District Level Household and Facility Survey

Transcription

1 DLHS-3 Ministry of Health and Family Welfare Government of India District Level Household and Facility Survey International Institute for Population Sciences (Deemed University) Mumbai

2 INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES Vision: To position IIPS as a premier teaching and research institution in population sciences responsive to emerging national and global needs based on values of inclusion, sensitivity and rights protection. Mission: The Institute will strive to be a centre of excellence on population, health and development issues through high quality education, teaching and research. This will be achieved by (a) creating competent professionals, (b) generating and disseminating scientific knowledge and evidence, (c) collaboration and exchange of knowledge, and (d) advocacy and awareness.

3 Ministry of Health and Family Welfare Government of India District Level Household and Facility Survey India International Institute for Population Sciences (Deemed University) Mumbai April 2010

4 Suggested citation:- International Institute for Population Sciences (IIPS), District Level Household and Facility Survey (DLHS-3), : India. Mumbai: IIPS. For additional information, please contact: Director/Project Coordinator (DLHS-3) International Institute for Population Sciences Govandi Station Road, Deonar Mumbai (India) Telephone: /5/6, , Fax: , rchpro@iips.net, director@iips.net Website: Additional Director General (Stat.) Ministry of Health and Family Welfare Government of India Nirman Bhavan New Delhi Telephone: Fax: adg-mohfw@nic.in Chief Director (Stat.) Ministry of Health and Family Welfare Government of India Nirman Bhavan New Delhi Telephone: Fax: cdstat@nic.in Website: http: //

5 DLHS-3 Project Coordinators F. Ram L. Ladusingh B. Paswan Sayeed Unisa Rajiva Prasad T.V.Sekher Chander Shekhar

6 IMPORTANT INSTRUCTIONS TO READERS: This report is based on data collected from 7,20,320 households from 28 States and 6 Union Territories of India during From these households, 6,43,944 ever-married women aged years and 1,66,620 unmarried women aged years were interviewed. Most of the tables and analysis presented in the report is based on ever-married women aged years. However, for the purpose of comparison with DLHS-2 ( ) and the Fact Sheet of DLHS-3, we also provided some indicators based on currently married women aged years in selected tables. We request the readers to keep this distinction in mind while using and comparing the DLHS-3 indicators with other surveys. DLHS-3 questionnaires are available in the CD along with this report (inner back cover). For more information, visit DLHS website:

7 CONTENTS List of Tables, Figures and Maps Acronyms... Foreword... Preface and Acknowledgements Executive Summary Page x xv xvii xix xxi CHAPTER I: INTRODUCTION Background and Objectives of the Survey Survey Design House Listing, Household and Facility Selection Survey Instruments Fieldwork and Sample Coverage Data Processing and Tabulation Sample Weights Sample Implementation CHAPTER II: BACKGROUND CHARACTERISTICS OF HOUSEHOLDS Age-Sex Structure of Household Population Household Characteristics Educational Attainment, Current Enrolment and Reasons for Dropout Marriage Housing Characteristics and Assets.... Household Wealth Index..... Village Infrastructure Availability of Educational and Health Facilities by State/Union Territory CHAPTER III: CHARACTRERISTICS OF WOMEN AND FERTILITY Background Characteristics of Women Educational Level of Women Birth Order Children Ever Born Fertility Preferences Desire for Additional Children... Pregnancy Outcomes CHAPTER IV: MATERNAL HEALTH CARE Place of Antenatal Check-up by Background Characteristics and States Components of Antenatal Check-up Advice during ANC The Number and Timing of ANC Visits Antenatal Care Services TT Injection IFA Tablet/Syrup Any ANC Full ANC Antenatal Care Indicators by States & Union Territories... Place of Delivery and Assistance Place of Delivery by State/District..... Mode of Transport, Transport Cost and Delivery Cost

