3 27.6 27.3 4.3 19.0

Goa 52.2 77.4 77.1 17.5 66.3

Gujarat 36.8 37.2 55.7 12.8 11.4

Maharashtra 35.8 44.8 62.0 21.9 61.5

South

Andhra Pradesh 29.7 44.6 66.9 45.6 42.4

Karnataka 43.9 55.3 62.1 22.0 37.2

Kerala 49.2 67.1 67.6 19.8 37.2

Tamil Nadu 40.7 50.6 55.3 23.3 27.7


Table 6.18: Growth monitoring of children by state

Percentage of children aged 0-71 months for whom growth chart was available and percentage of children

aged 0-35 and 36-71 months with growth chart who were weighed at least once in three months prior to

survey, by state.

State

Have a

growth

chart/card



last 3 months preceding the

survey



last 3 months preceding the

survey

India 14.1 64.0 66.1

North

Delhi 9.0 68.2 64.0

Haryana 13.5 70.8 62.4



Punjab 6.9 14.2 15.4



Central



East

Bihar 6.7 15.9 16.3

Jharkhand 5.4 56.2 39.1

Odisha 27.2 86.5 76.6

West Bengal 23.2 62.2 56.9

Northeast


Assam 7.4 47.1 70.0

Manipur 1.1 72.5 23.1

Meghalaya 23.1 21.7 14.8

Mizoram 6.5 41.3 52.0


Sikkim 28.3 80.2 81.0

Tripura 8.0 52.0 42.7

West

Rajasthan 9.5 24.8 18.8

Goa 37.4 85.8 76.8

Gujarat 30.1 81.6 79.1


South


Karnataka 35.0 71.1 66.1

Kerala 32.3 75.0 71.1

Tamil Nadu 24.3 53.8 51.9


CHAPTER 7


Percentage of mothers with child aged 0-35 months covered by an AWC, aware of any services and specific

services provided at AWC by background characteristics.

Characteristics

Services provided at AWC Percentage not

aware of any of

the services

Percentage aware of all the

6 services

Number of

mothers

Supplementary food

Immuni--zation

Pre-school education

Health Check-

up

Referral Services

Nutrition and Health

education

Mothers of child 0-35 months

85.1 57.4 41.7 29.4 12.2 17.2 9.8 9.3 44,485

Age

15-19 87.9 43.5 36.6 25.4 10.5 13.7 8.4 8.2 1,349 20-24 86.4 57.2 40.9 31.3 13.0 18.2 8.6 10.4 16,634 25-29 84.6 58.5 42.9 30.0 13.2 18.1 10.3 9.9 16,824 30-34 83.9 57.9 42.2 25.8 9.8 14.2 11.0 6.7 6,615 35-39 81.9 56.7 41.1 26.3 9.8 15.7 11.4 6.8 2,266 40-44 82.5 55.6 31.6 17.1 3.2 12.0 11.0 2.6 542 45-49 87.3 67.1 51.8 29.1 10.4 16.0 8.0 8.0 256

Residence

Urban 79.3 52.5 41.1 31.0 13.3 18.4 15.9 10.3 11,853 Rural 87.2 59.2 41.9 28.8 11.8 16.7 7.5 8.9 32,632

Mother's education

No education 84.3 61.5 38.9 23.5 9.5 13.2 9.5 6.7 14,272 Below Primary (Class - 1 to 4)

89.7 47.9 41.2 26.8 6.8 12.5 5.7 5.0 2,217


88.8 56.4 41.1 30.1 11.7 17.8 6.8 9.4 6,904


87.0 53.7 42.7 29.7 11.2 15.6 8.8 8.1 7,190


84.5 57.3 45.1 36.0 17.4 23.1 10.6 14.0 6,268


80.7 56.9 43.7 34.8 16.1 22.2 14.4 12.7 7,634

Religion

Hindu 85.2 58.9 41.3 29.7 12.4 17.1 9.6 9.3 34,877 Muslim 84.3 50.5 41.3 26.4 9.9 14.8 10.5 7.7 7,192 Christian 84.3 46.9 46.4 32.1 16.6 27.9 11.5 14.1 1,135 Sikh 87.2 64.9 53.9 25.4 8.8 15.0 9.3 6.3 693 Jain 86.2 71.0 59.7 62.6 49.0 53.1 11.2 46.8 105 Buddhist/Neo-Buddhist

85.0 65.8 48.0 51.2 25.4 35.3 7.6 21.7 285

No religion (95.8) (37.5) (37.5) (18.8) (14.6) (25.0) (4.2) (14.6) 48 Other 89.7 51.5 37.8 31.4 6.5 14.2 7.0 3.3 167

Social Group

Scheduled Caste 86.5 56.0 39.0 27.6 11.6 15.6 8.5 8.6 9,125 Scheduled Tribe 89.2 62.8 41.6 29.8 11.9 17.6 6.1 9.4 5,300 Other Backward Classes

84.0 61.8 41.6 28.7 13.5 17.9 10.0 10.2 17,721

Other 83.6 50.9 44.3 32.0 11.2 17.6 12.0 8.8 11,890 No Response 91.1 21.4 32.1 17.8 3.3 5.1 6.7 2.0 450


Characteristics


aware of any of

the services

Percentage aware of all the

6 services

Number of

mothers

Supplementary food

Immuni--zation


Health Check-

up

Referral Services


education

Wealth index

Lowest 86.0 55.3 33.8 21.0 7.1 10.5 8.2 4.4 9,133 Second 86.9 56.6 41.0 26.3 10.0 13.9 7.7 7.2 9,419 Middle 88.1 59.0 44.1 32.8 14.2 20.4 7.2 11.4 9,358 Fourth 84.3 58.0 44.3 34.2 15.5 21.2 10.9 12.4 8,975 Highest 79.1 58.3 46.0 33.3 14.8 20.7 15.9 11.6 7,600



Percentage of mothers with child aged 36-71 months covered by an AWC, aware of any services and specific

services provided at AWC by background characteristics.

Characteristics


aware of any of

the services

Percentage aware of all the 6 services

Number of

mothers Supplementary food

Immunization

Pre-school Educati

on

Health Check-

up

Referral Services


Mothers of child 0-35 months

91.0 59.8 49.9 30.5 13.4 18.6 3.4 9.7 42,944

Age 15-19 93.2 46.2 51.6 41.0 15.5 15.3 0.9 7.8 140 20-24 91.3 55.8 48.2 32.3 13.7 20.5 4.0 10.4 7,889 25-29 90.6 60.2 49.5 32.0 14.9 20.0 3.9 10.8 18,312 30-34 90.9 61.5 50.7 28.9 12.0 16.5 2.8 8.4 10,254 35-39 91.5 60.8 52.6 29.0 12.3 16.9 2.2 8.9 4,379 40-44 92.7 61.3 47.9 20.7 8.7 14.8 2.1 6.3 1,360 45-49 92.4 64.5 52.7 20.8 7.3 10.4 2.1 3.1 609

Residence Urban 89.5 59.0 51.6 35.2 16.4 22.3 4.7 12.2 11,176 Rural 91.5 60.1 49.3 28.9 12.3 17.3 2.9 8.8 31,767

Mother's education No education 89.6 62.5 47.3 24.6 10.2 14.0 3.9 7.0 16,335 Below Primary (Class - 1 to 4)

93.9 47.3 48.2 25.9 9.1 14.0 2.1 5.7 2,429


93.2 56.8 48.9 31.7 13.0 19.7 2.3 9.1 6,873


92.5 55.0 50.6 30.6 12.9 18.2 3.4 9.6 6,218


90.9 61.9 53.8 39.0 19.9 25.4 3.6 15.2 5,404


89.6 64.1 54.7 39.8 19.0 26.4 3.7 14.3 5,686

Religion Hindu 91.0 61.3 49.2 30.8 13.5 18.7 3.3 9.8 33,905 Muslim 90.4 52.4 49.8 26.8 10.7 15.3 4.3 7.5 6,786 Christian 92.6 55.9 61.6 40.1 25.1 34.5 2.6 19.5 1,222 Sikh 94.5 70.0 62.2 26.0 11.3 16.1 2.5 6.8 585


Characteristics


aware of any of

the services

Percentage aware of all the 6 services

Number of

mothers Supplementary food

Immunization

Pre-school Educati

on

Health Check-

up

Referral Services


Jain (95.0) (77.5) (60.0) (42.5) (20.0) (20.0) (2.5) (12.5) 40

Buddhist/Neo-Buddhist

93.7 57.8 50 44.8 18.9 26.9 1.6 7.5 247

No religion (94.9) (30.8) (38.5) (10.3) (5.1) (15.4) (5.1) (5.1) 39

Other 93.3 51.6 48.4 31.2 7.6 16.5 2.4 3.4 130 Social Group

Scheduled Caste 91.5 56.3 46.3 27.6 12.2 16.4 3.2 8.4 9,105 Scheduled Tribe 93.1 64.7 50.1 31.6 12.6 18.1 2.2 9.1 5,073 Other Backward Classes

89.5 64.5 49.4 29.8 14.1 19.2 3.7 10.1 17,446

Other 91.7 54.3 54.0 34.1 13.9 20.1 3.6 10.6 10,869 No Response 95.7 22.4 39.8 17.4 4.2 7.9 1.3 2.9 451

Wealth index Lowest 90.7 55.8 42.1 21.6 7.4 10.8 3.7 4.2 9,517 Second 91.7 56.3 48.7 26.2 10.8 15.0 3.1 7.3 9,345 Middle 92.2 61.2 52.2 34.3 16.2 22.4 2.7 12.5 9,129 Fourth 90.5 62.3 52.4 36.1 16.5 22.5 3.2 12.2 8,178 Highest 89.5 65.5 56.3 37.1 17.8 24.5 4.6 13.7 6,775




Percentage of mothers with child aged 0-71 months covered by an AWC, aware of any services and specific services provided at AWC by background characteristics

Characteristics


aware of any of

the services

Percentage

aware of all

the 6 services

Number of

mother Supplementary

food Immunization

Pre-school

Education

Health Check-

up

Referral

Services

Nutrition and

Health

education

Mothers of child 0-35 months 88.5 58.4 46.6 30.6 13.2 18.3 6.0 9.5 70,209

Age

15-19 88.4 43.1 37.7 25.7 10.7 14.0 7.0 7.4 1,419

20-24 88.0 57.0 43.6 32.0 13.4 19.2 6.8 9.9 20,211

25-29 88.3 59.1 47.6 32.0 14.7 19.7 6.3 10.7 26,880

30-34 88.7 59.5 48.3 28.4 11.6 16.3 5.1 8.1 13,661

35-39 89.2 59.3 50.1 28.4 11.9 16.8 4.4 8.5 5,604

40-44 90.9 60.3 44.8 20.8 7.7 14.1 3.6 5.5 1,646

45-49 92.3 65.9 53.9 23.6 8.5 12.1 2.6 4.3 788

Residence

Urban 84.7 55.6 46.9 33.5 15.1 20.6 9.7 11.2 19,093

Rural 89.9 59.4 46.5 29.5 12.5 17.5 4.6 8.9 51,116

Mother's education

No education 87.9 62.0 44.5 24.6 10.3 14.1 5.6 7.2 23,304

Below Primary (Class - 1 to 4) 92.5 46.9 44.7 26.6 8.2 13.3 3.3 5.3 3,740

Completed Primary (Class 5-7) 91.4 56.2 46.3 31.2 12.6 18.8 4.2 9.1 11,003

Completed Middle (Class 8 -9) 90.1 54.1 46.8 30.5 12.1 17.0 5.4 8.7 10,880

Completed Secondary (Class 10-

11) 87.8 59.5 49.9 37.9 18.6 24.4 6.7 14.1 9,747


(Class 12) 84.8 59.9 48.8 37.2 17.5 24.2 9.1 12.9 11,535

Religion

Hindu 88.5 59.8 46.1 30.9 13.3 18.3 5.8 9.6 55,464

Muslim 87.9 50.9 46.1 27.0 10.5 15.4 6.7 7.6 10,858

Christian 88.8 52.9 55.4 37.2 21.7 31.9 6.5 17.2 1,957


Characteristics


aware of any of

the services

Percentage

aware of all

the 6 services

Number of

mother Supplementary

food Immunization

Pre-school

Education

Health Check-

up

Referral

Services

Nutrition and

Health

education

Sikh 90.5 67.3 58.3 25.8 10.6 15.3 5.9 6.8 1,066

Jain 88.7 72.1 61.6 62.7 45.2 48.5 9.2 40.0 128

Buddhist/Neo-Buddhist 88.9 61.6 50.5 50.3 24.4 33.1 4.9 16.7 446

No religion (97.0) (40.9) (39.4) (19.7) (13.6) (24.2) (3.0) (13.6) (66)

Other 90.6 51.9 43.1 31.3 7.5 16.9 4.8 4.1 242

Social Group

Scheduled Caste 89.5 55.7 43.6 28.4 12.0 16.3 5.3 8.3 14,428

Scheduled Tribe 91.3 63.7 46.7 30.8 12.6 18.2 3.8 9.2 8,182

Other Backward Classes 87.3 63.3 46.3 30.1 14.5 19.3 6.2 10.3 28,017

Other 88.0 52.2 49.8 33.3 12.7 19.0 7.2 9.7 18,839

No Response 93.4 21.6 35.9 16.4 3.5 5.9 3.9 2.3 743

Wealth index

Lowest 89.1 54.7 38.4 21.3 7.2 10.6 5.2 4.1 14,059

Second 89.9 56.1 45.7 26.8 10.8 15.0 4.6 7.4 14,739

Middle 90.6 59.6 48.9 33.9 15.4 21.6 4.4 11.8 14,916

Fourth 87.6 59.9 48.9 35.7 16.4 22.3 6.7 12.2 14,275

Highest 84.5 61.9 51.7 35.7 16.4 22.7 9.5 12.5 12,219


Table 7.6: Awareness of services provided at AWC Percentage of currently pregnant women covered by an AWC, aware of any services and specific services provided at AWC by background characteristics.

Characteristics

Services provided at AWC Percentage not aware of any

services

Percentage aware of all

the 6 services

Number of currently pregnant women Supplementary food Immunization

Health Check-up

Referral Services


Pregnant women 87.7 59.6 29.9 11.0 16.5 6.6 8.3 5,247 Age

15-19 89.3 46.8 28.8 5.1 13.2 5.9 4.1 240 20-24 87.6 58.3 30.4 11.0 17.0 7.3 8.7 2,352 25-29 87.5 63.4 30.9 13.1 18.0 5.7 9.9 1,905 30-34 89.1 61.8 29.2 8.5 14.5 5.3 5.0 531 35-39 84.3 45.2 17.5 2.7 6.3 12.3 1.4 182 40-44 (88.9) (63.0) (22.2) (7.4) (22.2) (3.7) (3.7) 27 45-49 * * * * * * * 12


Mother's education No education 86.2 61.6 23.3 7.7 12.5 7.8 5.7 1,842 Below Primary (Class - 1 to 4) 87.4 48.8 25.7 7.9 11.0 6.8 5.9 281 Completed Primary (Class 5-7) 90.7 61.7 33.4 10.5 19.6 3.7 8.5 854 Completed Middle (Class 8 -9) 89.2 53.8 26.1 8.4 13.0 5.8 6.0 817 Completed Secondary (Class 10-11) 90.5 60.0 36.0 13.7 22.9 5.6 9.9 617 Completed Higher Secondary (Class 12) 84.5 62.1 41.3 20.2 23.0 8.2 15.3 836

Religion Hindu 87.8 60.9 30.1 10.9 16.3 6.4 8.0 3,942 Muslim 85.9 54.0 25.3 8.2 12.6 8.0 6.0 1,045 Christian 94.9 63.4 47.9 23.8 44.1 2.1 23.3 118 Sikh 90.5 60.2 32.2 11.1 16.7 3.0 7.2 77 Jain * * * * * * * 6 Buddhist/Neo-Buddhist (87.8) (43.9) (31.7) (14.6) (24.4) (9.8) (7.3) 41 No religion * * * * * * * 3 Other (92.9) (19.6) (10.7) (5.4) (14.3) (5.4) (1.8) 56

Social Group Scheduled Caste 88.4 59.1 33.1 11.4 19.0 6.9 9.5 1,121 Scheduled Tribe 91.0 62.5 27.7 11.9 14.2 4.1 9.0 616 OBC 86.2 62.7 27.2 11.2 16.2 7.2 7.8 2,217 Other 87.6 55.4 33.7 10.2 16.9 6.6 8.0 1,231 No Response 95.2 10.8 13.9 0.8 1.3 4.8 0.8 62

Wealth index Lowest 86.4 53.5 20.8 5.6 10.2 6.8 2.6 1,146 Second 88.8 59.5 26.3 9.5 13.8 7.0 7.7 1,183 Middle 89.5 62.0 36.0 12.9 20.0 5.6 11.0 1,115 Fourth 86.0 61.6 34.3 12.4 21.9 7.9 10.2 970 Highest 87.3 62.5 34.0 16.3 18.3 5.5 10.8 833




Among the mothers of children aged 0-5 months residing in area covered by AWC, percentage availing specific

services by background characteristics

Characteristics

Type of services availed Number of mothers of

children aged 0-5 months

Supplementary food

Immunization Health

check-up Referral services

Nutrition and health education or advice on feeding and care

of young children

Other


Mother's education No education 41.4 34.6 26.5 8.8 12.3 5.8 2,953 Below Primary (Class - 1 to 4) 54.0 37.0 36.6 14.9 19.8 7.4 423 Completed Primary (Class 5-7) 48.1 37.9 35.3 12.7 18.2 6.4 1,278 Completed Middle (Class 8 -9) 48.4 34.8 32.2 13.4 17.3 6.0 1,297 Completed Secondary (Class 10-11)

39.7 30.2 31.1 14.9 19.6 8.2 1,182


31.8 24.2 24.7 12.4 17.1 7.1 1,335

Religion Hindu 44.4 36.0 31.9 12.9 17.3 7.1 6,718 Muslim 35.0 21.5 20.1 6.6 10.6 4.0 1,356 Christian 34.1 22.1 23.6 9.3 12.5 4.6 185 Sikh 19.4 13.3 10.3 2.1 4.6 4.0 117 Jain * * * * * * 10 Buddhist/Neo-Buddhist (38.8) (16.5) (20.4) (6.8) (20.4) (6.8) 103 No religion * * * * * * 6 Other (29.7) (17.2) (20.3) (7.8) (7.8) (0.0) 64

Social Group Scheduled Caste 46.7 36.6 29.4 11.8 16.1 7.9 1,801 Scheduled Tribe 53.8 41.5 40.3 14.3 21.3 6.7 1,041 OBC 40.4 33.3 28.2 11.7 16.2 6.0 3,373 Others 35.9 26.4 27.1 10.9 14.0 6.3 2,171 Do Not Know 53.6 11.5 20.2 12.4 1.4 3.8 83

Wealth Index Lowest 53.1 43.9 34.8 10.8 15.8 7.8 1,909 Second 46.4 35.7 30.9 11.5 16.3 5.6 1,877 Middle 43.8 31.9 31.3 14.5 18.9 5.8 1,778 Fourth 35.9 26.9 27.1 12.3 15.6 6.3 1,581 Highest 26.8 22.4 21.0 9.6 13.1 7.2 1,324

Total 42.4 33.0 29.6 11.8 16.1 6.5 8,469




Among children aged 6-35 months residing in area covered by AWC, percentage availing specific services by

background characteristics

Characteristics


Number of

children Supplementary

food Immunization

Health check-

up

Referral services

Nutrition and health education

or advice on feeding and

care of young

children

Other


Mother's education No education 47.0 43.5 27.1 9.5 14.6 3.4 13,376 Below Primary (Class - 1 to 4) 63.2 44.9 43.2 9.8 19.4 4.2 2,060 Completed Primary (Class 5-7) 57.4 47.2 37.2 13.7 21.0 5.7 6,456 Completed Middle (Class 8 -9) 52.7 43.2 34.1 12.3 20.5 5.2 6,678 Completed Secondary (Class 10-11) 47.3 40.3 34.2 14.8 22.5 6.1 5,726 Completed Higher Secondary (Class 12)

39.9 32.7 27.8 14.1 18.6 5.9 6,885

Religion Hindu 50.5 44.7 33.2 12.9 19.3 5.3 32,257 Muslim 44.1 30.2 25.8 7.9 14.3 3.1 6,719 Christian 53.2 38.2 31.5 17.1 24.4 6.7 1,028 Sikh 27.4 21.8 10.9 3.2 5.4 1.4 644 Jain 57.7 52.3 55.9 40.3 54.2 2.7 82 Buddhist/Neo-Buddhist 60.1 58.9 52.9 21.9 31.2 2.0 264 No religion (61.0) (29.3) (14.6) (7.3) (14.6) 0 41 Other 52.4 37.8 36.6 8.8 16.7 6.7 160

Social Group Scheduled Caste 53.0 44.2 33.7 13.8 19.3 5.1 8,436 Scheduled Tribe 62.8 54.2 39.8 13.3 22.1 5.9 4,893 OBC 45.1 42.6 28.3 12.6 18.1 4.8 16,583 Others 45.7 34.1 31.2 10.0 16.9 4.5 10,837 Do Not Know 65.6 23.8 48.4 3.7 23.2 3.3 431