8 Reasons for Not Going to Health Institution for Delivery.. Delivery Complications Post Delivery Complications Any Check-up After Delivery Complications during Pregnancy, Delivery and Post Delivery Period Complications during Pregnancy, Delivery, and Post Delivery by State/Union Territories... Knowledge of Danger Signs for New Born CHAPTER V: CHILD CARE AND IMMUNIZATION Timing and Place of Childhood Check up Initiation of Breastfeeding..... Immunization of Children..... Reasons for Not Immunizing Children Source of Immunization Vitamin A and Hepatitis-B Supplementation Management of Diarrhoea.... Management of Acute Respiratory Infection CHAPTER VI: FAMILY PLANNING Awareness of Contraceptive Methods Ever Use of Contraceptive Method Current Use of Contraceptive Method Duration of Use of Spacing Method... Age at Sterilization... Contraceptive Prevalence Rate by State/District Sources of Modern Method of Contraception Cash Benefits Received after Sterilization.... Health Problems Faced by Current Contraceptive Users and Treatment Received.... Reasons for Discontinuation of Contraception Future Intension to Use..... Advise on Contraceptive Use.. Unmet Need for Family Planning Services CHAPTER VII: REPRODUCTIVE HEALTH PROBLEMS AND AWARENESS OF RTIs/STIs AND HIV/AIDS Menstruation Related Problems Awareness of RTI/STI Knowledge Regarding Mode of Transmission of RTI/STI Prevalence of RTI/STI Sources of Treatment Awareness and Prevalence of RTI/STI by State Knowledge of HIV/AIDS Knowledge of Mode of Transmission about HIV/AIDS Knowledge about Prevention of HIV/AIDS Misconceptions about HIV/AIDS Place of HIV/AIDS Test Undergone HIV/AIDS Test HIV/AIDS Indicators by States and Districts Infertility Primary and secondary infertility Childlessness and Infertility Treatment for Infertility Infertility and treatment by State..... Obstetric Fistula by State viii

9 CHAPTER VIII: CHARACTERISTICS OF UNMARRIED WOMEN Family Life Education Knowledge about Minimum Legal Age at Marriage Menstruation Related Problems and Practices Knowledge about Contraceptive Methods and Sources of Contraception.. Knowledge about RTI/STI and HIV/AIDS Knowledge about Various Reproductive Health and Other Issues CHAPTER IX: HEALTH FACILITY: AVAILABILITY AND QUALITY Population Covered by Health Facility Sub-Centres Primary Health Centres Community Health Centres..... District Hospitals APPENDICES Appendix - A Sampling Error Estimation Appendix - B India Fact-Sheet Appendix - C State and district level indicators Appendix - D Regional agencies involved in DLHS Appendix - E Monitoring agencies involved in DLHS Appendix - F List of contributors Appendix - G Members of Technical Advisory Committee (TAC) Appendix - H Staff involved in DLHS ix

10 LIST OF TABLES, FIGURES AND MAPS CHAPTER I: INTRODUCTION Table 1.1 Number of households, ever married women & unmarried women interviewed... 8 CHAPTER II: BACKGROUND CHARACTERISTICS OF HOUSEHOLDS Table 2.1 Household population by age and sex Table 2.2 Characteristics of head of the Household Table 2.3 Educational status of the household population Table 2.4 Currently attending school Table 2.5 Reasons for dropping out of school Table 2.6 Marital status of the household population Table 2.7 Age at marriage by states Table 2.8 Housing characteristics and assets Table 2.9 Housing amenities and quality by states Table 2.10 Household wealth index by states Table 2.11 Distance from the nearest educational facility Table 2.12 Distance from the nearest health facility Table 2.13 Availability of facility and health personnel by states Table 2.14 Knowledge about government health programmes Figure 2.1 Age-sex pyramid Figure 2.2 Percentage of girls marrying below 18 years by states Figure 2.3 Lowest wealth quintile by states Map 2.1 Spatial variation in percentage of girls marrying below eighteen years by districts Map 2.2 Percentage of households with low wealth quintiles by districts CHAPTER III: CHARACTRERISTICS OF WOMEN AND FERTILITY Table 3.1 Background characteristics of ever married women Table 3.2 Level of education of ever married women Table 3.3 Birth order Table 3.4 Birth order distribution by states Table 3.5 Children ever born Table 3.6 Children ever born by states Table 3.7 Fertility preferences Table 3.8 Desire for additional children by background characteristics Table 3.9 Fertility preferences by states Table 3.10 Sex preferences for the next child by states Table 3.11 Outcomes of pregnancy Table 3.12 Outcome of pregnancy by states Figure 3.1 Birth order 3 and above by selected background characteristics Figure 3.2 Percentage of 3 and above birth order by states Figure 3.3 Mean children ever-born by states x