Total 49.2 41.9 31.7 12.1 18.5 4.9 41,181




Among children aged 36-71 months residing in area covered by AWC, percentage availing specific services by

background characteristics

Characteristics


Number of children

Supplementary food


Immunization Health

check-up Referral services

Nutrition and health education

or advice on feeding and care of young children

Other

Residence Urban 31.1 26.9 24.3 21.1 9.1 13.8 4.8 12,268

Rural 48.7 42.7 37.5 28.6 11.2 17.6 5.6 35,605

Mother's education

No education 45.2 39.1 34.6 22.8 8.6 13.5 4.1 18,598

Below Primary (Class - 1 to 4) 63.3 55.2 41.0 39.3 13.3 21.1 8.2 2,691

Completed Primary (Class 5-7) 50.9 44.6 39.0 33.2 13.1 20.4 6.2 7,666

Completed Middle (Class 8 -9) 45.2 39.7 33.9 28.8 10.0 17.3 5.9 6,875


39.7 36.1 33.9 29.7 14.5 20.9 6.3 5,937


27.2 24.0 23.5 19.5 10.0 14.3 5.5 6,105

Religion

Hindu 44.8 39.6 36.7 27.6 11.2 17.1 5.6 37,609

Muslim 41.6 34.9 23.3 23.2 7.6 14.0 4.2 7,787

Christian 45.3 38.7 31.1 26.6 15.9 22.6 7.4 1,342

Sikh 27.5 23.2 17.1 8.0 3.5 5.8 1.2 646

Jain (28.6) (26.2) (28.6) (28.6) (11.9) (16.7) (11.9) 42

Buddhist/Neo-Buddhist 57.2 50.8 45.8 43.6 17.5 27.3 7.0 266

No religion (57.1) (26.2) (9.5) (9.5) (2.4) (16.7) (0.0) 42

Other 50.9 44.9 30.2 27.5 8.1 13.2 3.3 147

Social Group

Scheduled Caste 46.6 40.6 35.5 27.4 12.1 17.3 5.6 10,193

Scheduled Tribe 57.9 50.6 46.6 33.5 13.0 20.1 6.0 5,665

OBC 39.1 34.5 33.9 22.9 10.6 15.6 5.2 19,520

Others 43.0 37.8 27.9 28.4 8.9 15.9 5.1 11,994

Do Not Know 63.5 46.3 17.3 43.9 3.0 17.2 4.4 502

Wealth Index

Lowest 53.7 46.6 40.3 28.8 9.3 15.6 5.3 10,749

Second 52.3 45.5 37.3 28.7 10.4 16.3 5.4 10,533

Middle 46.3 41.1 36.6 29.5 13.2 20.0 5.3 10,191

Fourth 37.3 33.2 30.6 26.4 11.9 17.6 5.6 9,046

Highest 24.0 20.7 21.0 17.3 8.1 12.6 5.2 7,353

Total 44.2 38.7 34.1 26.7 10.7 16.6 5.4 47,873




Among currently pregnant women residing in area covered by AWC, percentage availing AWC services, by


Characteristics

Type of services availed Number of


Supplementary food

Immunization Health check-

up

Referral services

ANC IFA supplementation

Other


Mother’s education No education 39.1 37.2 24.7 10.0 18.9 14.2 2.0 1,842 Below Primary (Class - 1 to 4)

39.5 32.9 27.0 8.0 17.2 14.1 0.7 281


41.8 36.6 26.8 9.2 18.4 14.6 3.0 854


42.0 37.4 27.8 10.3 22.2 15.5 2.6 817


43.3 33.8 30.5 13.7 25.5 18.6 2.4 617


40.6 33.8 26.8 14.5 20.4 19.1 5.3 836

Religion Hindu 43.7 39.5 28.7 11.9 21.7 16.9 3.0 3,942 Muslim 28.1 21.6 16.1 4.5 12.2 8.8 1.7 1,045 Christian 57.4 42.1 38.8 22.5 34.5 30.4 4.7 118 Sikh 19.0 20.8 19.3 4.1 9.1 5.7 1.5 77 Jain * * * * * * * 6 Buddhist/Neo-Buddhist (43.9) (19.5) (26.8) (12.2) (24.4) (24.4) (7.3) 41 No religion * * * * * * * 3 Other (21.4) (19.6) (16.1) (5.4) (7.1) (7.1) (3.6) 56

Social Group Scheduled Caste 43.9 37.4 27.5 15.0 21.5 18.7 3.2 1,121 Scheduled Tribe 55.6 48.7 35.9 11.9 26.0 16.3 2.2 616 OBC 36.7 36.2 24.7 10.8 19.0 15.1 2.6 2,217 Others 36.7 28.4 24.8 7.5 19.0 13.9 3.2 1,231 Do Not Know 60.7 23.0 28.9 3.1 11.5 19.6 0.1 62

Wealth Index Lowest 43.7 40.2 27.9 8.4 17.8 15.5 2.3 1,146 Second 44.4 38.1 29.1 12.8 23.7 15.6 2.5 1,183 Middle 44.2 38.4 28.6 12.3 23.4 19.7 3.6 1,115 Fourth 40.5 35.3 26.7 12.7 20.0 15.9 2.9 970 Highest 27.1 24.4 18.9 8.0 15.0 10.9 2.6 833

Total 40.7 35.9 26.7 11.0 20.3 15.8 2.8 5,247 *Percentage not shown; based on fewer than 25 unweighted cases.



Table 7.14: Utilization of services provided at AWC by state

Among mother with children aged 0-5 months covered by an AWC, percentage utilizing specific services provided

at AWC, according to states.

State

Percentage

availing any

service from AWC


Number of

mothers Supplementary

Food Immunization

Health Check-up

Referral Services


education or advice on

feeding and care of young

children

Other

India 47.8 42.4 33.0 11.8 16.1 6.5 8.2 8,469 North

Delhi 7.7 4.3 3.4 6.0 1.3 1.3 0.8 199 Haryana 26.5 11.8 19.5 14.6 6.4 7.6 7.8 236 Himachal Pradesh 67.4 65.2 27.5 34.5 19.0 25.1 15.6 208 Jammu & Kashmir 16.7 14.2 2.2 2.5 0.0 3.0 0.7 174 Punjab 16.4 15.5 8.6 7.4 3.1 5.1 3.2 185 Uttar Pradesh 26.5 23.6 18.1 11.5 5.0 3.2 2.7 1,254 Uttarakhand 28.2 21.0 17.9 5.0 1.8 2.4 2.8 169

Central Chhattisgarh 83.3 81.5 61.4 51.2 20.1 35.6 11.1 264 Madhya Pradesh 67.5 54.0 44.3 35.1 12.7 19.2 12.6 461

East Bihar 51.3 39.3 42.7 21.7 7.9 11.2 10.4 679 Jharkhand 73.6 72.9 61.9 60.3 20.3 26.1 6.2 271 Odisha 81.7 76.5 72.0 68.4 20.0 28.3 2.9 286 West Bengal 50.2 46.5 7.1 24.3 3.4 7.0 3.3 394

Northeast Arunachal Pradesh 27.1 25.9 4.6 8.5 2.0 13.3 10.6 112 Assam 41.5 41.4 13.8 11.6 2.3 7.2 1.2 226 Manipur 25.8 25.8 7.0 0.0 0.0 2.6 0.0 209 Meghalaya 32.3 29.6 8.5 4.5 1.1 3.0 1.6 208 Mizoram 48.3 46.4 11.7 19.3 2.8 30.9 17.8 234 Nagaland 3.1 3.0 0.9 0.1 0.0 0.0 0.0 228 Sikkim 53.2 43.9 15.9 34.7 11.5 25.9 4.3 189 Tripura 31.3 27.2 19.2 16.9 5.4 12.5 3.3 156

West Rajasthan 41.9 35.5 30.7 28.0 5.7 5.0 3.0 441 Goa 70.8 70.2 30.6 34.8 12.3 34.7 14.6 132 Gujarat 54.4 49.4 42.5 46.9 13.9 24.6 4.4 357 Maharashtra 49.7 42.0 39.2 40.8 12.3 20.5 11.2 348

South Andhra Pradesh 62.2 60.1 50.2 45.0 28.6 38.2 10.6 344 Karnataka 53.3 52.3 39.6 38.1 23.6 26.2 4.5 283 Kerala 17.2 15.0 12.3 11.9 7.6 8.9 4.4 119 Tamil Nadu 36.0 30.5 22.2 21.7 20.4 23.5 10.1 232



Among children aged 6-35 months covered by an AWC, percentage utilizing specific services provided at AWC,

according to states

State

Percentage availing any

service from AWC


Number of

Children Supplementary

Food Immunization

Health Check-up

Referral Services


or advice on feeding and care of young children

Other

India 53.6 49.2 41.9 31.8 12.1 18.6 4.9 41,167

North

Delhi 14.5 11.9 10.7 7.9 3.2 4.1 0.9 906

Haryana 25.6 17.8 22.1 9.7 4.1 4.2 1.5 943

Himachal Pradesh

70.8 70.3 37.0 36.1 20.4 27.7 14.9 1,187

Jammu & Kashmir

29.7 28.8 7.1 8.4 3.3 5.4 3.5 868

Punjab 26.4 23.1 17.3 9.6 3.8 4.6 2.0 1,063

Uttar Pradesh 27.0 22.7 23.0 7.8 2.6 3.4 0.7 5,438

Uttarakhand 22.2 18.4 15.6 9.8 2.1 4.4 1.4 817

Central

Chhattisgarh 84.0 82.8 76.2 54.9 17.2 34.9 8.0 1,218

Madhya Pradesh

71.3 63.6 64.8 37.7 15.7 22.1 8.3 2,043

East

Bihar 50.2 36.6 47.6 16.3 6.0 10.9 3.3 3,013

Jharkhand 61.5 59.3 60.3 40.3 14.0 22.0 3.2 1,333

Odisha 89.5 89.2 84.7 72.5 22.8 26.4 5.7 1,298

West Bengal 74.1 71.9 15.4 47.5 2.5 15.8 2.2 1,977

North east

Arunachal Pradesh

51.2 51.1 24.7 19.4 9.3 22.7 18.8 949

Assam 71.3 71.2 29.3 12.4 2.7 7.1 1.0 1,072

Manipur 44.3 44.3 13.7 2.7 0.9 14.2 2.5 781

Meghalaya 49.3 47.1 23.1 17.0 11.5 14.0 6.1 918

Mizoram 64.3 63.4 33.8 33.4 3.5 39.0 15.3 673

Nagaland 9.0 9.0 0.5 0.2 0.0 0.1 0.0 822

Sikkim 68.7 65.7 17.1 50.1 17.0 42.3 5.2 906

Tripura 70.9 70.0 55.4 39.0 8.3 32.7 1.0 874

West

Rajasthan 38.4 33.7 34.4 17.7 2.9 4.7 1.0 1,856

Goa 67.4 66.5 38.6 41.2 9.0 40.1 12.5 871

Gujarat 60.0 54.5 52.6 43.2 11.6 23.0 4.5 1,634

Maharashtra 57.5 51.4 48.3 48.7 12.1 25.8 7.7 2,103

South

Andhra Pradesh

67.5 65.3 63.5 47.3 34.0 43.4 8.2 1,637

Karnataka 57.5 56.3 48.9 39.3 20.5 26.2 4.1 1,507

Kerala 44.4 43.2 30.6 27.8 18.7 21.6 12.6 884

Tamil Nadu 44.3 42.3 31.5 29.3 23.3 25.1 11.2 1,508



Among children age 36-71 months covered by an AWC, percentage utilizing specific services provided at AWC,

according to states

State

Percentage availing

any service from AWC


Number of

Children Supplementary

Food Immunization

Pre-school Education

Health Check-up

Referral Services


education or advice on

feeding and care of young

children

Other

India 47.5 44.2 38.7 34.1 26.7 10.7 16.6 5.4 47,873 North

Delhi 14.3 13.7 10.7 8.2 8.5 3.1 3.7 1.3 963 Haryana 21.4 17.9 14.6 17.3 8.3 2.8 3.6 1.7 953 Himachal Pradesh

42.4 42.2 35.2 25.2 26.0 18.6 24.7 12.1 1,258

Jammu & Kashmir

29.3 28.5 15.4 7.8 7.4 3.2 6.3 3.7 851

Punjab 21.3 20.9 17.9 11.7 6.2 3.4 5.0 2.0 1,134 Uttar Pradesh 23.7 22.5 16.4 16.7 6.0 3.4 3.2 1.1 6,503 Uttarakhand 26.0 24.2 25.1 10.1 6.2 2.4 4.9 1.8 999

Central Chhattisgarh 63.0 60.2 57.0 51.0 34.0 12.9 23.2 6.4 1,339 Madhya Pradesh

64.0 47.5 37.1 55.5 30.2 11.7 19.2 7.2 2,362

East Bihar 47.0 42.9 42.5 37.7 14.8 8.3 13.6 7.0 3,827 Jharkhand 30.1 27.0 25.5 24.5 15.5 6.0 9.1 2.3 1,489 Odisha 68.2 67.3 62.7 59.9 48.9 12.8 17.7 3.2 1,714 West Bengal 74.2 69.6 53.6 14.9 47.2 3.7 17.9 6.9 2,297

North east Arunachal Pradesh

63.2 63.2 57.2 28.3 23.1 11.2 24.7 19.9 1,260

Assam 74.5 72.9 64.6 23.8 9.4 2.4 5.5 2.6 1,473 Manipur 71.1 70.6 62.8 11.9 2.5 0.8 21.1 1.7 1,080 Meghalaya 61.9 61.3 30.3 31.2 21.0 15.2 19.0 11.2 1,092 Mizoram 69.2 68.9 60.9 38.3 32.6 3.6 44.0 15.5 1,113 Nagaland 13.9 13.8 1.4 1.8 1.1 0.0 1.2 0.0 1,142 Sikkim 58.0 51.8 44.9 13.7 44.8 16.7 37.7 4.7 800 Tripura 78.5 78.4 74.2 57.7 37.1 6.5 33.7 1.0 886

West Rajasthan 22.9 22.0 17.0 18.2 9.2 1.8 2.9 0.6 2,153 Goa 47.7 41.8 35.4 24.9 30.5 5.7 28.9 13.3 879 Gujarat 72.4 69.8 57.4 60.4 47.0 14.4 23.3 6.4 1,588 Maharashtra 63.7 60.7 58.4 53.7 54.6 13.8 30.8 11.4 2,379

South Andhra Pradesh

56.9 52.4 50.6 51.8 39.0 28.2 35.6 6.7 1,835

Karnataka 49.2 47.1 45.5 43.9 36.9 22.6 25.0 5.3 1,631 Kerala 38.3 36.4 32.0 27.3 24.1 17.3 20.6 10.6 1,175 Tamil Nadu 27.2 26.5 23.1 20.8 19.5 15.7 17.5 5.9 1,817



Among currently pregnant woman covered by an AWC, percentage utilizing specific services provided at AWC,

according to states.

State

Percentage availing any

service from AWC

Type of services availed Number of


Supplementary Food

Immunization Health Check-

up

Referral Services

ANC IFA Other

India 45.9 40.7 35.9 26.7 11.0 20.3 15.8 2.8 5,247 North

Delhi 13.7 8.8 9.6 8.1 3.4 3.4 1.7 3.2 102 Haryana 25.1 19.6 24.1 17.6 6.2 14.6 7.9 0.5 168 Himachal Pradesh

70.1 65.7 30.1 21.5 16 15.1 18.2 10.6 138

Jammu & Kashmir

15.6 14.9 4.8 1.8 0.0 0.4 1.1 0.7 96

Punjab 22.1 14.9 16.3 11.4 2.0 3.3 2.5 1.1 125 Uttar Pradesh 27.6 23.8 23.2 12.2 4.6 6.8 4.4 0.7 789 Uttarakhand 21.7 12.3 18.1 15 4.9 12.5 3.4 3.3 119

Central Chhattisgarh 70.4 65.4 59.1 49.2 17.9 42.1 41.8 6.4 183 Madhya Pradesh 59.1 47.7 54.5 28.0 8.1 20.7 12.8 3.8 293

East Bihar 33.8 21.7 30.1 10.4 3.8 10.1 8.5 1.0 498 Jharkhand 49.1 47.0 45.9 31.5 13.6 29.6 9.3 3.2 202 Odisha 63.5 60.6 61.2 47.8 10.5 19.8 27.5 0.0 146 West Bengal 55.6 55.6 10.6 20.6 2.3 8.5 4.8 0.9 223

North east Arunachal Pradesh

(17.2) (17.2) (6.9) (6.9) (1.7) (1.7) (10.3) (3.4) 58

Assam 29.8 29.8 9.6 10.1 0.0 7.7 0.7 0.0 89 Manipur 44.3 44.3 3.1 2.7 0.5 0.5 1.2 1.0 102 Meghalaya 35.0 34.3 13.4 13.8 5.5 11.0 11.0 1.1 93 Mizoram (44.0) (42.0) (30.0) (26.0) (2.0) (16.0) (14.0) (8.0) 50 Nagaland (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) (0.0) 54 Sikkim (52.1) (47.9) (6.3) (35.4) (14.6) (18.8) (27.1) (2.1) 48 Tripura (57.1) (55.7) (37.1) (31.4) (5.7) (31.4) (15.7) (0.0) 70

West Rajasthan 39.9 33.5 36.5 23.1 2.2 14.3 7.7 2.0 285 Goa 52.2 49.2 23.3 35.9 3.5 14.7 17.2 2.2 66 Gujarat 58.0 49.0 46.6 42.1 11.6 26.6 20.9 4.5 183 Maharashtra 53.8 47.4 41.1 41.7 11.4 37.5 32.5 4.7 224

South Andhra Pradesh 79.9 78.3 73.6 63.6 50.0 55.9 48.7 8.1 192 Karnataka 49.1 48.8 38.9 33.2 15.6 29 17.2 1.7 164 Kerala 23.6 23.0 17.6 14.1 8.4 12.7 13.2 8.3 82 Tamil Nadu 47.9 45.7 28.6 26.2 21.8 24.9 23.9 3.5 163



Table 7.22: Intake of supplementary food by states

Among children aged 6-35 months and 36-71 months covered by an AWC by utilization of supplementary foods services provided at AWC, by state.

State

Children 36-71 months Children 6-35 months

Percentage

received

Supplementary

food

Type of Supplementary food

received

Percentage

received

Supplementary

food for 21 or

more days

Percenta

ge

consume

d entire

quantity

of the

food

received

from the

AWC

Percentage

received

Supplemen

tary food

Type of Supplementary

food received Percenta

ge

received

Supplem

entary

food for

21 or

more

days

Percenta

ge

consum

ed

entire

quantity

of the

food

received

from the

AWC

Hot

Cooked

meal

Ready

To Eat

(RTE)/

Take

Home

Ration

(THR)

Morning

Snacks

Hot

Cooked

Meal

(HCM)

Ready To

Eat (RTE)/

Take

Home

Ration

(THR)

India 44.2 41.6 12.0 10.6 14.9 36.9 49.2 21.6 38.5 11.8 17.3

North

Delhi 13.7 13.6 1.3 2.3 4.7 6.7 11.9 13.6 5.0 3.1 3.2

Haryana 17.9 25.7 3.8 1.9 10.0 10.6 17.8 24.8 5.6 9.4 8.9

Himachal

Pradesh

42.2 37.9 8.7 9.2 17.5 33.9 70.3 31.6 55.2 33.7 23.5

Jammu &

Kashmir

28.5 23.4 12.6 5.3 5.5 22.1 28.8 18.9 19.6 7.4 8.8

Punjab 20.9 17.9 9.0 4.0 7.2 13.8 23.1 14.7 19.2 6.6 6.3

Uttar Pradesh 22.5 10.8 17.5 5.1 3.1 13.1 22.8 2.8 25.8 4.3 6.0

Uttarakhand 24.2 18.9 5.1 5.1 3.2 20.4 18.6 9.2 15.6 3.2 5.8

Central

Chhattisgarh 60.2 58.7 3.7 16.0 18.0 55.7 82.8 4.7 81.2 42.0 8.8

Madhya Pradesh 47.5 39.7 20.5 11.1 9.7 36.5 63.6 15.7 62.8 18.5 17.2

East

Bihar 42.9 42.0 3.2 3.1 16.6 40.6 36.6 6.1 37.9 0.0 9.9

Jharkhand 27.0 25.5 6.7 6.5 7.2 26.0 59.3 9.0 57.7 18.5 8.9

Odisha 67.3 63.1 7.6 45.3 23.6 61.0 89.2 2.7 88.2 0.0 12.3

West Bengal 69.6 68.0 0.3 2.0 22.3 40.4 71.9 73.5 0.2 0.0 13.3

North east

Arunachal

Pradesh

63.2 52.4 58.0 18.4 0.6 56.6 51.1 30.3 48.7 0.2 3.4

Assam 72.9 60.0 40.9 27.0 4.0 63.1 71.2 7.7 70.0 0.0 7.0

Manipur 70.6 52.2 60.7 35.3 4.1 34.8 44.3 22.5 39.3 0.0 8.5

Meghalaya 61.3 51.7 30.3 12.6 6.0 43.8 47.1 31.9 40.4 0.0 17.4

Mizoram 68.9 55.5 60.8 50.4 10.8 38.0 63.4 41.6 63.0 0.0 18.5

Nagaland 13.8 1.5 16.7 6.7 0.0 3.3 9.0 2.0 10.4 0.0 0.6

Sikkim 51.8 48.4 23.1 31.5 21.7 50.0 65.7 34.1 55.7 0.0 46.3

Tripura 78.4 70.5 8.6 9.5 29.1 69.7 70.0 55.3 20.9 0.0 40.8

West

Rajasthan 22.0 16.8 13.5 7.9 6.9 14.6 33.7 5.1 33.3 9.5 3.9

Goa 41.8 39.4 5.5 6.7 29.4 40.4 66.5 15.8 57.6 44.8 21.2

Gujarat 69.8 65.7 31.8 26.2 30.2 59.0 54.5 36.4 49.4 16.8 42.3

Maharashtra 60.7 61.2 12.0 13.1 25.0 51.3 51.4 36.8 31.1 21.2 28.1

South

Andhra Pradesh 52.4 50.8 12.0 7.0 16.5 50.2 65.3 32.6 42.9 17.0 40.6

Karnataka 47.1 46.4 4.0 15.8 25.3 45.5 56.3 16.1 47.6 24.2 19.8

Kerala 36.4 29.0 17.8 9.7 12.1 23.1 43.2 14.8 38.1 11.7 14.0

Tamil Nadu 26.5 24.1 7.1 2.0 10.0 26.1 42.3 22.7 29.5 16.8 26.4


Table 7.23: Intake of supplementary food among lactating and pregnant women by state

Percentage of mothers with child aged 0-5 months and pregnant women covered by an AWC, utilizing supplementary foods and services provided at AWC, by state

State

Mothers of children 0-5 months (Lactating mothers) Currently Pregnant women

Percentage received

Supplementary food

Type of Supplementary food received Percentag

e received Supplementary food for 21 or

more days

Percentage consumed

entire quantity received

from AWC

Percentage received

Supplementary food

Percentage received

Supplementary food for 21 or more

days

Percentage consumed

entire quantity received

from AWC

Hot Cooked

Meal (HCM)

Ready to eat

(RTE)/Take Home Ration (THR)

India 42.4 26.7 78.5 20.3 32.1 40.7 27.8 46.9 North

Delhi 4.3 100 29.2 26.0 37.1 8.8 44.2 30.9 Haryana 11.8 93.6 20.9 41.3 27.8 19.6 22.8 31.7 Himachal Pradesh 65.2 22.6 85.0 44.0 23.0 65.7 37.9 36.4 Jammu & Kashmir 14.2 60.4 44.0 35.1 63.3 14.9 31.6 48.7 Punjab 15.5 19.9 90.8 9.3 27.6 14.9 5.8 45.3 Uttar Pradesh 23.6 8.2 93.5 18.4 26.6 23.8 12.7 34.6 Uttarakhand 21.0 0.0 100.0 8.8 33.5 12.3 0.0 44.4

Central Chhattisgarh 81.5 1.5 99.4 49.9 13.8 65.4 62.0 15.1 Madhya Pradesh 54.0 9.0 96.3 30.3 23.9 47.7 24.4 35.8

East Bihar 39.3 4.0 97.7 0.0 16.0 21.7 33.2 41.9 Jharkhand 72.9 8.8 93.8 28.5 15.6 47.0 21.6 19.6 Odisha 76.5 2.8 98.1 0.0 17.0 60.6 24.8 22.2 West Bengal 46.5 98.6 1.4 0.0 47.3 55.6 35.6 68.4

North East Arunachal Pradesh 25.9 74.3 100.0 0.0 0.0 20.6 0.0 0.0 Assam 41.4 10.4 100.0 0.0 14.8 29.8 1.9 33.1 Manipur 25.8 11.8 98.1 0.0 8.0 44.3 5.0 34.0 Meghalaya 29.6 61.5 85.3 0.0 37.4 34.3 26.9 30.1 Mizoram 46.4 56.0 94.4 0.0 30.1 44.1 4.7 23.8 Nagaland 3.0 11.7 100 0.0 0.0 0.0 0.0 83.8 Sikkim 43.9 18.0 83 0.0 40.4 55.1 19.3 86.1 Tripura 27.2 77.2 28.1 0.0 58.1 60.0 49.5 0.0

West Rajasthan 35.5 5.7 96.8 23.9 7.4 33.5 28.9 9.5 Goa 70.2 15.7 84.3 69.9 32.8 49.2 76.3 36.0 Gujarat 49.4 39.8 82.7 19.6 62.5 49.0 20.2 63.4 Maharashtra 42.0 56.9 48.9 27.3 36.8 47.4 19.0 55.6

South Andhra Pradesh 60.1 44.4 67.0 22.3 52.2 78.3 29.9 80.7 Karnataka 52.3 13.3 87.6 37.6 41.0 48.8 40.7 45.0 Kerala 15.0 26.4 73.6 11.8 4.4 23.0 28.5 60.8 Tamil Nadu 30.5 30.8 72.2 31.3 57.7 45.7 24.5 53.3



Percent distribution of mothers with children aged 0-5 months covered by an AWC who receive supplementary

food from AWC, by frequency of receiving supplementary food in month prior to survey, according to background

characteristics

Characteristics

Number of days received supplementary food Average number of days received supplementary

food

Number of mothers of child aged 0-5

months who received

supplementary food

Not at all

1-7 8-14 15-20 21 or more

Not present in

last month

Don't know/can't say

Mother of children aged 0-5 months

7.8 43.5 6.2 13.3 20.3 4.5 4.4 10.5 3,590

Residence Urban 11.1 44.9 5.2 11.5 18.9 3.8 4.4 9.6 580 Rural 7.2 43.2 6.3 13.6 20.5 4.7 4.4 10.7 3,011

Mother's education

No Education 7.5 42.8 7.5 14.4 17.2 4.9 5.4 9.9 1,224 Below Primary (Class - 1 to 4)

6.6 57.2 7.6 7.4 14.8 3.3 3.0 7.8 229


10.9 46.7 5.2 12.4 18.3 2.9 3.3 10.1 614


7.9 45.4 4.8 8.5 21.9 6.9 4.6 10.1 628


6.1 39.0 5.2 17.0 25.6 3.1 4.0 12.9 470

Higher Secondary and above (Class 12)

6.5 35.6 5.8 17.4 26.5 4.5 3.8 12.4 426

Religion Hindu 8.1 42.3 6.6 12.6 21.4 4.3 4.5 10.8 2,982 Muslim 6.2 47.4 3.7 18.0 15.4 5.9 3.3 9.4 475 Christian 0.9 60.4 8.4 11.8 7.0 6.6 5.1 6.7 63 Sikh (20.7) (27.6) (10.3) (10.3) (17.2) (6.9) (6.9) (8.9) 29 Jain * * * * * * * * 4 Buddhist/Neo-Buddhist

(2.5) (77.5) (2.5) (5.0) (5.0) (5.0) (2.5) (4.2) 40

No religion * * * * * * * * 8 Other * * * * * * * * 19

Social Group Scheduled Caste 7.3 44.7 5.5 12.7 22.3 4.5 3.0 11.2 843 Scheduled Tribe 9.0 38.5 7.4 14.2 26.0 1.3 3.7 11.8 560 OBC 6.8 40.1 7.0 14.7 19.9 4.5 6.8 11.0 1,363 Other 9.5 49.2 4.9 11.4 15.8 6.7 2.4 8.7 780

Wealth Index Lowest 7.4 46.4 8.3 11.8 16.5 4.3 5.3 9.4 1014 Second 6.4 48.0 4.1 14.0 18.8 4.9 3.7 9.8 872 Middle 8.5 41.0 5.8 14.0 21.6 5.8 3.1 11.4 779 Fourth 8.8 40.9 6.3 10.9 23.7 3.7 5.5 10.9 568 Highest 9.2 33.5 5.9 17.8 26.4 2.8 4.5 13.1 357

( ) Percentage based on 25-49 unweighted cases. *Percentage not shown; based on fewer than 25 unweighted cases.



Percent distribution of children aged 6-35 months covered by an AWC who receive supplementary food from AWC,

by frequency of receiving supplementary food in month prior to survey, according to background characteristics.

Characteristics

Number of days received supplementary food Average

number of

days

received

supplement

ary food

Number of

children who

received

supplementa

ry food

Not

at all 1-7 8-14 15-20

21 or

more

Not

present in

last

month

Don't

know/can't

say

Children aged 6-35

months

0.0 42.2 5.9 13.9 21.3 5.3 11.5 11.5 20,255

Residence

Urban 0.0 40.1 5.5 14.6 24.3 4.5 11.0 12.4 3,999

Rural 0.0 42.7 6.0 13.7 20.5 5.5 11.6 11.3 16,256

Mother's education

No Education 0.0 42.3 7.2 15.4 17.7 5.3 12.1 10.9 6,281

Below Primary

(Class - 1 to 4)

0.0 53.9 4.5 8.9 16.7 5.5 10.4 9.1 1,303

Completed Primary

(Class 5-7)

0.0 41.9 5.9 13.7 22.2 4.8 11.5 11.8 3,703

Completed Middle

(Class 8 -9)

0.0 44.2 5.2 11.9 20.9 6.1 11.8 11.0 3,516

Completed

Secondary (Class

10-11)

0.0 40.3 5.6 14.1 26.0 4.1 10.0 12.5 2,704

Higher Secondary

and above (Class

12)

0.0 36.3 4.7 15.1 26.2 6.2 11.5 13.3 2,749

Social -Group

Scheduled Caste 0.0 44.7 5.7 12.8 20.8 4.6 11.4 11.0 4,467

Scheduled Tribe 0.0 37.6 7.3 15.0 24.8 4.2 11.3 12.8 3,071

OBC 0.0 36.4 5.6 15.8 23.7 6.3 12.2 12.8 7,480

Other 0.0 49.9 5.8 11.8 16.7 5.3 10.5 9.7 4,955

Don’t know 0.0 72.4 1.8 4.1 5.6 4.2 11.8 4.7 283

Wealth Index 0.0 42.2 5.9 13.9 21.3 5.3 11.5 11.5 20,255

Lowest 0.0 49.0 6.7 11.6 16.8 4.7 11.3 9.7 4,811

Second 0.0 45.5 5.4 12.3 19.0 6.4 11.4 10.5 4,843

Middle 0.0 40.1 5.3 16.7 21.6 5.6 10.7 12.1 4,634

Fourth 0.0 37.2 6.5 14.9 25.6 4.3 11.5 13.0 3,796

Highest 0.0 33.3 5.3 14.4 28.0 5.4 13.5 13.9 2,171



Percent distribution of children aged 36-71 months covered by an AWC who receive supplementary food from AWC, by frequency of receiving supplementary food in month prior to survey, according to background characteristics.

Characteristics

Number of days received supplementary food from AWC in last

month

Average

number

of days

received

suppleme

ntary

food

Number

of

children

received

suppleme

ntary

food

Not at

all 1-7 8-14 15-20

21 or

more

Not

present

in last

month

Do not

know/c

an't say

Children aged 36-

71 months

9.1 12.2 11.4 29.6 31.0 2.6 4.0 15.6 21,140

Residence

Urban 11.7 13.1 10.5 26.5 31.7 3.1 3.3 15.1 3,816

Rural 8.5 11.9 11.6 30.3 30.9 2.5 4.2 15.7 17,325

Mother's

education

No Education 8.0 12.6 12.5 31.6 28.1 2.1 5.1 15.4 8,404

Below Primary

(Class - 1 to 4)

10.8 13.5 11.9 27.5 30.8 2.0 3.5 15.0 1,704

Completed

Primary (Class 5-

7)

10.6 10.0 11.3 30.2 32.0 2.5 3.4 15.7 3,902

Completed

Middle (Class 8 -

9)

9.6 12.3 11.7 28.9 30.7 3.4 3.4 15.4 3,109

Completed

Secondary (Class

10-11)

7.7 11.9 8.6 27.1 38.7 3.3 2.7 16.7 2,358

Higher Secondary

and above (Class

12)

10.3 13.9 9.2 25.2 33.9 3.5 4.1 15.3 1,664

Social Group

Scheduled Caste 7.8 13.1 11.4 28.5 31.6 2.9 4.7 15.8 4,747

Scheduled Tribe 6.2 12.3 12.7 30.0 33.1 2.0 3.8 16.1 3,279

OBC 8.1 12.5 10.9 31.0 29.8 3.0 4.8 15.6 7,635

Others 12.6 10.7 11.7 28.8 31.3 2.3 2.5 15.1 5,160

Do Not Know 25.2 12.9 6.5 23.6 26.9 2.4 2.4 12.6 319

Wealth Index

Lowest 7.7 11.7 13.3 30.7 29.9 1.9 4.8 15.6 5,770

Second 9.4 12.3 12.3 29.4 29.7 2.8 4.0 15.3 5,507

Middle 9.5 11.8 10.0 29.9 31.9 2.9 3.9 15.8 4,720

Fourth 8.3 12.6 9.8 29.7 32.5 3.2 3.9 15.8 3,377

Highest 13.0 13.2 9.4 25.5 33.9 2.6 2.4 15.0 1,766



Percent distribution of currently pregnant women covered by an AWC who receive supplementary food from AWC, by frequency of receiving supplementary food in month prior to survey, according to background characteristics.

Characteristics

Number of days received supplementary food Average

number of

days received

supplementary

food

Number of

currently pregnant

women who

received

supplementary

food

Not at

all 1-7 8-14 15-20

21 or

more

Don't

know/can't

say

Not

present

in last

month

Pregnant women 5.1 34.8 7.8 15.9 27.8 4.7 3.9 13.8 2,137

Residence

Urban 6.8 33.2 4.8 15.1 31.4 5.1 3.6 14.7 359

Rural 4.7 35.2 8.5 16.1 27.0 4.6 3.9 13.6 1,778

Mother's

education

No Education 6.5 35.2 9.4 14.0 25.7 6.2 3.0 13.3 720

Below Primary

(Class - 1 to 4)

5.5 41.8 5.4 13.6 28.3 2.3 3.1 12.7 111

Completed

Primary (Class 5-

7)

5.3 31.4 8.8 18.9 28.2 3.7 3.6 14.7 357

Completed

Middle (Class 8 -

9)

5.2 27.2 5.5 16.2 34.1 5.2 6.6 15.9 343

Completed

Secondary (Class

10-11)

4.2 39.2 7.2 16.3 25.3 4.3 3.5 12.6 267

Higher

Secondary and

above (Class 12)

2.2 39.6 7.3 17.3 26.9 2.8 3.8 13.3 339

Social Group

Scheduled Caste 4.2 32.1 6.8 11.5 37.1 3.8 4.4 15.2 492

Scheduled Tribe 5.4 33.9 10.4 14.0 26.8 6.2 3.2 13.7 342

OBC 4.0 39.2 7.5 17.2 23.3 5.1 3.7 12.8 813

Other 7.0 33.2 6.8 19.5 25.4 3.6 4.5 13.7 452

Don’t know (6.5) (19.4) (12.9) (22.6) (29.0) (6.5) (3.2) (15.5) 31

Wealth Index

Lowest 4.0 32.7 10.8 14.3 26.6 7.0 4.6 13.9 501

Second 7.4 35.7 8.9 16.3 25.1 3.3 3.3 13.2 526

Middle 5.6 35.3 4.8 15.8 30.6 3.9 4.1 14.2 492

Fourth 3.6 36.7 6.2 17.0 28.4 4.1 3.9 13.9 393

Highest 3.4 33.3 8.1 17.3 29.3 5.3 3.3 14.0 225



Table 7.36: Awareness regarding child’s weight normal or underweight

Percentage distribution of children aged 0-35 months and 36-71 months residing in areas covered by Anganwadi centre (AWC), by state.

States

Percent mothers

aware that child’s

weight was normal

Number of

children aged 0-

35 months

Percent mothers aware

that child’s weight was

normal

Number of

children aged

36-71 months

North

Delhi 97.3 112 95.4 88

Haryana 89.3 134 96.0 112

Himachal Pradesh 86.3 244 87.8 143

Jammu & Kashmir 85.2 17 78.2 9

Punjab 68.9 21 100.0 6

Uttar Pradesh 59.5 77 94.8 17

Uttarakhand 88.6 52 91.6 22

Central

Chhattisgarh 79.3 284 73.0 161

Madhya Pradesh 77.3 65 82.9 22

East

Bihar 65.2 74 54.1 11

Jharkhand 93.5 62 95.0 28

Odisha 74.3 592 78.0 193

West Bengal 68.7 680 64.6 44

North-East

Arunachal Pradesh 87.7 16 100.0 9

Assam 76.4 79 92.8 35

Manipur 91.6 14 100.0 1

Meghalaya 95.6 67 98.6 37

Mizoram 100.0 25 97.3 38

Nagaland 0.0 0 29.2 1

Sikkim 90 381 92.3 93

Tripura 71.7 62 77.2 18

West

Rajasthan 77.0 81 75.7 27

Goa 92.2 454 96.0 184

Gujarat 87.3 592 88.2 403

Maharashtra 85.4 249 91.6 242

South

Andhra Pradesh 85.7 390 91.4 229

Karnataka 71.0 560 77.0 310

Kerala 93.2 277 93.4 266

Tamil Nadu 73.2 301 71.9 201

Total 78.2 6635 84.4 3389




Table 7.43: Pre-School Education (PSE)- frequency of attending PSE at AWC in last month*

Percentage distribution of children aged 36-71 months residing in area covered by Anganwadi centre (AWC), by frequency of attending Pre- School education in last month* , according to background characteristics

Characteristics

Number of days PSE attended in last month* (in days) Mean

number

of days

attended

PSE at

AWC

Number of

children

covered by

an AWC

attending

ICDS run

PSE

Not at

all 1-6 7-15

16 or

more

Do not

Know/can't

remember

Sex of Child Male 7.2 8.4 22.9 57.2 4.2 18.1 9,249 Female 6.7 8.2 21.8 58.9 4.3 18.3 9,262


Mother's education No education 5.6 9.6 24.0 56.5 4.3 17.8 7,278 Below Primary (Class 1-4) 6.9 8.7 20.8 60.2 3.4 18.1 1,487 Completed Primary (Class 5-7) 8.7 6.5 22.2 58.6 3.9 18.5 3,416 Completed Middle (Class 8 -9) 7.3 9.3 22.5 56.5 4.4 17.9 2,727 Completed Secondary (Class 10-11)

6.2 6.4 18.0 65.4 3.9 19.5 2,141


10.5 7.0 22.4 54.5 5.6 18.5 1,463

Religion Hindu 6.3 8.5 22.3 58.4 4.4 18.3 14,899 Islam 10.0 7.3 23.7 55.9 3.0 17.9 2,719 Christian 9.3 7.2 21.9 57.6 4.1 18.0 520 Sikh 8.8 9.7 10.9 66.3 4.3 19.3 150 Jain * * * * * * 11 Buddhist/Neo- Buddhist 7.3 9.6 20.4 58.6 4.2 17.6 135 No Religion * * * * * * 11 Other 6.7 3.3 34.6 45.0 10.3 16.8 66

Social Group Scheduled Caste 6.1 10.2 21.7 57.2 4.8 17.9 4,142 Scheduled Tribe 4.2 9.3 24.5 58.0 4.0 18.1 2,864 OBC 7.0 8.4 21.0 58.4 5.1 18.2 6,737 Other 9.2 5.7 23.6 58.9 2.6 18.7 4,536 Do Not Know 13.5 12.6 24.2 46.2 3.4 16.5 232


Total 7.0 8.3 22.4 58.1 4.2 18.2 18,511



Table 7.44: Pre-School Education (PSE)- time spent by children on PSE activities in a day at AWC

Percentage of children aged 36-71 months residing in area covered by Anganwadi centre (AWC), by time spent by children on PSE activities in a day at AWC, according to background characteristics.

Characteristics

Time spent by children on PSE activities in a day at

AWC

Number of

children living in

an area

attending ICDS

run PSE

Less than

1 hour 1-2 hours 3 hours

4 hours or

more

Age of child (months)

36-47 2.1 41.4 26.5 26.0 6,967

48-59 2.0 40.0 28.5 24.9 6,763

60-71 3.1 39.3 29.3 24.3 4,782

Sex of child

Male 2.4 41.4 27.8 24.1 9,249

Female 2.2 39.3 28.1 26.3 9,262

Residence

Urban 3.5 41.6 21.4 29.0 3,296

Rural 2.1 40.1 29.4 24.4 15,215

Mother's education

No education 1.8 41.3 28.1 25.0 7,278





Completed Higher Secondary and

above

4.3 28.6 25.1 36.3 1,463

Religion

Hindu 2.4 38.0 29.3 26.1 14,899

Islam 1.8 55.0 20.2 19.2 2,719

Christian 3.8 32.9 23.7 33.8 520

Sikh 1.7 19.5 48.9 22.9 150

Jain * * * * 11

Buddhist/Neo- Buddhist 4.4 50.7 22.3 14.8 135

No Religion * * * * 11

Other 0.0 46.9 29.1 17.9 66

Social Group

Scheduled Caste 1.7 39.4 28.2 26.1 4,142

Scheduled Tribe 1.7 47.3 28.5 19.1 2,864

OBC 2.5 30.2 30.6 32.0 6,737

Other 3.0 50.3 24.1 19.1 4,536

No response 1.0 72.4 14.6 4.9 232

Wealth Index

Lowest 1.4 46.2 29.9 18.6 5,010

Second 1.8 43.3 27.7 22.4 4,795

Middle 2.2 36.5 28.0 29.6 4,185

Fourth 3.3 36.2 26.0 30.6 2,999

Highest 5.3 30.9 26.1 33.1 1,522

Total 2.3 40.4 27.9 25.2 18,511



Table 7.45: Pre-School Education (PSE) in Anganwadi Centre (AWC) by state

Percentage of children aged 36-71 months residing in area covered by AWC, by various PSE indicators according to state.