11 CHAPTER IV: MATERNAL HEALTH CARE Table 4.1 Place of antenatal check-up by background characteristics Table 4.2 Antenatal care by states Table 4.3 Components of antenatal check-up by background characteristics Table 4.4 Women received advice during antenatal care by background characteristics Table 4.5 (A) Antenatal care: ANC visits and time of first ANC check-up by background characteristics Table 4.5 (B) Antenatal care: TT, IFA and ANC by background characteristics Table 4.6 Antenatal care indicators and complications by states Table 4.7 Place of delivery and assistance by background characteristics Table 4.8 Place of delivery and assistance characteristics by states Table 4.9 Mode of transportation used for delivery and arrangement of transportation by background characteristics Table 4.10 Reasons for not going to health institutions for delivery by background characteristics Table 4.11 Delivery complications by background characteristics Table 4.12 Post delivery complications by background characteristics Table 4.13 Any check-up after delivery by background characteristics Table 4.14 Complications during pregnancy, delivery and post-delivery period by background characteristics Table 4.15 Complications during pregnancy, delivery and post-delivery period by states Table 4.16 Knowledge of danger sign of new born by background characteristics Figure 4.1 Any ANC by background characteristics Figure 4.2 Institutional delivery by background characteristics Figure 4.3 Progress in institutional delivery Map 4.1 Percentage women received full ANC by states Map 4.2 Percentage women received full ANC by districts Map 4.3 Institutional delivery by states Map 4.4 Institutional delivery by districts Map 4.5 Safe delivery by districts CHAPTER V: CHILD CARE AND IMMUNIZATION Table 5.1 Timing and place of early childhood check-up by background characteristics Table 5.2 Initiation of breastfeeding by background characteristics Table 5.3 Breastfeeding and weaning status by children s age Table 5.4 Exclusive breastfeeding by background characteristics Table 5.5 Breastfeeding by states Table 5.6 Vaccination of children by background characteristics Table 5.7 Childhood vaccination by states Table 5.8 Reasons for not given vaccination Table 5.9 Place of childhood vaccination by background characteristics Table 5.10 Vitamin A and Hepatitis-B supplementation for children by background characteristics Table 5.11 Knowledge regarding diarrhoea management by background characteristics Table 5.12 Treatment of diarrhoea by background characteristics Table 5.13 Knowledge of diarrhoea management and treatment status by states Table 5.14 Knowledge and treatment of Acute Respiratory Infection by background characteristics Table 5.15 Knowledge of Acute Respiratory Infection management and treatment status by states. 105 xi

12 Figure 5.1 Initiation of breastfeeding in India Figure 5.2 Initiation of breastfeeding by states Figure 5.3 Trends in full immunization coverage of children Figure 5.4 Percentage of children aged months who received specific vaccination Map 5.1 Full immunization coverage of children of aged months by states Map 5.2 Full immunization coverage of children of aged months by districts CHAPTER VI: FAMILY PLANNING Table 6.1 Awareness of contraceptive methods by place of residence Table 6.2 Awareness of contraceptive methods by background characteristics Table 6.3 Awareness of contraceptive methods by states Table 6.4 Ever use of contraceptive methods by background characteristics Table 6.5 (A) Current use of contraceptive methods by background characteristics Table 6.5 (B) Duration of use of spacing methods by background characteristics Table 6.6 Age at the time of sterilization by background characteristics Table 6.7 Contraceptive prevalence rate by states Table 6.8 Sources of modern contraceptive methods by background characteristics Table 6.9 Cash benefits received after sterilization by states Table 6.10 Health problems with current use of contraception and treatment received Table 6.11 Reasons for discontinuation of contraception by background characteristics Table 6.12 Future intention to use by background characteristics Table 6.13 Advice on contraceptive use Table 6.14 Reasons for not using modern contraceptive method among rhythm and withdrawal method users by background characteristics Table 6.15 Unmet need for family planning services by background characteristics Table 6.16 Unmet need for family planning services by states Figure 6.1 Percent currently married women using contraceptive method Figure 6.2 Progress in contraceptive prevalence rate Figure 6.3 Use of any modern method by states Figure 6.4 Trend in unmet need for contraception Figure 6.5 Contraceptive prevalence rate and unmet need by states Map 6.1 Contraceptive prevalence rate by districts CHAPTER VII: REPRODUCTIVE HEALTH PROBLEMS AND AWARENESS OF RTIs/STIs AND HIV/AIDS Table 7.1 Menstruation related problems by background characteristics Table 7.2 Source of knowledge about RTI/STI by background characteristics Table 7.3 Knowledge of mode of transmission of RTI/STI by background characteristics Table 7.4 Symptoms of RTI/STI by background characteristics Table 7.5 Discussed about RTI/STI problems with husband and sought treatment by background characteristics Table 7.6 RTI/STI indicators by States Table 7.7 Knowledge of HIV/AIDS by background characteristics Table 7.8 Knowledge about mode of transmission of HIV/AIDS by background characteristics xii

13 Table 7.9 Knowledge of HIV/AIDS prevention methods by background characteristics Table 7.10 Misconception about transmission of HIV/AIDS by background characteristics Table 7.11 Knowledge about the place where HIV/AIDS test can be done by background characteristics Table 7.12 Undergone HIV/AIDS test by background characteristics Table 7.13 HIV/AIDS indicators by states Table 7.14 Ever had infertility problem by background characteristics Table 7.15 Childlessness and infertility by background characteristics Table 7.16 Treatment for infertility by background characteristics Table 7.17 Infertility problem and sought treatment by states Table 7.18 Women having Obstetric fistula by states Figure 7.1 Heard about RTI/STI by background characteristics Figure 7.2 Knowledge about mode of transmission of HIV/AIDS Map 7.1 Heard about HIV/AIDS by districts Map 7.2 Knowledge that HIV/AIDS can be transmitted from mother to her baby by districts Map 7.3 Knowledge about place of HIV/AIDS test by districts CHAPTER VIII: CHARACTERISTICS OF UNMARRIED WOMEN Table 8.1 Background characteristics of unmarried women Table 8.2 At what age and standard family life education should be introduced by background characteristics Table 8.3 Sources of family life education by background characteristics Table 8.4 Ever received family life education by sources and by background characteristics Table 8.5 Knowledge of legal age at marriage and reported ideal age at marriage for boys and girls by background characteristics Table 8.6 Current status of menstruation and experienced menstruation related problems during last three months and reported problems by background characteristics Table 8.7 Practices during menstrual period by background characteristics Table 8.8 Knowledge of contraceptive methods by background characteristics Table 8.9 Sources from where to get pill and condom by background characteristics Table 8.10 Discussion about family planning method by source of information by background characteristics Table 8.11 Knowledge of RTI and STI by sources and by background characteristics Table 8.12 Knowledge of RTI/STI transmission by background characteristics Table 8.13 Awareness and knowledge of RTI/STI transmission by states Table 8.14 Knowledge of HIV/AIDS by sources and by background characteristics Table 8.15 Knowledge of HIV/AIDS transmission by background characteristics Table 8.16 Misconception about transmission of HIV/AIDS by background characteristics Table 8.17 Knowledge about how to avoid or reduce the chances of infecting HIV/AIDS by background characteristics Table 8.18 Knowledge regarding where to get tested for HIV/AIDS and sources by background characteristics Table 8.19 HIV/AIDS indicators by states Table 8.20 Knowledge of some selected statements by background characteristics Table 8.21 Awareness of selected characteristics by states xiii