State

Percentage

attending

PSE in AWC

Number

of

Children

Mean

age at

which

started

attending

PSE

Average

number

of days

attended

PSE in

one

month

prior to

survey

Average

number

of days

attended

PSE in

the 3

months

prior to

survey

Percenta

ge of

children

attended

PSE 16

days or

more in

one

month

prior to

survey

Average

number

of hours

attended

PSE in

one

month

prior to

survey

Percentage of

children attended

PSE for 4 hours or

more

Percentage

whose

mothers

participated

in parent's

meet in the

3 months

prior to

survey

Number

of

children

living in

an area

covered

by an

AWC

India 38.7 47874 38.9 16.9 42.6 58.1 2.8 25.2 27.8 18,509

North

Delhi 10.7 963 19.6 17.1 34.4 61.7 2.1 8.1 8.4 103

Haryana 14.6 953 13.3 16.6 41.9 53.3 2.4 6.4 16.8 139

Himachal Pradesh 35.2 1258 13.0 17.9 45.9 62.9 2.9 18.8 52.5 442

Jammu & Kashmir 15.4 851 13.3 11.2 26.4 35.6 1.9 5.2 21.3 131

Punjab 17.9 1134 16.3 17.0 40.6 61.5 2.9 16.1 19.5 203

Uttar Pradesh 16.4 6502 15.1 13.8 34.8 34.4 2.6 11.9 12.6 1,063

Uttarakhand 25.1 999 18.3 16.5 39.7 49.0 2.8 8.0 13.6 251

Central

Chhattisgarh 57.0 1339 11.4 16.2 40.9 48.9 3.0 21.7 9.8 763

Madhya Pradesh 37.1 2362 9.3 13.9 36.1 37.4 2.4 16.9 13.8 876

East

Bihar 42.5 3827 19.2 18.9 54.5 72.2 3.3 44.7 15.8 1,625

Jharkhand 25.5 1489 12.6 16.0 34.6 52.3 2.7 24.0 32.7 379

Odisha 62.7 1714 6.6 17.3 48.1 62.9 2.4 5.4 30.4 1,075

West Bengal 53.6 2297 10.0 15.1 42.9 55.1 1.8 0.6 18.3 1,232

North east

Arunachal Pradesh 57.2 1260 14.9 15.5 37.5 45.6 2.3 9.8 8.6 721

Assam 64.6 1473 10.3 14.8 37.1 46.4 2.1 1.7 13.3 951

Manipur 62.8 1080 24.8 10.7 27.0 23.7 1.9 1.4 44.0 678

Meghalaya 30.3 1092 9.9 12.4 31.8 25.6 1.9 0.4 9.8 331

Mizoram 60.9 1113 11.1 16.9 25.2 53.7 2.3 9.1 30.8 678

Nagaland 1.4 1142 (7.0) (4.0) (5.0) (3.6) (1.7) (0.0) (10.7) 28

Sikkim 44.9 800 12.9 18.7 50.6 74.8 3.0 44.7 70.0 359

Tripura 74.2 886 10.1 18.8 47.8 70.0 2.4 1.8 45.7 657

West

Rajasthan 17.0 2153 11.9 14.7 38.5 48.8 2.6 22.1 16.4 366

Goa 35.4 879 16.6 21.6 60.9 81.9 3.2 40.9 57.1 311

Gujarat 57.4 1588 9.3 16.9 36.8 63.3 2.5 16.4 38.3 912

Maharashtra 58.4 2379 16.0 18.8 45.6 64.2 2.5 15.0 35.2 1,390

South

Andhra Pradesh 50.6 1835 10.3 18.1 39.9 65.7 3.6 48.4 50.5 929

Karnataka 45.5 1631 14.3 20.4 47.6 77.5 3.8 65.4 43.4 742

Kerala 32.0 1175 12.0 17.5 46.0 62.4 4.2 71.3 42.5 376

Tamil Nadu 23.1 1817 15.9 15.4 37.6 46.3 4.4 54.8 33.8 419



WEIGHT COMPUTATION

Household level

Sampling weights have been computed mainly for the four considerations, namely (i) to enable drawing

valid statistical inferences (ii) for correcting the bias primarily due to varying response rates (iii) varying

probability of selection of PSUs and households (HH) at state level and (iv) to keep the weighted sample

distribution close to the actual population distribution in view of oversampling done while selecting

households and also oversampling done in a few states for urban/rural sample.

Broadly, two types of weights have been computed: one to be used for generating national-level

indicators and another to be used for generating state-level indicators.

The probability (f) of selecting a HH is the product of (i) probability of selecting a PSU (f1), (ii) probability

of selecting a segment (fs) and (iii) probability of selecting a HH in the selected segment (f2).

(Probability of selecting a household)= f = f = f1*fs*f2 ; fs =1 if PSU is not segmented;

As PSUs were selected with probability proportional to their population size with replacement (PPSWR),

probability of selection of a PSU would be:

Where,

a = Number of PSUs selected from the stratum

pi = Population of the ith PSU in the as per Census 2011

P = Total population of the stratum as per Census 2011

Households within a PSU were selected using circular systematic random sampling. Probability of

selection of a household would be:

Where,

ni = Number HHs to be selected in a PSU

Li = Number of HHs listed in the ith PSU of the ‘cluster’

Adjustment due to segmentation: For large villages (with population >= 250 households) segmentation

was undertaken and two segments were selected randomly. The probability of selecting a segment is:

Where,

2 = Number of segments selected

Ki = Total number of segments made in the ith PSU

The household level weight at ‘cluster’ level, is computed as:

In order take care of differential response rates across the PSUs in the

‘cluster’, the design weight (wi) has been divided by the response rate, i.e.:


Where,

Ri is the response rate achieved in ith PSU.

Adjustment for over sampling in category A: In order to correct for the oversampling in category ‘A’ households in rural areas the rural household weights of a state are normalized so that the total number of weighted cases is equal to the total number of un-weighted cases in the rural areas of the state. This is done by multiplying the rural household weights by the ratio of total number of un-weighted cases to total number of weighted cases (obtained by applying weights before normalization to the number of cases in rural areas of the state). The final rural household weight in a state is calculated as:

Similar treatment has been done for adjusting weights in urban areas. (Whu) is the adjusted weight for

urban areas.

After normalization of the rural and urban household weights separately for each state the next step

was to compute the combined normalized state weights for the respective states as there was

disproportionate allocation in the rural and urban areas of state. For each state, this was done by

multiplying the rural normalized weights (Whr) by factor PR/pr and similarly the urban normalized weight

(Whu) was multiplied by PU/pu.

Where PR/PU refers to: proportion of rural population/proportion of urban population to the total

population of the state as per census and pr/pu refers to: proportion of rural sample/proportion of

urban sample to the total state sample.

Finally, weights have been normalized to keep the total weighted state sample size same as un-weighted

state sample size.

National Weights: Since the size of the population varies widely across the states covered in RSOC there

is a need to apply National level weights for presenting the combined National level estimates. Thus, in

order to take care of the disproportionate allocation of the sample across different states the National

level weights were computed. To obtain national normalized weights the state weights were multiplied

by factor PSi/psi.

Where,

PSi = proportion of the ith state population to the national population ps i= proportion of the ith state sample to the total sample at national level.


AWC level

In the absence of data on number of Anganwadis for each of the stratum/PSU, the weights for AWCs

have been computed with the assumptions that every AWC in both the rural and urban areas of a given

state has equal probability of being selected. For computation of the AWC weight, the total number of

AWCs functioning in the rural and the urban areas of each state were collected from the Department of

Women and Child Development of each state.

The Anganwadi weights (Aw) have been computed as under:

Anganwadi weights (Aw) = Total number of AWCs (N) in the state/Number of AWCs covered in the

state (n)

Separate weights have been computed for rural and urban areas. As in case of household based weights,

two types of weights have been computed in case of AWCs also-one for generating state-level indicators

and another for generating national-level indicators.


ANNEXURE B – SURVEY TOOLS:

E1 –LISTING FORMAT

RAPID SURVEY ON CHILDREN (2013-14)

COVER SHEET FOR LISTING

A1 State (Name and Census Code)

A2 District (Name and Census Code)

A3 Name and Census Code of Tehsil/Taluka/Community Development

Block/Mandal

Name ____________________________

Code

A4 Location of PSU RURAL 1

URBAN 2

A5 Name and code number of village/town

If urban PSU, please note ward number and CEB number (As per

census 2011)

VILLAGE/TOWN NAME ___________________________

VILLAGE/TOWN CODE

WARD NUMBER

CEB NUMBER

A6 Cluster Number

A7 PSU population as per Census 2011


A8

Type of Village/CEB

RURAL STRATUM-NOT SEGMENTED 1

RURAL STRATUM -SEGMENTED 2

URBAN 3

A9 Number of segments formed in the village

A10 Serial number of selected segment SEGMENT 1

SEGMENT 2

A11 Name, address and Serial Number of AWCs in the PSU

1._________________________________________

2._________________________________________

3.________________________________________

4._________________________________________

5._________________________________________

6._________________________________________


A12 Summary of the Coverage in Listing Total number of households (HHs) with at least

one EMW

Total number of EMWs in the PSU

Number of households (HHs) with at least one child

aged 0-6 years

Number of other households (Not having

any child aged 0-6 years)

Total number of 0-35 month old children

Total number of 36-71 month old children

Total number of lactating mothers

Total number of pregnant women


*CODES FOR TYPE OF HOUSE: Residential/partly residential -1, Non-residential -2, Vacant -3, Locked -4, Refused -5, Other -6. ** Y = Yes , N = No

HOUSE-LISTING SCHEDULE

STATE NAME

__________________

DISTRICT NAME

__________________

TYPE OF PSU

(RURAL/URBAN)

RURAL PSU URBAN PSU SERIAL NUMBER

OF SELECTED

SEGMENT

VILLAGE/TOWN NAME

__________________

WARD NUMBER

STATE CODE

DISTRICT CODE

RURAL=1 URBAN = 2 VILLAGE/TOWN CODE

CEB NUMBER

Serial No.

House No.

Type of house (REFER CODES*

)

HH No. (IF CODE 1 IN

COL 3 RECORD

HOUSEHOLD NO. ELSE

SKIP TO NEXT

HOUSE)

Address

Name of

Head of the Hous

e

Is there any

EMW (15-49

years) in

your HH? (Y-1, N-2) **

IF YES, record numbe

r of EMWs

Does the HH have any

children age 0-6

years? (Y-1, N-2) **

IF YES, record number of children

Does the HH have any

lactating

mother?

(Y-1, N-2) **

IF YES, record

the numbe

r

Does the HH have

any currentl

y pregnan

t women?

(Y-1, N-2) **

IF YES, record

the numbe

r

IF YES IN COL 9, 12, OR 14,

Is any member in

your HH availing


AWC Y 1 N 2

Code number of AWC

from where

the member

is accessin

g the services

Type of HH for

Selection (A= HH

with atleast 1 child 0-6 years; B

= HH with no child 0-6

years

0-3 years (0 – 35

MONTHS)

3-6 years (36 - 71

MONTHS)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

19


S

e

r

i

a

l

N

o

.

H

o

u

s

e

N

o.

Type

of

house

(REFE

R

CODE

S*)

HH No. (IF

CODE 1 IN COL

3 RECORD

HOUSEHOLD

NO. ELSE SKIP

TO NEXT

HOUSE)

A

d

d

r

e

s

s

Nam

e of

Head

of

the

Hous

e

Is there

any EMW

(15-49

years) in

your HH?

(Y-1, N-2)

**

IF

YES,

recor

d

numb

er of

EMW

s

Does the

HH have

any

children

age 0-6

years?

(Y-1,

N-2)

**

IF YES,

record

number of

children

Does

the HH

have

any

lactatin

g

mother

?

(Y-1,

N-2)

**

IF

YES,

reco

rd

the

num

ber

Does the

HH have

any

currently

pregnant

women?

(Y-1,

N-2)

**

IF

YES,

reco

rd

the

num

ber

IF YES IN COL 9, 12,

OR 14, Is any

member in your HH

availing

supplementary

food from AWC Y 1

N 2

Code number

of AWC from

where the

member is

accessing the

services

Type of HH for

Selection (A= HH

with atleast 1 child

0-6 years; B = HH

with no child 0-6

years 0-3

years

(0 –

35

MON

THS)

3-6

year

s (36

- 71

MO

NTH

S)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19


*CODES FOR TYPE OF HOUSE: Residential/partly residential -1, Non-residential -2, Vacant -3, Locked -4, Refused -5, Other -6. ** Y = Yes, N = No


Confidential for Research

Purpose only

E2 - Household Questionnaire

RAPID SURVEY ON CHILDREN (2013-2014)

INTRODUCTION & CONSENT

My name is (NAME) _____________, and I am working as an interviewer with ……………………., a leading

research organization. We do lot of surveys on various social issues like health, nutrition, education, poverty,

drinking water and sanitation, etc. [PAUSE]. At present, we are conducting a study for UNICEF, an UN

organization to assess the health and nutrition status of women and children across the country. We would like to

speak to you in this regard and ask some questions on health and nutrition related issues [PAUSE]. There are no

right or wrong answers for these questions. We only seek your responses and opinions regarding some of these

issues [PAUSE]. We will also be recording the height and weight of the children below 5 years and adolescent girls

aged between 10 to 19 years. We assure that your personal details as well as the information given by you will be

kept confidential. The interview is conducted with the help of a computer and might take around 1-2 hours. During

the survey, your voice will be recorded for some of the basic factual questions. [PAUSE] We seek your cooperation

in this regard. May we proceed? ...........Thank you.

Respondent signature or thumb impression to be taken on log sheet

H.1 IDENTIFICATION PARTICULARS

H1.1 State (NAME AND CODE)

STATE NAME ______________________________________

STATE CODE

H1.2 District (NAME AND CODE)

DISTRICT NAME____________________________________

DISTRICT CODE

H1.3 Tehsil/taluka/community

development block/mandal (NAME

AND CODE)

TEHSIL/TALUKA/BLOCK NAME _____________________

TEHSIL/TALUKA/BLOCK CODE

H1.4 Residence RURAL

URBAN

1

2

H1.5 If rural PSU, name and code

number (village/town)

VILLAGE/TOWN NAME ___________________________

VILLAGE/TOWN CODE


If urban PSU, town name and code,

ward number and CEB number

WARD NUMBER

CEB NUMBER

H1.6 PSU population as per census 2011

H1.7 Type of village/CEB

RURAL STRATUM-NOT SEGMENTED

RURAL STRATUM -SEGMENTED

URBAN

1

2

3

H1.10

H1.10

H1.8 Number of segments formed in the

village

NUMBER OF SEGMENTS

H1.9 Serial number of selected segment

SEGMENT SERIAL NUMBER

H1.10 House number

(HOUSE NUMBER TO BE FILLED

FROM INTERVIEWER’S

ASSIGNMENT SHEET )

H1.11 Household number

(HOUSEHOLD NUMBER TO BE

FILLED FROM INTERVIEWER’S

ASSIGNMENT SHEET)

H1.12 Name of head of household

FIRST NAME _________________________________

MIDDLE NAME ________________________________

SURNAME_____________________________________

H1.13 Address

HOUSE NO. _________________________________

STREET NAME/NO. __________________________


LOCALITY _________________________________

H1.14 Please specify the number of usual

members living in your household

TOTAL NUMBER OF USUAL MEMEBERS

H

1.14A

Does your household have a

MGNREGA job card?

YES

NO

NOT ELIGIBLE

1

2

3

H1.15

H1.14

B

When was the Job Card prepared?

Month is to recorded in two digits (

e.g.: January – 01)

Years to be recorded in two digits (

e.g.: 2013 to be recorded as ‘13’)

Month and Year

H

1.14C

Did any member of your household

get work under MGNREGA

scheme during last 365 days?

YES

NO

1

2

H1.15

H

1.14D

For how many days did member(s)

of your household work under

MGNREGA in the last 365 days?

(IF MORE THAN ONE MEMBER

OF THE HOUSEHOLD WORKED

UNDER MGNREGA IN THE

LAST 365 DAYS, ADD THE

NUMBER OF DAYS WORKED

BY ALL MEMBERS AND

RECORD).

TOTAL DAYS

H1.15 Date and time of first visit

(PLEASE RECORD DATE AS

DD/MM/YY AND TIME IN 12

HOUR FORMAT)

DATE DD/MM/YY

START TIME aM/PM


H1.16 Date and time of second visit



HOUR FORMAT)

DATE DD/MM/YY

START TIME AM/PM

NOT APPLICABLE..................................................9999

H1.17 Date and time of third visit



HOUR FORMAT)

DATE DD/MM/YY

START TIME aM/PM

NOT APPLICABLE.........................................................9999


H2.0 HOUSEHOLD ROSTER AND OTHER INFORMATION

Ser

ial

no

.

Please give me the

names of the

persons who usually live in your

household starting

with the head of the household.

Name

(start with head of the household)

Sex

(M

AL

E-1

, F

EM

AL

E-2

)

Rel

atio

nsh

ip t

o h

ead

of

the

hou

seho

ld (

CO

DE

) A

ge

(IN

CO

MP

LE

TE

D Y

EA

RS

)

FOR

AGED

10 YEARS

AND

ABOVE

FOR

AGE

GRO

UP

3-6

YEA

RS

FOR

AGE

GROU

P

18YEA

RS OR

OLDE

R

FOR AGE 5 YEARS

OR OLDER

FOR AGE 5 YEARS – 24 YEARS

BIRTH

REGISTRATION

(CHILDREN

BELOW 5

YEARS)

Ser

ial

Nu

mb

er o

f th

e M

oth

er (

for

chil

dre

n l

ess

than

6 y

ears

of

age)

Mar

ital

sta

tus

(CO

DE

) IF

CO

DE

D 1

0R

7 S

KIP

TO

C

OL

H

2.8

Ag

e at

fir

st m

arri

age

(IN

CO

MP

LE

TE

D Y

EA

RS

)

Is (n

ame)

cu

rren

tly at

tend

ing

any

pre

-sch

ool?

(I

F Y

ES

, C

OD

E T

HE

SO

UR

CE

OF

PR

E-S

CH

OO

L E

DU

CA

TIO

N)

CH

EC

K H

.14

C –

IF

CO

DE

D Y

ES

TH

EN

AS

K H

2.8

A

Wh

ether

he/

she

has

wo

rk e

d u

nd

er M

GN

RE

GA

sch

eme

in t

he

last

365

day

s? (

YE

S –

1,

N0

– 2

)

Can

(nam

e) r

ead

and

wri

te (

YE

S-1

, N

O-2

)

Has

(n

ame)

ev

er a

tten

ded

sch

oo

l? (

YE

S-1

, N

O-2

) IF

CO

DE

D 2

,

SK

IP T

O H

2.1

7

Wh

at

is

the

hig

hes

t ed

uca

tional

g

rad

e co

mp

lete

d?

(PL

EA

SE

RE

CO

RD

T

HE

N

UM

BE

R

OF

Y

EA

RS

A

S

PE

R

GR

AD

E

ME

NT

ION

ED

)

CO

DE

S T

O B

E U

SE

D A

S R

EF

ER

EN

CE

F

OR

C

OD

ING

TH

E N

UM

BE

R O

F Y

EA

RS

Du

ring

the

201

2-1

3 s

chool

yea

r d

id (

nam

e) a

tten

d s

chool/

coll

ege

at

any

tim

e? (

YE

S-1

, N

O-2

) IF

CO

DE

D 2

, S

KIP

TO

CO

L H

2.1

4

Du

ring

20

12

-13

(s

choo

l y

ear)

, w

hat

st

andar

d/y

ear

was

(n

ame)

atte

ndin

g?

(CO

DE

)

CO

DE

S T

O B

E U

SE

D A

S R

EF

ER

EN

CE

FO

R C

OD

ING

TH

E N

UM

BE

R O

F Y

EA

RS

Du

ring

the

pre

vio

us

schoo

l y

ear

that

is

201

1-1

2,

did

(n

ame)

att

end

scho

ol

or

coll

ege

at a

ny

tim

e? (

YE

S-1

, N

O-2

) I

F C

OD

ED

2,

SK

IP

TO

CO

L H

2.1

7

Duri

ng

2

011

-12

(p

revio

us

schoo

l yea

r),

what

st

andar

d/y

ear

was

(nam

e) a

tten

din

g?

(CO

DE

)

CO

DE

S T

O B

E U

SE

D A

S R

EF

ER

EN

CE

FO

R C

OD

ING

TH

E N

UM

BE

R O

F Y

EA

RS

IF

C

OD

ED

2

IN

C

OL

H

2.1

2

AS

K:

What

w

as

the

mai

n

reas

on

(nam

e) d

id n

ot

atte

nd

sch

oo

l/co

lleg

e? –

(C

OD

E)

, Wh

ether

th

e bir

th o

f (n

ame)

is

regis

tere

d?

(YE

S-1

, N

O-2

) I

F C

OD

E

2 T

HE

N S

KIP

TO

TH

E N

EX

T M

EM

BE

R

Was

the

bir

th o

f (n

ame)

reg

iste

red

wit

hin

21

day

s o

f b

irth

? (Y

ES

-1,

NO

-2 )

Do

es (

nam

e) h

ave

a bir

th c

erti

fica

te?

(YE

S,

SH

OW

N -

1,

YE

S,

BU

T

NO

T S

HO

WN

-2,

NO

-3 )

H2.1 H2.2 H2.

3 H2.4

H2

.5

H2.

5A

H2.6 H2.7 H2.8

H2.8A

H2

.9

H2.1

0 H2.11

H2.1

2 H2.13

H2.14

H2.15

H2.1

6

H2.1

7

H2.1

8 H2.19




CODES FOR HOUSEHOLD ROSTER

COL. H2.4. RELATIONSHIP TO HEAD OF

HOUSEHOLD

01 = HEAD

02 = WIFE OR HUSBAND

03 = SON OR DAUGHTER

04 = SON-IN-LAW OR DAUGHTER-IN-

LAW

05 = GRANDCHILD

06 = PARENT

07 = PARENT-IN-LAW

08 = BROTHER OR SISTER

09 = BROTHER- IN – LAW/SISTER-IN-

LAW

10 = NIECE/NEPHEW

11 = OTHER RELATIVE

12 = ADOPTED/FOSTER/STEPCHILD

13 = NOT RELATED

98 = DON'T KNOW

Col H2.5. aGE

00 = AGE LESS THAN ONE YEAR

00 =

95 = AGE 95 YEARS OR MORE

95 =

COL H2.6. MARITAL STATUS

1= UNMARRIED

2= MARRIED BUT GAUNA NOT

PEFORMED

3= MARRIED AND GAUNA PERFORMED

4= WIDOW/WIDOWER

5= DIVORCED

6= SEPARATED

7= NOT STATED

COL H2.8. SOURCE OF PRE- SCHOOL

EDUCATION

01 = ATTENDING ICDS RUN PSE

02 = ATTENDING PRIVATE RUN PSE

(PLAY SCHOOL, NURSERY ETC.)

03 = DO NOT ATTEND ANY PSE

98 = DO NOT KNOW

COL H2.16. REASONS OF NOT ATTENDING

SCHOOL/COLLEGE


.

01 = SCHOOL/COLLEGE TOO FAR

AWAY

02 = TRANSPORT NOT AVAILABLE

03 = FURTHER EDUCATION NOT

CONSIDERED NECESSARY

04 = REQUIRED FOR HOUSEHOLD

WORK

05 = REQUIRED FOR WORK ON

FARM/FAMILY BUSINESS

06 = REQUIRED TO EARN IN CASH OR

KIND BY WORKING OUTSIDE

07 = COSTS TOO MUCH

08 = LACK OF PROPER FACILITIES FOR

GIRLS IN SCHOOLS/COLLEGE

09=NOT SAFE TO SEND GIRLS

10 = NO FEMALE TEACHER

11 = REQUIRED FOR CARE OF

SIBLINGS

12 = NOT INTERESTED IN STUDIES

13 = REPEATED FAILURES

14 = GOT MARRIED

15= DID NOT GET ADMISSION

16 = CULTURALLY NOT ACCEPTABLE

96 = OTHER, SPECIFY…………

98 = DON'T KNOW

COL H2.11 H2.13 & H2.15- CODES TO BE USED AS REFERNCE FOR CODING THE NUMBER OF YEARS

AS PER GRADE MENTIONED

00 = <LESS THAN 1 YEAR COMPLETED

00= (FOR COL. H2.11 ONLY. THIS CODE IS ALLOWED FOR COL. H2.13 AND COL.H2.15)

98 = DON’T KNOW


THIS SECTION (H2.20- H2.23) WILL BE AUTO-PULATED FROM HOUSEHOLD ROSTER.

LIST ALL MEMBERS WHO ARE 18 YEARS AND ABOVE BY THEIR NAME, SERIAL

NUMBER, AGE AND SEX. SELECT THE RESPONDENT.

(NAME, SERIAL NUMBER, AGE AND SEX OF THE RESPONDENT WILL BE

AUTOMATICALLY POPULATED AFTER SELECTING THE RESPONDENT)

No. Questions/Filters

Response/Codes

Skip

H2.20 Name of respondent

FIRST NAME _________________________________

MIDDLE NAME ________________________________

SURNAME_____________________________________

H2.21 Serial number of the respondent

H2.22 Age (IN COMPLETED YEARS)

H2.23 Sex of respondent

MALE

FEMALE

1

2

Now I am going to ask some questions that relate to the head of this household.

H2.24 What is the religion of the head

of the household?

HINDUISM

ISLAM

CHRISTIANITY

SIKHISM

JAINISM

BUDDHISM

NO RELIGION

OTHER

01

02

03

04

05

06

07

96


H2.25 What is the caste/tribe of the

head of the household? Is this a

scheduled caste, scheduled

tribe, other backward caste or

other group?

SCHEDULED CASTE

SCHEDULED TRIBE

OBC

OTHER

DO NOT KNOW/DO NOT WANT TO RESPOND

01

02

03

04

98

H2.26 What is the main occupation of

the head of the household with

reference to last one year?

CULTIVATOR

AGRICULTURAL WAGE LABOURER

NON-AGRICULTURAL WAGE LABOURER

SELF-EMPLOYED

REGULAR SALARIED/WAGE EMPLOYEE

RENTIER, PENSIONER, OTHER REMITTANCE

RECIPIENTS

DID NOT WORK

DOMESTIC CHORES

OTHER

01

02

03

04

05

06

07

08

96

Now, I am going to ask you questions about your house, the number and kind of rooms it has, the ownership

status/possession and information on some of your household assets.

H2.27 Type of the dwelling where

household is living?

RECORD OBSERVATION

KUTCHA

SEMI-PUCCA

PUCCA

1

2

3

H2.28 How many rooms are used for

sleeping?

NUMBER OF ROOMS


H2.29 Do you have a separate room,

which is used, as kitchen?

YES

NO

1

2

H2.30 MAIN MATERIAL OF THE

FLOOR

RECORD OBSERVATION.

NATURAL FLOOR

MUD/CLAY/EARTH

SAND

RUDIMENTARY FLOOR

RAW WOOD PLANKS

PALM/BAMBOO

BRICK

STONE

FINISHED FLOOR

PARQUET OR POLISHED WOOD

VINYL OR ASPHALT

CERAMIC TILES

CEMENT

CARPET

POLISHED STONE/MARBLE

GRANITE

OTHER

11

12

21

22

23

24

31

32

33

34

35

36

37

96



ROOF.

RECORD OBSERVATION

NATURAL ROOFING

THATCH/PALM LEAF/REED/GRASS

MUD

SOD/MUD AND GRASS MIXTURE

PLASTIC/POLYTHENE SHEETING

RUDIMENTARY ROOFING

RUSTIC MAT

PALM/BAMBOO

RAW WOOD PLANKS/TIMBER

UNBURNT BRICK

LOOSELY PACKED STONE

FINISHED ROOFING

METAL/GI

WOOD

CALAMINE/CEMENT FIBER

ASBESTOS SHEETS

RCC/RBC/CEMENT/CONCRETE

ROOFING SHINGLES

TILES

SLATE

BURNT BRICK

OTHER

11

12

13

14

21

22

23

24

25

31

32

33

34

35

36

37

38

39

96



EXTERIOR WALLS.

RECORD OBSERVATION

NATURAL WALLS

CANE/PALM/TRUNKS/BAMBOO

MUD

GRASS/REEDS/THATCH

RUDIMENTARY WALLS

BAMBOO WITH MUD

STONE WITH MUD

PLYWOOD

CARDBOARD

UNBURNT BRICK

RAW WOOD/REUSED WOOD

FINISHED WALLS

CEMENT/CONCRETE

STONE WITH LIME/CEMENT

BURNT BRICKS

CEMENT BLOCKS

WOOD PLANKS/SHINGLES

GI/METAL/ASBESTOS SHEETS

OTHER

11

12

13

21

22

23

24

25

26

31

32

33

34

35

36

96

H2.33 Does this household own this

house or any other house?

YES

NO

1

2


H2.34 Does any member of this

household have a bank account

or a post office account?

YES

NO

DON’T KNOW

01

02

98

H2.35 Does your household have:

(PLEASE READ THE LIST

AND CIRCLE YES OR NO

APPROPRIATELY FOR

EACH ITEM)

YES

NO

ELECTRICITY 1 2

MATTRESS MADE OF COTTON/FOAM

1 2

PRESSURE COOKER

1 2

CHAIR

1 2

COT/BED

1 2

TABLE

1 2

ELECTRIC FAN

1 2

RADIO/TRANSISTOR

1 2

BLACK AND WHITE TELEVISION

1 2

COLOUR TELEVISION

1 2

SEWING MACHINE

1 2

MOBILE TELEPHONE

1 2

LAND LINE TELEPHONE

1 2

INTERNET CONNECTION

1 2

DEKSTOP COMPUTER 1 2


LAPTOP 1 2

REFRIGERATOR

1 2

AIR COOLER

1 2

AIR CONDITIONER

1 2

WASHING MACHINE

1 2

WATCH/CLOCK-

1 2

BICYCLE

1 2

MOTORCYCLE/SCOOTER

1 2

ANIMAL DRAWN CART

1 2

CAR/JEEP

1 2

WATER PUMP

1 2

THRESHER

1 2

TRACTOR

1 2

H2.36 What type of fuel does your

household mainly use for

cooking?

ELECTRICITY

01

LPG/NATURAL GAS

02

BIOGAS/GOBAR GAS

03

KEROSENE

04

COKE/COAL/LIGNITE

05

CHARCOAL

06


WOOD

07

STRAW/SHRUBS/GRASS

08

AGRICULTURAL CROP WASTE

09

DUNG CAKES

10

OTHER 96

NO FOOD COOKED IN THE HOUSEHOLD 95

Now I am going to ask about the drinking water and toilet arrangements that your household has.

H2.37 What is the main source of

drinking water for your

household?

IMPROVED/SAFE

PIPED WATER INTO DWELLING YARD/PLOT

01

PUBLIC TAP/STAND PIPE

02

TUBEWELL OR BOREWELL

03

HANDPUMP

04

DUG WELL – PROTECTED

05

SPRING – PROTECTED

06

RAIN WATER

07

UNIMPROVED/UNSAFE-

UNPROTECTED SPRING

08

UNPROTECTED DUG WELL

09

CART WITH SMALL TANK/DRUM 10

H2.39


TANKER/TRUCK

11

SURFACE WATER (RIVER/DAM/ LAKE/POND/CANAL)

12

BOTTLED WATER

13

OTHER 96

H2.38 Where is that water source

located?

IN OWN DWELLING

IN OWN YARD/PLOT

ELSEWHERE

1

2

3

H2.39 What kind of toilet facility

does your household use?

(PLEASE OBSERVE)

IMPROVED TOILET

FLUSH/POUR FLUSH TO - PIPED SEWER SYSTEM

01

FLUSH/POUR FLUSH TO -SEPTIC TANK

02

FLUSH/POUR FLUSH TO - PIT LATRINE

03

VENTILATED IMPROVED PIT LATRINE (VIP)

04

PIT LATRINE WITH SLAB

05

COMPOSTING TOILET

06

UNIMPROVED TOILET

FLUSH/POUR FLUSH TO –ELSEWHERE

07

FLUSH/POUR FLUSH TO - UNKNOWN PLACE

08

PIT LATRINE WITHOUT SLAB/OPEN PIT 09


BUCKET

10

HANGING TOILET/HANGING LATRINE

11

OTHER

96

NO TOILET FACILITY/USES OPEN SPACE/FIELD

13

H2.42

H2.40 Do all members of your

household use this toilet

facility?

YES

NO

1

2

H2.41 Do you share this toilet facility

with other households?

YES

NO

1

2


Now I am going to ask you some questions related to the hand washing practices in your household.

H2.42 Can you please show me where

members of your household most

often wash their hands?

(PLEASE OBSERVE)

OBSERVED

NOT OBSERVED

NOT IN DWELLING/PLOT/YARD

NO PERMISSION TO SEE

OTHER (SPECIFY)______________________

01

02

03

96

H2.45

H2.43 OBSERVE PRESENCE OF

WATER AT THE PLACE FOR

HANDWASHING.

VERIFY BY CHECKING THE

TAP/PUMP, OR BASIN,

BUCKET, WATER CONTAINER

OR SIMILAR OBJECTS FOR

PRESENCE OF WATER.

(PLEASE OBSERVE)

WATER IS AVAILABLE

WATER IS NOT AVAILABLE

1

2

H2.44 Is soap, detergent or ash/mud/sand

present at the place for hand

washing?

MULTIPLE CHOICE POSSIBLE

FOR FIRST 4 CODES

(PLEASE OBSERVE)

SOAP

DETERGENT

ASH

MUD/SAND

NONE

A

B

C

D

E

H2.47

H2.45 Do you have any soap or detergent

or ash/mud/sand in your house for

washing hands?

YES

NO

1

2

H2.47

H2.46 Can you please show it to me?

(PLEASE OBSERVE)

YES, SHOWN

NO, NOT SHOWN

1

2


SALT TESTING

H2.47 Could you please give me a

teaspoon of the salt that your

household uses for cooking

purpose?

Test salt for Iodine.

RECORD PPM (Parts per

Million)

0 PPM(NO IODINE)

1

LESS THAN 15 PPM

2

MORE THAN OR EQUAL TO 15 PPM

3

NO SALT IN HOUSEHOLD

4

SALT NOT TESTED

5


Confidential for Research

Purpose only

E3: Ever Married Women (15-49 years) Questionnaire

Rapid Survey on Children (2013-14)

0.0 IDENTIFICATION PARTICULARS OF HOUSEHOLD

0.01 State name and code

STATE NAME _____________________

STATE CODE

0.02 District name and code

DISTRICT NAME ______________

DISTRICT CODE

0.03

Tehsil/taluka/community development

block/mandal name and code

TEHSIL/TALUKA/CD BLOCK NAME

___________________

TEHSIL/TALUKA/CD BLOCK CODE

0.04 Residence

RURAL

URBAN

1

2

0.05 If rural PSU, name and code number of

village

If urban PSU, town name and code, ward

number and CEB number

VILLAGE/TOWN NAME _______________________

PSU CODE

WARD NUMBER

CEB NUMBER

0.06 Type of village/CEB RURAL STRATUM-NOT SEGMENTED

RURAL STRATUM -SEGMENTED

URBAN

1

2

3

0.09

0.09

0.07 Number of segments formed in the village

NUMBER OF SEGMENTS

0.08 Serial number of segment selected

SEGMENT NUMBER

0.09 (A) House(Structure) Number

(B) HOUSEHOLD NUMBER


(HOUSE NO. & HOUSEHOLD NO. TO BE

POPULATED FROM LISTING SCHEDULE)

0.10 Result Status

COMPLETED 01

PARTIALY

COMPLETED 04

NOT AT HOME

02

OTHER

96

REFUSED

03

0.11 Name and code of investigator

NAME ___________________CODE

0.12 Name and code of supervisor

NAME ___________________CODE

0.13 Date of interview

(DD/MM/YY)

0.14 Time of interview

START(AM/PM)

END(AM/PM)


No. Questions/Filters Response Codes/Skip

1.0 PARTICULARS OF THE EVER MARRIED WOMAN(15-49 YEARS)

QUESTIONS 1.1 TO 1.14 WILL BE PROBED IN RESPECT OF THE ELIGIBLE EMW IN THE

HOUSEHOLD.

QUESTIONS 1.1 TO 1.6 TO BE AUTOMATICALLY POPULATED (EDITABLE) FROM THE HOUSEHOLD ROSTER

AND ALSO QUESTIONS 1.2 TO 1.6 TO BE ASKED TO ELIGIBLE EMW AND VERIFIED. IN CASE, THE

RESPONSE IN ANY QUESTION IS DIFFERENT FROM THE AUTO-POPULATED RESPONSE, THEN

PREFERENCE WILL BE GIVEN TO WOMEN’S RESPONSE, AND WILL BE CORRECTED ACCORDINGLY.

1.1 Serial number in household roster

SERIAL NUMBER

1.2 What is your NAME?

___________________________________

1.3 What is your current age?

AGE (IN COMPLETED YEARS)

1.4 What is your marital status?

CURRENTLY MARRIED BUT GAUNA NOT

PERFORMED

CURRENTLY MARRIED AND GAUNA

PERFORMED

WIDOWED

DIVORCED

SEPARATED

NOT STATED

01

02

03

04

05

92

1.5 What was your age at the time of your

(first) marriage?


1.6 What is the highest educational standard

completed by you?

PLEASE CODE NUMBER OF YEARS

AS PER GRADE COMPLETED

CODE ‘00’ IF LESS THAN 1 YEAR

NUMBER OF YEARS

1.7 Apart from your own household chores,

have you done any work in last one

month?

YES

NO

1

2 1 .9



1.8 What type of occupation you were

engaged in last one month?

IF ENGAGED IN MORE THAN ONE

OCCUPATION RECORD THE

OCCUPATION IN WHICH SHE HAS

WORKED FOR MORE DURATION OF

TIME.

CULTIVATOR

WAGE LABOURER

SELF EMPLOYED (excluding cultivator)

REGULAR SALARIED/WAGE EMPLOYEE OTHER

01

02

03

04

96

1.9 CHECK Q 1.4

THE MARITAL STATUS OF THE

WOMAN IS CURRENTLY MARRIED

BUT GAUNA NOT PERFORMED OR

MARITAL STATUS NOT STATED

(RESPONSE CODE 01 or 92)?

YES

NO

1

Terminate

Interview

2

1.10 What is the NAME of your husband?

___________________________________

CHECK IF CODED 3, 4 OR 5 IN 1.4, SKIP TO 1.12

1.11 Serial number of husband in household

roster

TO BE AUTO POPULATED FROM

HOUSEHOLD ROSTER

RECORD ‘00’ IF NOT USUAL

RESIDENT OF THE HOUSEHOLD

SERIAL NUMBER

(NOT LISTED IN HOUSEHOLD ROSTER)

00

1.12

Have you ever been pregnant?

YES

NO

1

2 C1.1

1.13 What was your age at the time of first

pregnancy?

AGE(IN COMPLETED YEARS)

1.14 Have you ever given a live birth?

YES

NO

1

2 1.17

1.15

How many children had been born alive

and how many of them are surviving

(STATUS TO BE ASSESSED AS ON

DATE OF SURVEY)?

BOYS

GIRLS

TOT

AL

CHILDREN

BORN ALIVE



CHILDREN

SURVIVING

1.16 What was your age at the time of first live

birth?


1.17 Has the outcome of any pregnancy(s) resulted

in live birth/still birth/abortion during the last

three years (STARTING ON OR AFTER 1ST

AUGUST 2010) preceding the date of survey?

YES

NO

1

2 B1.1


A1.

0

MODULE FOR 0-35 MONTHS CHILDREN – OUTCOME OF PREGNANCY

A1.

1

RECORD THE HISTORY OF OUTCOME(S) OF ALL PREGNANCIES IN LAST THREE YEARS.

START WITH THE LAST PREGNANCY EXCLUDING THE CURRENT ONE YOU ARE

PREGNANT WITH. USE SEPARATE LINES FOR TWINS/TRIPLETS. SAME PREGNANCY NO.

TO BE RECORDED FOR TWINS/TRIPLETS.

PREGN

ANCY

NUMBE

R

OUTCO

ME OF

PREGN

ANCY

IF CODE 1 OR 2 IN A1.3,

ASK A1.4 AND A1.5

ELSE ASK ABOUT

NEXT PREGNANCY. IN

CASE THERE IS NO

OTHER PREGNANCY

SKIP TO A2.1

IF LIVE BIRTH (CODE 1. IN a1.3)

WAS THE

OUTCOM

E SINGLE

OR

MULTIPL

E?

SEX OF

BABY

SURVI

VAL

STATU

S (TO

BE

ASSESS

ED AS

ON

DATE

OF

SURVE)

IF

CODE’1’

IN A1.6

(SURVIVI

NG),

A1.6

Record the

serial

number of

child from

HH

schedule

IF CODE ‘2’ IN a1.6( NOT

SURVIVING) ,

A1.6Record age at death

RECORD DAYS IF BELOW 1

MONTH, RECORD IN

COMPLETED MONTHS IF 1

TO 11 MONTHS

& RECORD IN COMPLETED

YEARS IF 1 YEAR AND

ABOVE

A1.2 A1.3 A1.4 A1.5 A1.6 A1.7 A1.8

LAST

PREGN

ANCY

(……)

LIVE

BIRTH-

1STILL

BIRTH-

2

ABORT

ION-3

SINGLE-1

MULTIPL

E-2

MALE-1

FEMALE-2

SURVI

VING-1

NOT-

SURVI

VING-2

SERIAL

NUMBER.

OF CHILD

DAYS 1

MONTHS 2

YEARS 3

PREVIO

US TO

LAST

PREGN

ANCY

(……)

LIVE

BIRTH-

1STILL

BIRTH-

2

ABORT

ION-3

SINGLE-1

MULTIPL

E-2

MALE-1

FEMALE-2

SURVI

VING-1

NOT-

SURVI

VING-2

SERIAL

NUMBER.

OF CHILD

DAYS 1

MONTHS 2

YEARS 3

SECON

D

FROM

LAST

PREGN

ANCY

(…….)

LIVE

BIRTH-

1STILL

BIRTH-

2

ABORT

ION-3

SINGLE-1

MULTIPL

E-2

MALE-1

FEMALE-2

SURVI

VING-1

NOT-

SURVI

VING-2

SERIAL

NUMBER.

OF CHILD

DAYS 1

MONTHS 2

YEARS 3


No. Questions/Filters

Response/Codes

Skip

A2.0 DETAILS OF LAST TWO LIVE BIRTHS (SURVIVING/NOT SURVIVING) DURING LAST

THREE YEARS (START WITH THE YOUNGEST CHILD)

A2.1 CHECK a1.3

OUTCOME OF ANY PREGNANCY RESULTED IN LIVE BIRTH

OUTCOME OF ALL PREGNANCIES RESULTED IN STILL BIRTH OR ABORTION

1

2 B1.1

A2.2 PREGNANCY NUMBER (TO BE POPULATED

AUTOMATICALLY FROM QUESTION A1.2)

PREGNANCY NUMBER (LAST 3

YEARS)

A2.3 What is/was the date of birth of baby?

(ASK FOR BIRTH CERTIFICATE. IF NOT

AVAILABLE, CHECK WITH MCP CARD. IF

MCP CARD NOT AVAILABLE CONSIDER

OTHER DOCUMENT OR VERBAL RESPONSE)

(IN CASE THERE IS NO CONCLUSIVE PROOF

OF DATE OF BIRTH, FOLLOW THE

GUIDELINES AS GIVEN IN THE MANUAL TO

SOLICIT CORRECT INFORMATION.)

DATE OF BIRTH

DD MM YYYY

(IN CASE THE AGE OF THE CHILD IS MORE

THAN 35 MONTHS, MOVE TO NEXT LIVE

BIRTH IN LAST 3 YEARS. IF NO OTHER LIVE

BIRTH GO TO B1.1)

A2.4 What is the order of this live birth?

IF THE ORDER OF BIRTH IS 9 OR MORE

RECORD 9

BIRTH ORDER

A2.5 IF BIRTH ORDER>=2, what is the interval

between previous and current live birth?

INTERVAL (IN COMPLETED

MONTHS)


A3.0 ANTENATAL CARE ( ANC)

A3.1 Did you register your pregnancy for getting antenatal

care services when you were pregnant with (NAME)?

YES

NO

1

2 A3.6

A3.2 Did you get a card (Mother & Child Protection/any

other similar card) at the time of registration?