14 Figure 8.1 Age for introducing family life education Figure 8.2 Standard from which family life education should be introduced Figure 8.3 Sources of family life education Figure 8.4 Knowledge about legal age at marriage by background characteristics Figure 8.5 Menstruation related problems in the last three months Figure 8.6 Knowledge of contraceptive methods Figure 8.7 Knowledge about mode of transmission of HIV/AIDS Figure 8.8 Knowledge about reducing the chances of getting infected with HIV/AIDS Figure 8.9 Knowledge regarding where to get tested for HIV/AIDS and sources Figure 8.10 Awareness on reproductive issues Figure 8.11 Awareness of selected characteristics Map 8.1 Median age when family life education should be introduced by states Map 8.2a Knowledge about minimum legal age at marriage for boys Map 8.2b Knowledge about minimum legal age at marriage for girls Map 8.3 Knowledge about place of HIV/ADIS test by states Map 8.4 Perceived family life education to be important by states CHAPTER IX: HEALTH FACILITY: AVAILABILITY AND QUALITY Table 9.1 Average population covered by health facility by states Table 9.2 Percentage of villages having a Sub-Centre within villages & ANM available at Sub-Centre and staying in Sub-Centre quarter by states Table 9.3 Status of infrastructure at Sub-Centre functioning in government building by states Table 9.4 Percentage of Sub-Centre having adequately equipped and essential drugs by states Table 9.5 Percentage of Sub-Centre having different activities by states Table 9.6 Available human resources at Primary Health Centres by states Table 9.7 Available infrastructure at Primary Health Centres by states Table 9.8 Specific health facilities available at Primary Health Centres by states Table 9.9 Percentage of Primary Health Centres by different activities by states Table 9.10 Human resources available at Community Health Centres by states Table 9.11 Specific health care facilities available at Community Health Centres by states Table 9.12 Percentage of Community Health Centres having different activities by states Table 9.13 Human resources available at District Hospitals by states Table 9.14 Investigative and laboratory services available at District Hospitals by states Table 9.15 Infrastructure facility available at District Hospitals by states Table 9.16 Twenty-four hours emergency obstetric care services available at District Hospitals by states Table 9.17 Percentage of District Hospitals having different activities by states xiv

15 ACRONYMS AIDS: ANC: ANM: ARI: ASHA: AWW: AYUSH: BCG: BP: BPL: CEB: CHC: CPR: CSPro: DLHS: DPT: EAG: ECG: ECP: ELISA: EPI: FHW: FRU: GoI: HIV: ICDS: ICTC: IEC: IFA: IIPS: IMNCI: IMR: IPHS: IUD: JSY: LMO: LPG: MCEB: MDG: MMR: MO: MoHFW: MTP: NIC: NGO: NPP: NRHM: NSV: OBC: OPD: ORS: ORT: OT: PHC: PPS: Acquired Immuno Deficiency Syndrome Antenatal Care Auxiliary Nurse Midwife Acute Respiratory Infection Accredited Social Health Activist Anganwadi Worker Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. Bacillus Calmette Guerin Blood Pressure Below Poverty Line Census Enumeration Block Community Health Centre Contraceptive Prevalence Rate Census and Survey Processing System District Level Household and Facility Survey Diphtheria, Pertussis and Tetanus Empowered Action Group Electrocardiogram Emergency Contraceptive Pill Enzyme-linked Immunosorbent Assay Expanded Programme on Immunization Female Health Worker First Referral Unit Government of India Human Immuno Deficiency Virus Integrated Child Development Scheme Integrated Counseling and Testing Centre Information, Education and Communication Iron and Folic Acid International Institute for Population Sciences Integrated Management of Neonatal and Childhood Illnesses Infant Mortality Rate Indian Public Health Standards Intra-uterine Device Janani Suraksha Yojana Lady Medical Officer Liquefied Petroleum Gas Mean Children Ever Born Millennium Development Goal Maternal Mortality Ratio Medical Officer Ministry of Health and Family Welfare Medical Termination of Pregnancy National Informatics Centre Non-Governmental Organization National Population Policy National Rural Health Mission Non-scalpel Vasectomy Other Backward Class Out-Patient Department Oral Re-hydration Salt Oral Re-hydration Therapy Operation Theatre Primary Health Centre Probability Proportional to Size xv

16 ACRONYMS PSU: RA: RCH: RKS: RTI: SC: SPSS: ST: STI: T.V: TAC: TT: UFWC: UHP: UIP: UNFPA: UNICEF: UT: VCTC: VHSC: WHO: Primary Sampling Unit Regional Agency Reproductive and Child Health Rogi Kalyan Samiti Reproductive Tract Infection Scheduled Caste Statistical Package for Social Sciences Scheduled Tribe Sexually Transmitted Infection Television Technical Advisory Committee Tetanus Toxoid Urban Family Welfare Centre Urban Health Post Universal Immunization Programme United Nations Population Fund United Nations Children s Fund Union Territory Voluntary Counseling and Testing Centre. Village Health and Sanitation Committee World Health Organization xvi