(PLEASE SHOW THE MCP CARD)

YES, SHOWN

YES, BUT NOT SHOWN

NO

1

2

3

A3.3 How many months pregnant were you when you

registered for ANC?

MONTHS OF PREGNANCY

(COMPLETED MONTHS)

A3.4 Who advised/motivated you to get registered?

ANY OTHER PERSON?

(NOT TO BE PROMPTED)

RECORD ALL PERSONS MENTIONED

AWW

ASHA

ANM

GOVT. DOCTOR

PVT. DOCTOR/HEALTH

PERSONNEL

DAI/TBA

NGOWORKER

RELATIVES/NEIGHBOUR/FRIENDS/

FAMILY MEMBERS

NONE/SELF MOTIVATED

OTHER

A

B

C

D

E

F

G

H

I

X

A3.5 Did you register the pregnancy associated with this

birth at the AWC?

YES

NO

NO ANGANWADI CENTRE/NOT

APPLICABLE

01

02

99

A3.6 Did you receive any antenatal check-up during this

pregnancy?

YES

NO

DON’T KNOW/CAN’T SAY

01

02 A3.11

98 A3.11

A3.7 How many months pregnant were you, when you

first received an antenatal check-up?

MONTHS OF PREGNANCY

(COMPLETED MONTHS) DON’T KNOW

98

A3.8 How many times did you receive antenatal check-

ups during pregnancy associated with this birth?

(RECORD ‘5’ ONLY IN CASE IT IS MORE

THAN 4 TIMES)

NUMBER OF TIMES

DON’T KNOW

98

A3.9 Where did you receive ANC(s) for pregnancy

associated with this birth?

ANGANWADI CENTRE

GOVERNMENT HEALTH

FACILITIES

PRIVATE HEALTH FACILITIES

MOBILE CLINIC

A

B

C

D


ANY OTHER PLACE?

RECORD ALL PLACES MENTIONED

AT HOME

OTHER


E

X

Y

A3.10 Who did the check-up(s) during these ANCs?

ANY OTHER PERSON?

RECORD ALL PERSONS MENTIONED

DOCTOR

ANM

LHV/NURSE

OTHER HEALTH PROFESSIONAL

TRAINED BIRTH ATTENDANT

OTHER

A

B

C

D

E

X

A3.11 Did you receive TT (Tetanus Toxoid) injection

during pregnancy associated with this birth?

YES

NO

1

2 A3.13

A3.12 How many times did you receive TT?

NUMBER OF TIMES

IF ‘2’ OR MORE, GO TO

A3.15

A3.13 At any time before this pregnancy, did your receive

any tetanus toxoid injection?

YES

NO

1

2 A3.15

A3.14 When was the last TT injection taken before this

pregnancy?

WITHIN THE LAST ONE YEAR

BEFORE THE CURRENT

PREGNANCY

MORE THAN ONE YEAR BEFORE

THE CURRENT PREGNANCY

DON’T REMEMBER

01

02

98

A3.15 Did you receive or purchase any iron folic acid

(IFA) tablets/bottles during the pregnancy

associated with this birth?

YES

NO

1

2 A3.19

A3.16 If yes, how many tablets/bottles of

IFA did you receive/purchase?

TABLETS BOTTLES

Large Small Small –

50 ml

Large –

100 ml

RECEIVED

FROM GOVT.

SOURCES

PURCHASED

PRIVATELY

A3.17 If yes, how many tablets/bottles of

IFA did you consume?

IF THERE IS NO CONSUMPTION

SKIP TO A3.19

TABLETS BOTTLES

Large Small Small –

50 ml

Large –

100 ml

Number of

tablets/bottle

consumed


A 3.18 For how many days did you consume iron & folic

acid (IFA) tablets/bottles of Syrup during pregnancy

with this child?

NUMBER OF DAYS

A3.19

Did the following visit you at home during period of

pregnancy?

READ OUT OPTIONS

AWW YES-1 NO -2

ASHA YES-1 NO -2

ANM YES-1 NO -2

Doctor YES-1 NO -2

A3.20 CHECK Q A3.19 CODE 1 IN ANY OF THE 3 OPTIONS

- AWW OR ASHA OR ANM

CODE 2 IN ALL 3 - AWW, ASHA

AND ANM

1

2A4.1

A3.21 How many times did AWW/ANM/ASHA visit your

home during the entire period of this pregnancy?

RECORD ‘0’ IF NOT VISITED AT ALL

NUMBER OF VISITS AWW

ANM ASHA

A4.0 DELIVERY CARE

A4.1

Where did you deliver this birth/child?

GOVERNMENT HOSPITAL/HEALTH

CENTRE

PVT. HOSPITAL/CLINIC/NURSING

HOME

AT HOME

OTHER

01

02

03

96 A4.4

A4.2

Who advised/counselled you to deliver at a health

facility?

ANY OTHER PERSON?

RECORD ALL MENTIONED PERSONS.

AWW

ANM ASHA

ANY OTHER HEALTH

PROFESSIONALFAMILY/RELATIVE

S/OTHER SELF/NONE

A

B

C

D

E

F

A4.3 How long did you stay at the health facility after

delivery?

IF <=48 HOURS RECORD HOURS OTHERWISE

RECORD NUMBER OF DAYS.

HOURS

DAYS

DON’T KNOW

98

A4.4 Who assisted with the delivery?

(IN CASE MORE THAN ONE PERSON WAS

INVOLVED, CODE WILL BE GIVEN TO THOSE

WHO WERE THE HIGHEST IN HIERARCHY.)

DOCTOR (GOVT/PVT)

ANM/MIDWIFE/LHV/NURSE

TRAINED BIRTH ATTENDANT

FRIENDS/RELATIVES/FAMILY

MEMBERS

OTHER

NO ONE

01

02

03

04

96

05


A4.5 What type of delivery was it?

CHECK: CODE 02 WILL BE CODED ONLY IF

CODED ‘01’ OR ‘02’ IN A4.1

NORMAL

CAESAREAN

OTHER

01

02

96

A4.6 Did the AWW, ANM or ASHA visit you at home, after deliver or after discharge from hospital/health centre within one week of delivery?

YES

NO

1

2

A4.7 CHECK Q A 4.1

IN CASE OF INSTITUTIONAL DELIVERY

(CODE01 OR 02 IN Q A4.1) ASK,

When did the first postnatal care (PNC) check-up

take place after discharge from the health facility?

IN CASE OF HOME DELIVERY (CODE03

OR 96 IN Q A4.1)ASK,

When did the first check-up take place after

delivery?

CHECKED UPWITHIN 48HRS 2ND TO 3RD DAY

4TH DAY TO 7TH DAY 7TH DAY TO 10TH DAY

AFTER 10TH DAY

NOT CHECKED UP AT ALL

1

2

3

4

5 A4.10

6

A4.8 How many postnatal check-ups (s) did you receive

at the health facility and at home during first 10

days of delivery?

NUMBER AT THE HEALTH

FACILTY

AT HOME

A4.9 Where did the first PNC check-up take place?

HOME INSTITUTION

1

2

A4.10 CHECK Q A 4.1

IN CASE OF INSTITUTIONAL DELIVERY

(CODES 01 OR 02 IN Q A4.1) ASK,

When was the new born baby checked up after

discharge from the health facility?

IN CASE OF HOME DELIVERY (CODE 03 OR

96 IN Q A4.1) ASK,

When was the new born baby checked up first after

birth?

CHECKED UPWITHIN 24 HRS WITHIN 24 TO 72 HRS

4TH TO 7TH DAY 7TH DAY TO 10TH DAY

AFTER 10TH DAY

NOT CHECKED UP AT ALL

1

2

3

4

5

6 A4.13

A4.11 How many check-up(s) did the new born baby

receive at the health facility and at home during first

10 days of delivery?

NUMBER AT THE HEALTH

FACILTY

AT HOME


A4.12 Where did the first postnatal check-up take place for

your baby?

HOME INSTITUTION

1

2

A4.13 Were you ever referred for health problem by the AWW during pregnancy/delivery/post-delivery with this child?

YES

NO

DID NOT GO TO AWC

NO AWC IN OUR LOCALITY

NO HEALTH PROBLEM

1

2

3 A4.16

4

5

A4.14 Where were you referred?

(IN CASE A PERSON WAS REFERRED MORE

THAN ONCE FOR DIFFERENT HEALTH

PROBLEMS AND TO DIFFERENT HEALTH

INSTITUTIONS, THIS QUESTION PERTAINS

TO THE LAST REFERRAL)

SUB-CENTRE

PHC

CHC

OTHER

01

02

03

96

A4.15 Did you receive the service for which you were

referred?

YES

NO

SENT TO SOME OTHER FACILITY

DID NOT GO AT ALL

1

2

3

4

A 4.16 Are you aware of Janani Suraksha Yojana (JSY),

run by the Government?

YES

NO

1 A4.18

2

A 4.17 Are you aware about any scheme under which

financial assistance is given to women for delivering

the child at the health facility?

YES

NO

1

2

A 4.18 Are you aware of Janani Shishu Suraksha

Karyakaram (JSSK), run by the Government?

YES

NO

1 A4.20

2

A4.19 Are you aware about any scheme under which free

and cashless maternity services and newborn care in

all Government healthcare institutions including

diet, no out-of-pocket expenditure for drugs,

disposables, diagnostics, blood transfusion, referral

transport and drop back facility is provided.

YES

NO

IF NO IN A 4.16 TO A4.19, SKIP TO

A4.21.

1

2

A 4.20 Did you receive any assistance under JSY/JSSK

schemes?

YES, FROM JSY

YES, FROM JSSK

YES FROM BOTH JSY AND JSSK

NONE

1

2

3

4

A 4.21 Was the baby weighed within 24 hours of birth?

YES

NO

DON’T KNOW

01

02

98 A5.1


A4.22 How much did he/she weigh?

(ASK FOR ANY DOCUMENT/MCP CARD IN

SUPPORT, IF AVAILABLE)

KG. &GRAMS . COPIED FROM MCP/HEALTH CARD ..................... 01

VERBAL RESPONSE OF THE MOTHER 02

DON’T KNOW………………..…………… 98

A5.0 INFANT AND YOUNG CHILD FEEDING PRACTICES FOR CHILDREN AGED 0-23

MONTHS (BORN AFTER 1st AUGUST 2011)

A 5.1 CHECK Q A 2.3

CHILD IS 23 MONTHS OR BELOW

CHILD IS MORE THAN 23 MONTHS

1

2A6.1

A 5.2 Did you ever breastfeed (NAME)?

YES

NO

1

2 A5.7

A5.3 How long after birth did you first put (NAME) to

the breast?

IF WITHIN AN HOUR, RECORD 00; IF LESS

THAN 24 HOURS, RECORD HOURS.

OTHERWISE, RECORD DAYS.

IMMEDIATELY/WITHIN AN HOUR HOURS

DAYS

A 5.4 Did you feed first yellow thick breast milk

(Colostrum)/Khees to the baby?

YES

NO

1

2

A 5.5 In the first 3 days after delivery, was (NAME) given

anything to drink other than breast milk?

YES

NO

1

2 A5.7

A5.6 What was (NAME) given to drink?

ANYTHING ELSE?

RECORD ALL LIQUID MENTIONED?

MILK (OTHER THAN BREASTMILK)

PLAIN WATER

SUGAR OR GLUCOSE WATER

GRIPE WATER

SUGAR-SALT-WATER SOLUTION

FRUIT JUICE

INFANT FORMULA

HONEY

JANAMGHUTTI

OTHER

A

B

C

D

E

F

G

H

I

X


A 5.7 CHECK Q A1.6

THE CHILD IS SURVIVING-1 A5.8

THE CHILD IS NOT SURVIVING-2

IF CODED 2 ASK FOR NEXT LIVE BIRTH (A2.2). IF

NO OTHER LIVE BIRTH GO TO B1.1

A 5.8 Are you still breastfeeding this child?

YES

NO

1 A5.10

2

A5.9 How many days/months did you breastfeed the

child?

RECORD NUMBER OF DAYS IF BREASTFED

FOR LESS THAN ONE MONTH OTHERWISE

RECORD IN MONTHS.

DAYS

MONTHS

A 5.10 Was (NAME) breastfed yesterday during the day or

at night?

YES

NO

DON’T KNOW

01

02

98

A 5.11 Was (NAME) given any vitamin drops or other

medicines as drops yesterday during the day or at

night?

YES

NO

DON’T KNOW

01

02

98

A 5.12 Was (NAME) given ORS yesterday during the day

or at night?

YES

NO

DON’T KNOW

01

02

98

A 5.13 Yesterday during the day or night, did

(NAME) have any liquids (item from the

list)?

READ THE LIST OF LIQUIDS

STARTING WITH PLAIN WATER

LIST OF LIQUIDS YES 01,

NO 02,

DON’T

KNOW

98

IF CODED

01 IN ‘C

ORD OR F’

THEN ASK

5.14, ELSE

SKIP TO

A5.15 a) PLAIN WATER

b) WATERY ITEMS SUCH AS

DAL/RICE WATER

c) POWDER MILK/FORMULA

d)

COW'S/BUFFALO'S/GOAT'S/OTHE

R ANIMAL MILK

e) JUICE OR JUICE DRINKS

(MANGO, ORANGE, APPLE,

LEMON ETC.)


f) BUTTER MILK/BEATEN CURD

g) ANY OTHER LIQUIDS

A5.14 How many times yesterday during the day or at

night did (NAME) consume the following?

READ OUT OPTIONS

RECORD 00 IF NOT CONSUMED

RECORD ‘98’ FOR DON’T KNOW.

NUMBER OF TIMES

POWDER MILK/FORMULA

COW'S/BUFFALO'S/GOAT'S/OTHER

ANIMAL MILK

BUTTER MILK/BEATEN CURD

A5.15 Yesterday during the day or night, did (NAME)

drink/eat any (FOOD GROUP ITEMS)?

YES 01; NO 02; DON'T KNOW98

a) ANY COMMERCIALLY FORTIFIED BABY FOOD SUCH AS

CERELAC ETC. IF CODED

01IN

ATLEAST

ONE

OPTION

THEN SKIP

TO A5.17

b) BREAD, ROTI, CHAPATI, RICE, KITCHDI, NOODLES, PORRIDGE,

BISCUITS, IDLI, OR ANY OTHER FOODS MADE FROM GRAINS?

c) PULSES/LENTILS/BEANS OR FOOD PREPARED WITH MIXING

PULSES/LENTILS/LEGUMES

d) PUMPKIN, CARROTS, OR SWEET POTATOES THAT ARE

YELLOW OR ORANGE INSIDE?

e) POTATOES, WHITE YAMS, OR ANY OTHER FOODS MADE FROM

ROOTS?

f) ANY DARK GREEN, LEAFY VEGETABLES?

g) RIPE MANGOES, PAPAYAS, CANTALOUPE, OR JACKFRUIT?

h) ANY OTHER FRUITS OR VEGETABLES?

(i) LIVER, KIDNEY, HEART OR OTHER ORGAN MEATS?

j) ANY MEAT SUCH AS CHICKEN, BEEF, PORK, LAMB, GOAT OR

DUCK?

k) EGGS?

l) FRESH OR DRIED FISH OR SHELLFISH?

m) ANY FOODS MADE FROM NUTS SUCH AS PEANUTS, CASHEW

NUTS, ALMONDS ETC.?


n) CHEESE, PANEER, DAHI OR OTHER FOOD MADE FROM MILK?

ANY OTHER SOLID OR SEMI-SOLID FOOD?

A 5.16 Did (NAME) eat any solid, semi-solid, or soft foods

yesterday during the day or at night?

RECORD FOOD EATEN YESTERDAY

YES

NO

DON’T KNOW

01 A5.15

02

A6.1 98

A5.17 How many times did (NAME) eat solid, semi-solid,

or soft foods other than liquids yesterday during the

day or at night?

NUMBER OF TIMES

DON'T KNOW

98

A6.0

IMMUNIZATION

(FOR ALL CHILDREN AGED 0-35 MONTHS – BORN AFTER 1st AUGUST 2010 )

A6.1 Do you have an Immunisation card/Mother Child

Protection (MCP) card for this child (NAME) where

details of all his/her vaccinations are written down.

IF YES, OBSERVE THE CARD.

SHOW A SAMPLE OF THE CARD AND THEN

ASK.

YES, SHOWN

YES, BUT NOT SHOWN

NO

1

2 A6.3

3

A 6.2

(1) COPY DATES FROM THE

CARD.

(2) WRITE ‘44’ IN ‘DAY’

COLUMN IF CARD SHOWS

THAT A DOSE WAS GIVEN

BUT NO DATE IS RECORDED.

(3) IF ONLY A PART OF

DATE OF IMMUNIZATION IS

SHOWN ON CARD RECORD

98 (DAYS/MONTHS) OR 9998

(YEAR) FOR DO NOT KNOW

IN THE COLUMN FOR

WHICH INFORMATION IS

NOT WRITTEN

(4) IF ANY OF THE VACCINE

IS NOT RECORDED IN THE

CARD PLEASE ASK,

FOR POLIO 0, OPV1, OPV 2

AND OPV3 QUESTIONS A 6.7,

A 6.8 AND A 6.9

PENTAVALENT1

IF PENTAVALEN

T RECORDED

POPULATE THE DATES

AUTOMATICA

LLY IN DPT1,DPT2 and

DPT3 AND

HEPB1, HEPB2 AND HEPB3

FOR

PENTAVALENT 1,2 AND 3

RESPECTIVEL

Y

IF

PENTAVAL

ENT ‘1’ TO

MEASLES 2

ALL RECORDED,

GO TO A6.16

A

PENTAVALENT 2

PENTAVALENT 3

POLIO 0

HEPB0

BCG

DPT1

HEPB1


A 6.7, A 6.8 a 6.9

FOR HEP B0, HEPB1, HEPB2

AND HEPB3 QUESTIONS A

6.12 AND A 6.13

A 6.12 a 6.13

FOR BCG QUESTION A 6.4

A 6.4

FOR DPT1 , DPT2 AND DPT3

QUESTIONS A 6.5 aND a 6.6

A 6.5 A 6.6

FOR MEASLES QUESTIONS A

6.10 AND A 6.11

A 6.5A 6.6

OPV1

DPT2

HEPB2

OPV2

DPT3

HEPB3

OPV3

MEASLES1

MEASLES2

VITAMIN A 1ST

DOSE

DPT BOOSTER 1

A6.3 Did (NAME) ever receive any vaccination to

prevent him/her from getting disease?

YES

NO

DON’T KNOW

01

02

98 a6.16

A 6.4 A BCG vaccination against tuberculosis, that is, an

injection in the left shoulder that caused a scar?

YES

NO

DON’T KNOW

01

02

98

A 6.5

A DPT vaccination against diphtheria, whooping

cough and tetanus given as an injection? This is an

injection given in the thigh or buttocks, sometimes

at the same time as polio drop.

YES

NO

DON’T KNOW

01

02

98 A6.7

A6.6 How many times?

NUMBER OF TIMES


A 6.7 Was Polio vaccine, that is, drops in the mouth, been

given to this child (NAME)?

YES

NO

DON’T KNOW

01

02

98 A6.10

A6.8

Was the first Polio vaccine received in the first two

weeks after birth or later?

FIRST TWO WEEK

LATER DON’TKNOW

01

02

98

A6.9 How many times (Excluding Polio '0' & excluding '

pulse polio) '?

NUMBER OF TIMES

A6.10 Was an injection against measles given? A measles

injection or an MMR injection is a shot in the arm at

the age of 9 months or older.

YES

NO

DON’T KNOW

01

02

98 A6.12

A6.11 How many times?

NUMBER OF TIMES

A6.12 Was an injection against Hepatitis-B given to child

(NAME)?

YES

NO

DON’T KNOW

01

02

98 A6.14

A 6.13 How many times?

NUMBER OF TIMES

A 6.14 Has (NAME) given the 1stbooster dose of DPT?

(1st booster dose is given between 15-18 months)

YES

NO

DON’T KNOW

01

02

98

A 6.15 Where did (NAME) receive most of his/her

vaccinations?

ANGANWADI CENTRE

GOVT. HOSPITAL/HEALTH

INSTITUTIONS


HOME

HOME

OTHER

01

02

03

04

96

A 6.16 CHECK Q A 2.3

CHILD IS 6 MONTHS OR MORE BUT

< 36 MONTHS

CHILD IS BELOW 6 MONTHS

1

2 A7.1

A 6.17 Has (NAME) ever been given any dose of Vitamin

'A'?

YES

NO

DON’T KNOW

01

02

98 a6.20


A 6.18 How many doses of Vitamin A was given in the last

one year?

RECORD ‘0’ IF NO DOSE GIVEN.

NO OF DOSES

IF ‘0’ IS RECORDED, SKIP TO A

6.20.

A 6.19 Has (NAME) received Vitamin ‘A’ dose in the last

six months?

YES

NO

DON’T KNOW

01

02

98

A 6.20 Was a dose of deworming given to (NAME) in the

last six months?

YES

NO

DON’T KNOW

01

02

98 a6.22

A 6.21 Where did (NAME) get the deworming medicine?

RECORD ALL MENTIONED

AWC

SUB-CENTRE (ANM)

MEDICINE SHOP

OTHER

A

B

C

X

A 6.22 Was (NAME) given Iron & Folic supplements in

the last six months?

YES

NO

DON’T KNOW

01

02

98

A7.0 MORBIDITY (ASK TO ALL MOTHERS OF 0 – 35 MONTHS CHILDREN)

A7.1 Did (NAME) suffer from any episode of diarrhoea

during last 15 days?

YES

NO

1

2 A7.7

A7.2 Did you seek advice or treatment for the diarrhoea

from any source?

YES

NO

1

2 A7.4

A7.3 Where did you seek advice or treatment?


ANGANWADI CENTRE

GOVT. HOSPITAL/HEALTH CENTRE


HOMES

FROM ANY MEDICINE SHOP

TRADITIONAL PRACTITIONER

ASHA

OTHER

A

B

C

D

E

F

A 7.4 Was (NAME) given any of the following to drink at

any time since he/she started having the diarrhoea?

PROMPT THE OPTIONS

ANY HOME AVAILABLE

FLUID (HAF*)

YES 1 NO 2

ORS YES 1 NO 2

ORS & ZINC YES 1 NO 2


*HAF REFERS TO HOME aVAILABLE FLUID OF

WATER, SALT AND SUGAR AND IT ALSO

INCLUDES RICE CONJEE AND DAL KA PANI WITH

ADDED SALT

A 7.5 If ORS was given, from where did you

receive/procure the ORS?

ANY OTHER SOURCE?

RECORD ALL SOURCE MENTIONED.

AWC

ANM

ASHA

GOVT. HEALTH INSTITUTIONS


PURCHASED FROM THE MARKET

OTHER

A

B

C

D

E

F

X

A 7.6 Was antibiotics (tablets/injections) given to treat the

Diarrhoea?

YES

NO


01

02

98

A 7.7 Has (NAME) been ill with a fever at any time in the

last 15 days?

YES

NO


01

02

98 A7.10

A 7.8 At any time during illness, did (NAME) have blood

taken from his/her finger for testing?

YES

NO


01

02

98

A 7.9 At any time during the illness, was (NAME)given

any anti- malarial drugs for the illness?

YES

NO


01

02

98

A 7.10 Has (NAME) had an illness with a cough at any

time in the last 15 days?

YES

NO


01

02

98 A7.14

A 7.11 When (NAME) had an illness with a cough, did

he/she breathe faster than usual with short, rapid

breaths or have difficulty breathing?

YES

NO


01

02

98 A7.13

A 7.12 Was there any fast breathing or difficulty in

breathing due to a problem in the chest or to a

blocked or runny nose?

CHEST ONLY

NOSE ONLY

BOTH

OTHER


01

02

03

96

98

A 7.13 Did you seek advice or treatment for the illness

from any source?

YES

NO


01

02

98


A 7.14 Was the health of (NAME) checked up in last 3

months even if he/she was not ill?

YES

NO

1

2 A7.17

A 7.15

How many times?

Number

A 7.16

Where was the last check-up done? GOVT. HOSPITAL/HEALTH CENTRE

PRIVATE HOSPITAL/CLINIC

AWC

OTHER

DON’T KNOW

01

02

03

96

98

A 7.17 CHECK Q A7.1, A7.7 AND A7.10

If coded 1 in 7.1, or in 7.7 or in 7.10 then ask A 7.18 and A 7.19 else skip to A8.1

A7.18 Has (NAME) been referred to any health facility by

AWW during his/her illness?

YES

NO

DON’T KNOW

01

02

98 A8.1

A7.19

Where the child has been referred

SHC

PHC

CHC

OTHER GOVT HOSPITAL

PVT. HOSPITAL/CLINIC

OTHER

01

02

03

04

05

96

A8.0 WEIGHT AND GROWTH, (0 – 35 MONTHS)

A8.1 Does (NAME) have a growth chart/card?

INVESTIGATOR TO CARRY A SAMPLE OF

MCP CARD.

YES

NO

DON’T KNOW

01

02

98

A 8.2 How many times was (NAME) weighed in the last 3

months?

NUMBER OF TIMES

IF NOT WEIGHED RECORD ‘00’

DON'T KNOW ……98

A 8.3 Where (NAME) was weighed last?

AWC

AT HOME


PVT. HOSPITAL/PVT. DOCTOR’S

CLINIC

OTHER

DON'T KNOW

01

02

03

04

96

98

A9.1

A9.1


A 8.4 Do you know, what is the present weight of

(NAME)?

(PRESENT WEIGHT REFERS TO THE MOST

RECENT WEIGHT THAT WAS TAKEN IN

LAST 3 MONTHS?)

YES

NO

DON’T KNOW

01

02

98

A8.5 Can you tell me whether the child’s weight is

normal or moderately underweight or severely

underweight?

(PROMPT RESPONSES)

NORMAL

MODERATELY UNDERWEIGHT

SEVERELY UNDERWEIGHT

DON'T KNOW

01

02

03 A8.7

98

A8.6 Did (NAME) ever fall in the category of severely

underweight children in the last 3 months?

YES

NO

DON’T KNOW/CANT SAY

01

02

98

A8.7 Did anyone discuss with you about (NAME)’s

nutritional status?

RECORD ALL MENTIONED PERSONS

NO ONE DISCUSSED

AWW

ANM

DOCTOR

OTHER

A

B

C

D

X

A9.0 AWARENESS OF SERVICES AT ANGANWADI CENTRE (0 – 35

MONTHS)

A9.1 Are you aware what all

services are provided at

the AWC?

FIRST RECORD ALL

THE SPONTANEOUS

RESPONSES AND

THEN PROMPT FOR

THE REMAINING

CODES

SPONTANEOU

S

PROMPT

YES NO

SUPPLEMENTARY FOOD

IMMUNISATION

PRE-SCHOOL EDUCATION

HEALTH CHECK UP

REFERRAL SERVICES

NUTRITION & HEALTH

EDUCATION

NO ANGANWADI CENTER

IN MY LOCALITY

A

B

C

D

E

F

G B1.1

1

1

1

1

1

1

2

2

2

2

2

2

A 9.2 Do you avail any services

for child (NAME) from

AWC in your area?

(ASK ABOUT HER

DESIGNATED AWC

AND INFORM YOUR

SUPERVISOR, IF

THERE IS ANY

DISCREPANCY)

YES

NO

01A9.4

02


A9.3 What are the reason(s) for

not availing services from

AWC?

ANY OTHER

REASON?

RECORD ALL

REASONS

MENTIONED.

AFTER ANSWERING

A9.3, SKIP TO B1.1

AWC OFTEN REMAINS

CLOSED

QUALITY OF SERVICES

NOT UPTO THE MARK

DID NOT FEEL THE NEED

OF SERVICES FROM AWC

NO BODY TO

ACCOMPANY THE CHILD

AWW’S/AWH BEHAVIOUR

IS BAD

I FEEL ME/MY CHILD IS

DISCRIMINATED

AWC IS FAR OFF

OTHER

A

B

C

D

E

F

G

X

A 9.4 CHECK Q A 2.3

CHILD IS BELOW 6

MONTHS

CHILD IS EQUAL TO OR

MORE THAN 6 MONTHS

BUT < 36 MONTHS

1 A11.1

2

A 9.5 Since what age did

(NAME) start availing

service(s) at the AWC?

AGE (IN COMPLETED MONTHS)

A 9.6 What services are availed

for (NAME) from the

AWC?

FIRST RECORD ALL

THE SPONTANEOUS

RESPONSES AND

THEN PROMPT FOR

THE REMAINING

CODES

SPONTANEO

US

PROMPT

YES NO

SUPPLEMENTARY FOOD

IMMUNISATION

HEALTH CHECK UP

REFERRAL SERVICES

HEALTH AND NUTRITION

EDUCATION OR ADVICE

ON FEEDING AND CARE

OF YOUNG CHILDREN

OTHER

A

B

C

D

E

X

1

1

1

1

1

1

2

2

2

2

2

2

A9.7 IF CODE A

(SUPPLEMANTARY

FOOD) IS NOT CODED

IN A9.6 THEN ASK

A9.7

What are the reason(s) for

not taking food from

AWC?

AWC OFTEN REMAINS

CLOSED

AWC FAR AWAY FROM

MY HOME

FOOD IS NOT

DISTRIBUTED BY AWW

FOOD IS OUT OF STOCK

FOR MOST OF THE DAYS

QUALITY OF FOOD

GENERALLY NOT EDIBLE

A

B

C

D


ANY OTHER?

RECORD ALL

MENTIONED

REASONS.

MY CHILD DOES NOT

LIKE AWC FOOD

DO NOT NEED FOOD

FROM AWC

FAMILY MEMBERS

OPPOSE

UNABLE TO GO TO AWC

FOR RECEIVING FOOD

NOT AWARE ABOUT

FOOD

SUPPLEMENTATION

NOT AWARE THAT MY

CHILD IS ELIGIBLE

OTHER

I FEEL ME/MY CHILD IS

DISCRIMINATED

E

F

G

I

J

K

L

X

M

A

10.0 INTAKE OF SUPPLEMENTARY FOOD FROM ANGANWADI CENTRE FOR

CHILDREN AGED 7 – 35 MONTHS

A 10.1 CHECK Q A 9.6

A9.6 CODED ‘A’

A9.6 IS NOT CODED ‘A’

1 2B1.1

A10.2 What type of food,

(NAME) is generally

received from AWC?

RECORD ALL

MENTIONED

HOTCOOKED MEAL

READY-TO-EAT (RTE)/TAKE

HOME RATION (THR)

A

B

A 10.3 If THR/RTE in A10.2

Are you aware about the

fortnightly (two weeks)

entitlement of


AWC for the child

(NAME) ?

YES

NO

1

2

A 10.4 For how many days did

(NAME) receive


AWC in the last month?

IF NIL, RECORD '00'.

LAST MONTH (IN DAYS)

NOT PRESENT IN LAST MONTH

DON’T KNOW/CAN'T SAY

95

98

A 10.5 Of the food received, can

you tell me generally

how much food is

consumed by the child

(NAME)?

ENTIRE STUFF/QUANTITY

SHARED WITH OTHER

SIBLINGS/FAMILY MEMBERS

HE DOES NOT LIKE THE FOOD

AND SO DOES NOT CONSUME aT

ALL

CANNOT SAY/DON'T REMEMBER

01

02

03

98


A10.5

A CHECK: Q. A2.3/A8.5/A8.6: If A2.3 is >= 7 months and A8.5 is coded 03 (Severely

underweight) or A8.6 is coded 1(yes) -1; Otherwise- 2( skip to A11.1)

A 10.6

How much quantity of

supplementary food did

(NAME) receive at that

point of time?

SAME AS EARLIER

SLIGHTLY MORE

ALMOST DOUBLE OF WHAT

RECEIVED EARLIER

DON'T REMEMBER

NOT APPLICABLE

01

02

03

98

99

A 11.0

INTAKE OF SUPPLEMENTARY FOOD FROM ANGANWADI CENTRE BY

LACTATING MOTHERS ( BELOW 6 MONTHS CHILDREN)

A11.1 What services are

availed by you from the

AWC?

MULTIPLE

RESPONSES

POSSIBLE

FIRST RECORD ALL

THE SPONTANEOUS

RESPONSES AND

THEN PROMPT FOR

THE REMAINING

CODES

SPONTANEO

US PROMPT

YE

S N

O

SUPPLEMENTARY FOOD

HEALTH CHECK UP

REFERRAL SERVICES

HEALTH AND NUTRITION

EDUCATION OR ADVICE ON

FEEDING AND CARE OF YOUNG

CHILDREN

OTHER

A

B

C

D

X

1

1

1

1

1

2

2

2

2

2

CHECK Q A 11.1

A11.1 CODED ‘A’

A11.1 IS NOT CODED ‘A’

1 A11.3 2

A11.2 What are the reason(s) for

not taking food from

AWC?

RECORD ALL

MENTIONED

REASONS.

AFTER ANSWERING

A11.2, GO TO Q B1.1

NOT AWARE ABOUT FOOD

SUPPLEMENTATION

NOT AWARE THAT I AM ELIGIBLE

SUPPLEMENTARY FOOD IS OUT OF

STOCK FOR MOST OF THE DAYS

QUALITY OF FOOD PROVIDED AT

AWC IS GENERALLY NOT EDIBLE

FOOD IS NOT DISTRIBUTED BY

AWW

AWC OFTEN REMAINS CLOSED

AWC FAR AWAY FROM MY HOME

I AM WORKING aND SO CANNOT

GO TO AWC FOR RECEIVING FOOD

I DO NOT NEED FOOD FROM AWC

FAMILY MEMBERS OPPOSE

DO NOT LIKE AWC FOOD

A

B

C

D

E

F

G

H

I

J


NOT AWARE WHEN AWC

DISTRIBUTES FOOD

OTHER

I FEEL I AM DISCRIMINATED

K

L

X

M

A11.3 What type of food do you

generally receive from

AWC?

HOTCOOKED MEAL

READY-TO-EAT (RTE)/

TAKE HOME RATION (THR)

A

B

A11.4 If THR/RTE in A 11.3

Are you aware about the

fortnightly (two weeks)

entitlement of


AWC?

YES

NO

1

2

A11.5 For how many days did

you receive




IN CASE HOUSEHOLD

NOT PRESENT IN THE

LAST 3 MONTHS,

THEN CODE 95

LAST MONTH(IN DAYS)



95

98

A11.6 Of the food received,

generally how much is

consumed by you?


SHARED WITH OTHER FAMILY

MEMBERS

I DON’T LIKE THE FOOD AND SO

DO NOT CONSUME aT ALL

CANNOT SAY/DON'T REMEMBER

01

02

03

98

A11.7 CHECK Q A1.3 FOR ANY OTHER LIVE BIRTH IN LAST 3 YEARS. IN CASE THERE

IS ANOTHER LIVE BIRTH IN LAST 3 YEARS START THE LOOP FOR THE NEXT

LIVE BIRTH (A2.2) ELSE PROCEED TO MODULE FOR 3-6 YEARS

B1.0 MODULE FOR 36 - 71MONTHS CHILDREN

B 1.1 Do you have a child aged

36 to71months?

TO BE AUTO

POPULATED

FROM THE HH

ROSTER

YES

NO

1

2 C1.1


B 1.2 How many children aged

36 -71months do you

have?

TO BE AUTO

POPULATED

FROM THE HH

ROSTER

NUMBER

B 2.0 BACKGROUND (START WITH THE YOUNGEST CHILD)

B2.1 Name of the child

-------------------------------------------------

B2.2 Sex of the child

TO BE POPULATED

FROM HH ROSTER

BOY

GIRL

1

2

B2.3 Date of Birth of the child

(DD/MM/YYYY) AFTER RECORDING THE DATE OF BIRTH INCASE IT IS FOUND

THAT THE AGE OF THE CHILD IS ACTUALLY 0-35 MONTHS

THE LOOP FOR 0-35 MONTHS SHOULD BE OPENED. HOWEVER,

IF IT IS FOUND THAT THE CHILD IS MORE THAN 71 MONTHS

OLD THEN THE MODULE FOR 36-71 MONTHS WILL NOT BE

APPLICABLE. IN SUCH CASE, PROBE FROM THE INDEX EMW

ABOUT ANY ANOTHER CHILD OF THIS AGE GROUP ELSE

MOVE TO MODULE C ON FAMILY PLANNING.

B3.0 CHILD HEALTH (36 – 71 MONTHS)

B3.1 Was (NAME) given the

2nd booster dose of

DPT?

VERIFY THE ANSWER

BY EXAMINING THE

IMMUNIZATION

CARD OF THE CHILD,

IF AVAILABLE. .

DPT BOOSTER DOSE

IS GIVEN TO

CHILDREN BETWEEN

4 – 6 YEARS.

YES

NO


01

02

98

B3.1A Was (Name) given the 2nd

dose of Measles? ? (2nd

dose of measles is usually

given between 15-18

months)

VERIFY THE ANSWER

BY EXAMINING THE

IMMUNIZATION

CARD OF THE CHILD,

IF AVAILABLE.

YES

NO


01

02

98


B3.2 Has (NAME) ever been

given any dose of

Vitamin 'A'?

YES

NO


01

02

98 B3.5

B3.3 How many doses of

Vitamin A were given to

(NAME) in the last one

year?

RECORD ‘0’ IF NO

DOSE IS GIVEN.

NUMBER OF DOSES

IF ‘0’ IS RECORDED, SKIP TO B3.5

B3.4 Has (NAME) been given

Vitamin 'A' dose in the

last six months?

YES

NO

1

2

B3.5 Was deworming done to

(NAME) in the last six

months?

YES

NO


01

02

98

B3.6 From where did (NAME)

get the deworming

medicine?

AWC

SUB CENTRE (ANM)

MEDICINE SHOP

OTHER

A

B

C

X

B3.7 Has (NAME) been given

Iron & Folic supplements

in the last six months?

YES

NO

DON’T KNOW

01

02

98

B3.8 Did (NAME) suffer from

any episode of diarrhoea

during last 15 days?

YES

NO

1

2 B3.14

B3.9 Did you seek advice or

treatment for the

diarrhoea from any

source?

YES

NO

1

2 B3.11

B3.10 Where did you seek

advice or treatment?

RECORD ALL

MENTIONED

ANGANWADI CENTRE



HOMES

FROM ANY MEDICINE SHOP

TRADITIONAL PRACTITIONER

ASHA

OTHER

A

B

C

D

E

F

X

B3.7


B3.11 Was (NAME) given any

of the following to drink

at any time since he/she

started having the

diarrhoea?

PROMPT THE

OPTIONS

ANY HOME

AVAILABLE FLUID

(HAF*)

YES 1 NO- 2

ORS YES 1 NO- 2

ORS & ZINC YES 1 NO—2

*HAF REFERS TO HOME AVAILABLE FLUID OF WATER, SALT

AND SUGAR AND IT ALSO INCLUDES RICE CONJEE AND DAAL

KA PANI WITH ADDED SALT

B3.12 If ORS was given, from

where did you

receive/procure the ORS?

ANY OTHER SOURCE?

RECORD ALL

SOURCES

MENTIONED

AWC

ANM

ASHA

GOVT. HEALTH INSTITUTIONS


PURCHASED FROM THE MARKET

OTHER

A

B

C

D

E

F

X

B3.13 Were antibiotic

(tablet/injection)

medicines given to treat

the diarrhoea?

YES

NO


01

02

98

B3.14 Has (NAME) been ill

with a fever at any time

in the last two weeks?

YES

NO


01

02

98 B3.17

B3.15 At any time during illness

did (NAME) have a

blood taken from his/her

finger for testing?

YES

NO


01

02

98

B3.16 At any time during the

illness, was (NAME)

given any anti-malarial

drugs for the illness?

YES

NO

DON’T KNOW

01

02

98

B3.17 Has (NAME) had an

illness with a cough at

any time in the last 15

days?

YES

NO

DON’T KNOW

01

02

98

B3.18 When (NAME) had an

illness with a cough, did

he/she breathe faster than

usual with short, rapid

breaths or had difficulty

in breathing?

YES

NO

DON’T KNOW

01

02

98

B3.21


B3.19 Was there any fast

breathing or difficulty in

breathing due to a

problem in the chest or to

a blocked or runny nose?

CHEST ONLY

NOSE ONLY

BOTH

OTHER


01

02

03

96

98

B3.20 Did you seek advice or

treatment for the illness

from any source?

YES

NO

DON’T KNOW

01

02

98

B3.21 Was the health of

(NAME) checked up in

last 3 months even if

he/she was not ill?

YES

NO

1

2 B3.24

B3.22 How many times?

IN NUMBER

B3.23 Where was the last

check-up done?


PRIVATE HOSPITAL/CLINIC

AWC

OTHER (

DON’T KNOW

01

02

03

96

98

B3.24 CHECK Q B3.8 or B3.14 or B3.17

IF CODED 1 IN B3.8 OR B3.14 OR B3.17 THEN ASK B3.25 AND B3.26 ELSE SKIP TO B4.1

B3.25 Has (NAME) been

referred to any health

facility by AWW during

his/her illness?

YES

NO

DON’T KNOW

01

02

98

B3.26 Where the child has been

referred?

SHC

PHC

CHC

OTHER GOVT HOSPITAL

PVT. HOSPITAL/CLINIC

OTHER

01

02

03

04

05

96

B.4.0 WEIGHT AND GROWTH ( 36 – 71 MONTHS CHILDREN)

B4.1 Does (NAME) have a

growth chart/card?

INVESTIGATOR TO

CARRY A SAMPLE OF

MCP CARD.

YES

NO

DON’T KNOW

01

02

98 B5.1

B4.1


B4.2 How many times was

(NAME) weighed in the

last 3 months?

NUMBER OF TIMES

IF NOT WEIGHED RECORD ‘00’

DON'T KNOW ……….98

B 5.1

B4.3 Where (NAME) was

weighed last?

AWC

AT HOME


PVT. HOSPITAL/PVT. DOCTOR’S

CLINIC

OTHER

DON'T KNOW

01

02

03

04

96

98

B4.4 Do you know, what is the

present weight of

(NAME)?

PRESENT WEIGHT

REFERS TO THE

MOST RECENT

WEIGHT THAT WAS

TAKEN IN LAST 3

MONTHS?

YES

NO

DON’T KNOW

01

02

98

B4.5 Can you tell me whether

the child’s weight is

normal or moderately

underweight or severely

underweight?

(PROMPT

RESPONSES)

NORMAL

MODERATELY UNDERWEIGHT

SEVERELY UNDERWEIGHT

DON'T KNOW

01

02

03 B4.7

98

B4.6 Did (NAME) ever fall in

the category of severely

underweight children in

the last 3 months?

YES

NO

DON’T KNOW/CANT SAY

01

02

98

B4.7 Did any one discuss with

you about (NAME)’s

nutritional status?

RECORD ALL

MENTIONED

PERSONS.

NO ONE DISCUSSED

AWW

ANM

DOCTOR

OTHER

A

B

C

D

X

B5.0 AWARENESS OF SERVICESAT ANGANWADI CENTRE ( 36 – 71 MONTHS)

B 5.1 CHECK Q A 1.6

A 1.6

THE EMW HAS A SURVIVING

CHILD BORN DURING LAST 3

YEARS

THE EMW DOES NOT HAVE A

SURVIVING CHILD AGED 0-3

YEARS AND HAS 3 – 6 YEARS

CHILD

1 B5.3

2


B5.2 Are you aware of what all

services are provided at the

AWC?