17 xvii

18 xviii

19 Preface and Acknowledgements The District Level Household and Facility Survey (DLHS-3) is a nationwide survey covering 601 districts from 34 states and union territories of India. This is the third round of the district level household survey which was conducted during December 2007 to December The survey was funded by the Union Ministry of Health and Family Welfare, United Nations Population Fund (UNFPA) and United Nations Children s Fund (UNICEF). We are very grateful to the Ministry of Health & Family Welfare, Government of India for designating the International Institute for Population Sciences (IIPS) as the nodal agency for the DLHS-3 Project and providing an opportunity to work closely with the health and programme officials. In particular, we would like thank Ms. K. Sujatha Rao, Secretary-Ministry of Health and Family Welfare (MoHFW), Government of India for her advice, suggestions and support. We also thank Shri Naresh Dayal, former Secretary-Ministry of Health and Family Welfare (MoHFW), Government of India for the advice and valuable support extended to the project. Our special thanks to Smt. Madhu Bala, the Additional Director General, Dr. Rattan Chand, the Chief Director and Shri. Rajesh Bhatia, the Director-Statistics Division, Ministry of Health and Family Welfare, Government of India for their active involvement and suggestions. We are also thankful to Dr. V.K. Malhotra and Shri S.K. Das, former Additional Director Generals, Shri Partha Chattopadhyay, former Chief Director, Shri K. D. Maiti, former Director and Ms. Rashmi Verma, former Deputy Director- Statistics Division, MoHFW, Government of India for the co-operation and support at various stages of this project. We are grateful to late Prof. P. N. Mari Bhat, former Director, IIPS and Prof. S. Lahiri, formerly officiating Director, IIPS for their keen interest and guidance in the initial stages of the project. We acknowledge the contributions of Regional Agencies for field implementation of DLHS-3 in various states and Monitoring Agencies involved in the project and the National Institute of Health and Family Welfare (NIHFW), New Delhi for independently monitoring the field work operations. Our thanks to the members of Technical Advisory Committee (TAC) of DLHS-3 and especially to its Chairman, Dr. P. M. Kulkarni, Professor, Jawaharlal Nehru University, New Delhi. We also thank Dr. N.K. Singh for guiding the software development and CSPro training for the project staff. We gratefully acknowledge the immense contributions of DLHS-3 project team at IIPS in developing survey instruments, training field staff, monitoring field work, data processing, preparation of district and state level fact sheets, and drafting the reports. We thank Dr. T.K. Roy and Dr. Sumati Kulkarni for reviewing the report and for their useful suggestions. Finally, special thanks to all respondents who spared their valuable time and cooperated with us by providing the required information. xix DLHS-3 Coordinators International Institute for Population Sciences

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21 EXECUTIVE SUMMARY In order to monitor the ongoing health and family welfare programmes, the need for a database at the district level was felt by the Government of India. For this, the District Level Household and Facility Survey (DLHS) was undertaken. The present District Level Household and Facility Survey (DLHS-3) is third in the series preceded by DLHS-1 in and DLHS-2 in DLHS-3 is one of the largest ever demographic and health surveys carried out in India, with a sample size of about seven lakh households covering all districts of the country. DLHS-3, like other two earlier rounds, is designed to provide estimates on maternal and child health, family planning and other reproductive health indicators. In addition, DLHS-3 provides information related to the programmes under the National Rural Health Mission (NRHM). Unlike other two rounds in which currently married women aged years were interviewed, DLHS-3 interviewed ever-married women (aged 15-49). In DLHS-3, along with ever-married women, unmarried women (aged 15-24) are also included as respondents. DLHS-3 adopted a multi-stage stratified probability proportion to size sampling design. The International Institute for Population Sciences (IIPS) was designated as the nodal agency for carrying out the survey. Bilingual questionnaires in local language and in English pertaining to Household, Ever Married Women (aged years), Unmarried Women (aged years) were used. Separate questionnaires for Village and Health Facilities were used to gather required information. In the household questionnaire, information on all members of the household and socio-economic characteristics of the household, assets possessed, number of marriages and deaths in the household since January 2004, etc. were collected. The ever-married women s questionnaire contained information on women s characteristics, maternal care, immunization and childcare, contraception and fertility preferences, reproductive health including knowledge about RTI/STI and HIV/AIDS. The unmarried women s questionnaire contained information on women s characteristics, family life education, awareness about reproductive health and contraception and HIV/AIDS, etc. The village questionnaire consists of information on availability of health, education and other facilities in the village, and whether the facilities are accessible throughout the year. The health facility questionnaires contained information on human resources, infrastructure and services. For the first time, population-linked facility survey was conducted in DLHS-3. At the district level, all Community Health Centres (CHC) and District Hospital were covered. Further, all Sub-Centres and Primary Health Centres (PHC) which were expected to serve the population of the selected Primary Sampling Unit (PSU) were also covered. Fieldwork was conducted during December 2007-December 2008, gathering information from 7,20,320 households from 601 districts across India. The salient findings of the survey: The data was collected from 7,20,320 households from 34 states and union territories of India (excluding Nagaland). From these households, 6,43,944 ever married women aged years and 1,66,260 unmarried women aged years were interviewed. This report is based on the data collected from these women. However, for the purpose of comparison of indicators given in the