FIRST RECORD ALL

THE SPONTANEOUS

RESPONSES AND THEN

PROMPT FOR THE

REMAINING CODES

SPON

TANE

OUS

PROMPT

YES NO

SUPPLEMENTARY FOOD

IMMUNISATION


HEALTH CHECK UP

REFERRAL SERVICES

NUTRITION & HEALTH

EDUCATION

NO ANGANWADI CENTER IN MY

LOCALITY

A

B

C

D

E

F

G C1.1

1

1

1

1

1

1

1

2

2

2

2

2

2

2

B5.3 Do you avail any anganwadi

services for (NAME) from the

AWC of your area?

(ASK ABOUT HER

DESIGNATED AWC AND

INFORM YOUR

SUPERVISOR, IF THERE IS

ANY DISCREPANCY)

YES

NO

1B5.5

2

B5.4 What are the reason(s) for not

availing services from the

AWC?

ANY OTHER REASON?

RECORD ALL REASONS

MENTIONED.

AFTER ANSWERING B5.4

GO TO C1.1

AWC OFTEN REMAINS CLOSED

QUALITY OF SERVICES NOT UPTO

THE MARK

DID NOT FEEL THE NEED OF

SERVICES FROM AWC

NO BODY TO ACCOMPANY THE

CHILD

AWW’S/AWH BEHAVIOUR IS BAD

I FEEL MY CHILD IS

DISCRIMINATED

AWC IS FAR OFF

OTHER

A

B

C

D

E

F

G

X

B5.5 Since what age did (NAME)

start availing service(s) at the

AWC?

AGE (IN COMPLETED MONTHS)

DON’T KNOW 98

B5.6 For how many days, did

(NAME) visit AWC in the last

30 days?

RECORD '00' IF NOT

VISITED. AT ALL

DAYS


B5.7 How long does (NAME)

normally spend at the AWC in

a day?

GOES FOR COLLECTING FOOD

ONLY

< 1 HOUR

1-2 HOURS

2-3 HOURS

3-4 HOURS

4 HOURS AND MORE

1

2

3

4

5

6

B5.8 Does anyone accompany

(NAME) to AWC?

ACCOMPANIED BY

MOTHER/FAMILY MEMBERS

ALONE

AWW/AWH COLLECTS

ALONG WITH OTHER CHILDREN

1

2

3

4

B5.9 What are the services availed

by (NAME) at the AWC?

FIRST RECORD ALL

THE SPONTANEOUS

RESPONSES AND THEN

PROMPT FOR THE

REMAINING CODES

SPON

TANE

OUS

PROMPT

YES NO

SUPPLEMENTARY FOOD


IMMUNIZATION

HEALTH CHECK UP

REFERRAL SERVICES

HEALTH & NUTRITION

EDUCATION OR ADVICE ON

FEEDING AND CARE OF YOUNG

CHILDREN

OTHER

A

B

C

D

E

F

X

1

1

1

1

1

1

2

2

2

2

2

2

B.5.1

0 CHEK Q B5.9:

IF CODED A (SUPPLEMENTARY FOOD) –1: GO TO B6.2

IF NOT CODED A (SUPPLEMENTARY FOOD) – 2

B6.0: INTAKE OF SUPPLEMENTARY FOOD FROM ANGANWADI CENTRE FOR

CHILDREN AGED 36 - 71 MONTHS

B.6.1 What are the reason(s) for not

taking food from AWC?


REASONS.

AFTER ANSWERING B6.1,

SKIP TO B6.12

NOT AWARE ABOUT THE

SERVICES FROM AWC

NOT AWARE THAT MY CHILD IS

ELIGIBLE

SUPPLEMENTARY FOOD NOT

AVAILABLE FOR MOST OF THE

DAYS

QUALITY OF FOOD PROVIDED AT

AWC IS GENERALLY NOT EDIBLE

TASTE OF THE FOOD IS NOT

GOOD/GIVES BAD SMELL

A

B

C

D


FOOD IS NOT DISTRIBUTED BY

AWW

AWC OFTEN REMAINS

CLOSED/NOT AWARE WHICH

DAYS AWC REMAINS OPEN OR

DISTRIBUTES FOOD

AWC FAR AWAY FROM MY HOME,

CHILD CANNOT GO

WE ARE WORKING PEOPLE AND

SO CANNOT GO AWC FOR

COLLECTING FOOD

WE DO NOT NEED SUPPORT FOR

FOOD

FAMILY MEMBERS OPPOSE US IF

WE TAKE FOOD FROM AWC

CHILD DOES NOT LIKE AWC FOOD

OTHER

I FEEL MY CHILD IS

DISCRIMINATED

E

F

G

H

I

J

K

L

X

M

B6.2 What type of food (NAME)

generally receives from

AWC?


HOT COOKED MEAL

READY-TO-EAT (RTE)/

TAKE HOME RATION (THR)

MORNING SNACKS

A

B

C

B6.3 For how many days did

(NAME) receive







95

98

B6.4 For how many days did

(NAME) receive Breakfast

(Morning Snacks) during last

month?

IF NIL, RECORD '00'




95

98

B6.5

A

CHECK Q. B4.5/B4.6: IF B4.5 IS CODED 03 (SEVERELY UNDERWEIGHT) OR

B4.6 IS CODED 1(YES) -1; OTHERWISE- 2 (SKIP TO B6.7)

B6.6 How much quantity of

supplementary food did

(NAME) receive at that point

of time?

SAME AS EARLIER

SLIGHTLY MORE

ALMOST DOUBLE OF WHAT

RECEIVED EARLIER

DON'T REMEMBER

NOT APPLICABLE

01

02

03

98

99


B6.7 Where does (NAME) consume

supplementary food given by

AWC?

AWC

HOME

PARTLY AT AWC

DO NOT CONSUME

1B6.10

2

3

4 B6.12

B6.8 Is the supplementary food

given by AWC shared with

others?

YES

NO

DON’T KNOW

01

02

98

B6.9 Of the last received food, can

you tell me generally, how

much food did (NAME)

consume?

ENTIRE STUFF

HALF

LESS THAN HALF

NOT AT ALL

DON'T REMEMBER

01

02

03

04

98

B6.1

0 Can you tell me, does

(NAME) like the taste of the

food given?

ALWAYS

MOST OF THE TIMES

SOME TIMES

INDIFFERENT

DOES NOT LIKE

DON’T KNOW

01

02

03

04

05

98

B6.1

1 Is (NAME) getting different

HCM on different days of the

week?

YES

NO

DON’T KNOW

NOT APPLICABLE

01

02

98

99

B6.1

2 CHEK QB5.9:

IF CODED B (PSE) –1 : GO TO B7.3

IF NOT CODED B (PSE) – 2

B7.0: PRE-SCHOOL EDUCATION (36 – 71 MONTHS CHILDREN)

B7.1 What are the reason(s) for not

going to Anganwadi Center

for pre-school education?

RECORD ALL

MENTIONED REASONS.

AWW NOT QUALIFIED OR

TRAINED

PSE CURRICULUM IS NOT

RELEVANT OR APPROPRIATE

PSE NOT CONDUCTED IN AWC

AWW NOT COMING TO AWC

REGULARLY

AWC REMAINS CLOSED/NOT

REGULARLY OPENED

NOT AWARE ABOUT PSE IN AWC

I FEEL MY CHILD IS

A

B

C

D

E

F


DISCRIMINATED

AWC IS TOO FAR AWAY

NOT AWARE PSE IS CONDUCTED

IN AWC

OTHER

G

H

I

X

B7.2 If not in the AWC, where does

(NAME) go for pre-school

education?

AFTER ANSWERING B7.2,

GO TO C1.1

GOVT. SCHOOL

PVT. SCHOOL

DOES NOT ATTEND PSE

1

2

3

B7.3 Since what age (Name) is attending pre-

school at AWC?

AGE IN MONTHS

B7.4 How many days did (Name) attend PSE

at AWC in the last month and last 3

months?

RECORD '00' IF NOT AT ALL

ATTENDED

LAST MONTH(IN DAYS)

LAST 3 MONTHS(IN DAYS)

DK/CAN’T REMEMBER

98

B7.5 Generally, for how long does (NAME)

stay at the preschool at AWC in a day?

HOURS MINUTES

GOES FOR COLLECTING FOOD ONLY 97

DON’T KNOW 98

B7.6 Did you participate in any Parent's meet

in the last 3 months?

YES

NO

NOT AWARE ABOUT

PARENTS MEET

1

2

3

C 1.0 FAMILY PLANNING

C1.1 CHECK Q 1.4

CODE OF MARITAL

STATUS OF THE WOMAN

IS 2 (CURRENTLY

MARRIED AND GAUNA

PERFORMED)

CODE IN MARITAL

STATUS OF THE WOMAN

IS OTHER THAN 2

1

2E1.1

C1.2 I WOULD LIKE TO TALK ABOUT

FAMILY PLANNING.

Are you pregnant now?

YES, CURRENTLY

PREGNANT

NO

UNSURE OR DON’T KNOW

01D 1.1

02

98


C1.3 COUPLES USE VARIOUS WAYS OR

METHODS TO DELAY OR AVOID A

PREGNANCY.

Are you/your husband currently doing

something or using any method to delay

or avoid getting pregnant?

YES

NO

1

2 D1.1

C 1.4 Which method you or your husband are

using/used to avoid pregnancy?

DO NOT PROMPT.

IF MORE THAN ONE METHOD

IS MENTIONED, CIRCLE EACH

ONE.

FEMALE STERILIZATION A

MALE STERILIZATION B

IUD C

INJECTABLES D

IMPLANTS E

PILLS F

MALE CONDOM G

FEMALE CONDOM H

DIAPHRAGM I

FOAM/JELLY J

LACTATIONAL

AMENORRHOEA METHOD

(LAM)

K

PERIODIC

ABSTINENCE/RHYTHM L

WITHDRAWAL M

OTHER X

D1.0 CURRENTLY PREGNANT WOMEN

D1.1 CHECK QC 1.2

C 1.1

EMW IS CURRENTLY

PREGNANT

EMW IS NOT CURRENTLY

PREGNANT

1

2E1.1

ANTENATAL CARE

D1.2 How many months pregnant are you

currently?

MONTHS

D1.3 Have you registered your current

pregnancy for ANC?

YES

NO

1

2 D1.6

D1.4 Did you get a card (MCP/any other

similar card) at the time of registration?

PLEASE SHOW THE MCP CARD

YES, SHOWN

YES, BUT NOT SHOWN

NO

1

2

3


D1.5 Did you register the pregnancy at the

AWC?

YES

NO

1

2

D1.6 Did you receive any antenatal check-up

during the current pregnancy?

YES

NO

1

2 D1.8

D1.7 How many months pregnant were you,

when you first received an antenatal

check-up?

MONTHS OF PREGNANCY

(COMPLETED MONTHS)

DON’T KNOW

98

IF THE EMW HAS A CHILD AGED 0 TO 3 YEARS, SKIP TO D 1.11

D1.8 Are you aware of Janani Suraksha Yojana

(JSY) run by the Government?

YES

NO

1 D1.10

2

D1.9 Are you aware about any scheme under

which financial assistance is given to

women for delivering the child at the health

facility?

YES

NO

1

2

D1.1

0 Are you aware of Janani Sishu Suraksha

Karyakaram (JSSK) run by the

Government?

YES

NO

1 D1.11

2

D1.1

0A

Are you aware about any scheme under

which free and cashless maternity services

and newborn care in all Government

healthcare institutions including diet, no

out-of-pocket expenditure for drugs,

disposables, diagnostics, blood transfusion,

referral transport and drop back facility is

provided?

YES

NO

IF ‘NO’ IN D1.8 TO

D1.10A, SKIP TO D1.12

1

2

D1.1

1 Did you receive any assistance under

JSY/JSSK schemes?

YES, FROM JSK

YES, FROM JSSK

YES FROM BOTH JSK

AND JSSK

NONE

1

2

3

4

D1.1

2 Did the following visit you at home during

present pregnancy?

(READ OUT THE OPTIONS)

AWW YES-1 NO-2

ASHA YES -1 NO -2

ANM YES -1 NO -2

DOCTOR YES -1 NO -2

D1.1

3

CHECK Q D1.12

CODE 1 IN ANY OF THE

3 OPTIONS (- AWW OR

ASHA OR ANM)

CODE 2 IN ALL 3 (-

AWW, ASHA AND

ANM)

1

2D2.1


D1.1

4 How many times did AWW/ANM/ASHA

visit your home during since you became

pregnant?

Number of Visits AWW

ANM

ASHA

D 2.0 SERVICES AVAILED FROM AGANWADI CENTRE (CURRENTLY

PREGNANT WOMEN)

D2.1 CHECK Q A 1.6 AND B1.1

EMW IS HAVING A

SURVIVING CHILD AGED

0-35MONTHS OR A CHILD

AGED 36-71MONTHS

EMW IS NEITHER HAVING

A SURVIVING CHILD

AGED 0-35 MONTHS NOR

A CHILD AGED 36-71

MONTHS

1D2.3

2

D2.2 Are you aware of what all services are

provided at the AWC?

FIRST RECORD ALL THE

SPONTANEOUS RESPONSES

AND THEN PROMPT FOR THE

REMAINING CODES

SPON

TANE

OUS

PROMPT

YES NO

SUPPLEMENTARY FOOD

IMMUNISATION

HEALTH CHECK UP

REFERRAL SERVICES

NUTRITION & HEALTH

EDUCATION

NO ANGANWADI CENTRE

IN MY LOCALITY

A

B

C

D

E

FF1

1

1

1

1

1

2

2

2

2

2

D2.3 Have you availed any services from

AWC in your area during current

pregnancy?

(ASK ABOUT HER DESIGNATED

AWC AND INFORM YOUR

SUPERVISOR, IF THERE IS ANY

DISCREPANCY)

YES

NO

01 D2.5

02

D2.4 Why are you not availing any services

from your AWC; the reason(s) thereof?


REASONS.

AWC IS FAR OFF

AWC OFTEN REMAINS

CLOSED

QUALITY OF SERVICES NOT

GOOD


FAMILY OPPOSES

NO BODY TO ACCOMPANY

A

B

C

D

E

F


SKIP TO E1.1

ME

AWW BELONGS TO OTHER

CASTE/RELIGION

TREATMENT AT AWW NOT

WELL

OTHER

I FEEL I AM DISCRIMINATED

G

H

X

I

D2.5 What services are availed by you at the

AWC?

FIRST RECORD ALL THE

SPONTANEOUS RESPONSES

AND THEN PROMPT FOR THE

REMAINING CODES

SPON

TANE

OUS

PROMPT

YES NO

SUPPLEMENTARY FOOD

IMMUNISATION

(TETANUS)

HEALTH CHECK UP

REFERRAL SERVICES

ANC

IFA SUPPLEMENTATION

OTHER

A

B

C

D

E

F

X

1

1

1

1

1

1

2

2

2

2

2

2

D2.6 CHECK Q D2.5

CODED ‘A’

NOT CODED ‘A’

1 D3.2 2

D3.0 INTAKE OF SUPPLEMENTARY FOOD FROM aNGANWADI CENTRE

D3.1 What are the reason(s) for not taking

food from AWC?


REASONS.

ANSWERS D3.1 AND GO SKIP TO

E1.1

AWC OFTEN REMAINS

CLOSED

QUALITY OF SERVICES

NOT UPTO THE MARK


OF SERVICES FROM AWC

AWW’S BEHAVIOUR IS

BAD

I FEEL I AM

DISCRIMINATED

AWC IS FAR OFF

OTHER

A

B

C

D

E

F

X

D3.2 For how many days did you receive

supplementary food from AWC in the

last month?


THEN CODE (NOT


NOT PRESENT IN LAST

MONTH


99

98

D3.3 Of the food received, generally how

much is consumed by you?


SHARED WITH OTHER

01

02


FAMILY MEMBERS

I DON’T LIKE THE FOOD

AND SO DO NOT

CONSUME aT ALL

CANNOT SAY/DON'T

REMEMBER

03

98

E 1.0 NUTRITION, HEALTH EDUCATION AND VISIT TO AWC

(FOR ALL EMWs I N RURAL PSUs ONLY)

E1.1 CHECK 0.05

PSU IS RURAL (CODE 1IN

Q0.05)

PSU IS URBAN (CODE 2 IN

Q0.05)

12E2.1

E1.2 Are you aware that a meeting on health

and nutrition popularly called as Village

Health and Nutrition Day (VHND) or a

mother’ meeting OR MOTHER’S DAY

is held at AWC?

YES

NO

1

2 E2.1

E1.3 Have you attended any such meeting in

the last 3 months?

YES

NO

NOT APPLICABLE

01

02

99

E.2.0 VISITS BY AWW

E2.1 Did the Anganwadi Worker visit you at

home during the last 3 months?

YES

NO

1

2 F1.0

E2.2 If yes, how many times did she visit

your home during the last 3 months?

NUMBER OF TIMES

F1.0 HEIGHT AND WEIGHT MEASUREMENT FOR CHILDREN AGED 0-59

MONTHS

F1.1 Any child is

between 0-59

months

(Autocode

from HH

Roster)

Yes

No

1

2TERMINATE

INTERVIEW

F1.2 NAME of the

child

(Autocode

from HH

Roster)

------------------------

--

-----------------------

---

-------------------------

-

F1.3 Serial number

from column 1 in

HH roster


(Autocode

from HH

Roster)

F1.4 Sex of the child

(Autocode

from HH

Roster)

MALE 1

FEMALE 2

MALE 1

FEMALE 2

MALE 1

FEMALE 2

F1.5 Date of birth

Auto code if

mention in

A2.3 or B1.3

for this child if

not mentioned

in A2.3 and

B1.3 ask the

date of birth

DD/MM/YYYY

DD/MM/YYYY

DD/MM/YYYY

F1.6 Status of weight

measurement

MEASURED 1

NOT PRESENT 2

REFUSED 3

MEASURED 1

NOT PRESENT 2

REFUSED 3

MEASURED 1

NOT PRESENT 2

REFUSED 3

F1.7 Weight of the

mother

(in case of 0-2

years children

KG

KG

KG

F1.8 Weight of the

mother and the

child (in case of 0-

2 years children)

KG

AKG

KG

F1.9 Weight of the

child (in case of

children 2-5 years)

KG

KG

KG

F1.9A Correction Factor

(mention the

weight required to

correct the fault)

Mention –ve or +ve in first box

Grams

F1.10 Status of

height/length

Measurement

MEASURED 1

NOT PRESENT 2

REFUSED 3

MEASURED 1

NOT PRESENT 2

REFUSED 3

MEASURED 1

NOT PRESENT 2

REFUSED 3


F1.10 A Height/length of

the child

HEIGHT 1

LENGTH 2

HEIGHT 1

LENGTH 2

HEIGHT 1

LENGTH 2

F1.11 Height/length of

the child

(centimetres)

CM

CM

CM

REPEAT THIS FOR ALL CHILDREN AGED 0-59 MONTHS

HEIGHT AND WEIGHT MEASUREMENT FOR ADOLESECENT GIRLS 10-19 YEARS (18

COMPLETED)

SERIAL NUMBER, NAME, SEX AND AGE (IN COMPLETED YEARS) OF ALL ADOLESCENTS AGED 10-

19 YEARS (18 COMPLETED) WILL BE AUTOPOPULATED FROM THE HOUSEHOLD ROSTER. FOR

EACH ADOLESCENT GIRL , ASK QUESTIONS

F1.12 F1.13 F1.14 F1.15 F1.16 F1.17 F1.18

Serial

Number

of the

adolesce

nt girl

(Autoco

de from

HH

Roster)

Name of

adolesce

nt girl

(Autoco

de from

HH

Roster)

Age

(IN

COMPLETE

D YEARS)

(Autocode

from HH

Roster)

Weight of

adolescent

girl

(KG )

Status of weight

measurement

Height of

adolescent

girl

(CENTIMET

RES)

Status of height

measurement

KG

MEASURED 1

NOT PRESENT

2

REFUSED 3

CM

MEASURED 1

NOT PRESENT 2

REFUSED 3

KG

MEASURED 1

NOT PRESENT 2

REFUSED 3

CM

MEASURED 1

NOT PRESENT 2

REFUSED 3

G1.0 SUMMARY OF TARGET POPULATION COVERED IN THE INTERVIEW (TO BE

AUTO-POPULATED BY PROGRAMME)

G1.1 The number of EMW, children

aged 0 – 35months, children aged

36 – 71 months lactating women

and pregnant women will be

calculated by the programme and

TARGET POPULATION NUMBER

EMW


populated here.

INTERVIEWER: PLEASE COPY

THIS SUMMARY IN THE

INTERVIEWER ASSIGNMENT

SHEET.

CHILDREN AGED 0 – 35MONTHS

CHILDREN AGED 36 – 71MONTHS

LACTATING WOMEN

PREGNANT WOMEN

H1.0 STATUS OF COMPLETION

H1.1 Result status of the questionnaire

COMPLETED BUT PAUSED

INCOMPLETE

COULD NOT BE INTERVIEWED

1

2

3

H1.3

H1.2 Please mention the reason if the

household could not be interviewed

HOUSEHOLD ABSENT

REFUSED

DWELLING VACANT/ADDRESS

NOT A DWELLING

DWELLING DESTROYED

DWELLING NOT FOUND

OTHER

01

02

03

04

05

96

H1.3 End time of first visit

(PLEASE RECORD TIME IN 12

HOUR FORMAT)

END TIME AM/PM

CHECK IF A16 HAS START TIME, ASK H1.4

IF A17 HAS START TIME, ASK H1.5

H1.4 End time of second visit


HOUR FORMAT)

END TIME AM/PM

H1.5 End time of third visit


HOUR FORMAT)

END TIME AM/PM

THANK THE RESPONDENT FOR HER INVALUABLE TIME AND END THE INTERVIEW

Documents

RSOC National Report 2013-14 (Final)