22 factsheet, we have also provided the indicators based on currently married women aged in selected tables. Among the total households interviewed, 22 percent were from urban areas. Seventy-six percent of the sampled households belonged to Hindus, 11 percent Muslims and 7 percent Christians. Thirtysix percent of the households belonged to either scheduled caste or scheduled tribe categories. Thirty-six percent of the households lived in kachcha houses and about 32 percent are in semi-pucca houses and the remaining in pucca houses. Less than one-fifth of the households in India are falling under the low standard of living category. More than 30 percent of the households in Bihar, Chhattisgarh, Jharkhand, Orissa and Uttar Pradesh come under the low standard of living category. But less than one percent of households in Punjab, Delhi, Himachal Pradesh and Kerala belonged to this category. About 72 percent of population (aged seven and above) are literate. Percent literate among females is only 63 whereas it is 81 for males. More than one-third women in the country are non-literates. The reporting of the marriages during the three years prior to the survey gives the mean age at marriage among boys and girls in the country as 24 and 19.8 years respectively. About one-fourth of the boys and a little more than one-fifth of the girls in India get married before attaining the legally prescribed minimum legal age at marriage of 21 and 18 years respectively. This proportion is much higher in the rural areas compared to urban areas. The mean age at marriage is highest in Goa (30 years for boys and 25 years for girls). The lowest mean age at marriage for boys is 21 years recorded in the state of Rajasthan. For girls, the lowest is 18 years observed in Rajasthan and Bihar. The percentage of girls who were married before attaining the legal age at marriage is highest in Bihar (46 percent) and Rajasthan (40 percent) and lowest in Himachal Pradesh (2 percent). In the case of boys, those married before reaching 21 years is highest in Rajasthan (48 percent), followed by Uttar Pradesh (43 percent), Bihar (42 percent) and Madhya Pradesh (41 percent) and it is lowest in Kerala (1 percent). On an average, women who complete their reproductive span given birth to 4 children. The share of births of the order 3 and above in the total births that occurred three years prior to the survey is 39 percent. The data on regional differentials for the third and higher order births show clear pattern between the southern states and the Empowered Action Group (EAG) states. Third and higher order births form about 55 percent of all births in Uttar Pradesh and Bihar. The data collected on the utilization of Antenatal Care (ANC) services for the women who had their last live/still birth during the three years prior to the survey shows that at the national level 75 percent of the women received at least one antenatal care visit during pregnancy. About 55 percent women received ANC from government health facilities. The percent of women who received any ANC during pregnancy is lowest in Meghalaya (55 percent) and almost universal in Tamil Nadu, Goa, Kerala and Lakshadweep. Though 75 percent of the women in India received any ANC, only 49, 46 and 50 percent women had check-up of weight, blood pressure and abdomen respectively. Forty-seven percent women received Iron and Folic Acid (IFA) tablets/syrup and 73 percent got at least one TT injection. A full package of ANC (including minimum of three ANC visits, at least one TT injection and 100 or more IFA tablets/syrup) was received by only 18 percent of women. xxii

23 Minimum of three ANC visits and timing of first antenatal check up is crucial for maternal and child care. In India, 45 percent of women got ANC in the first trimester of pregnancy and about half of the women had minimum of three antenatal check-up. The coverage of ANC in first trimester varies from 24 percent in Bihar to 96 percent in Kerala. At the national level, nearly half of the deliveries (47 percent) took place in health institutions. Seventy percent of the deliveries in urban areas took place in health institutions whereas it is only 38 percent in rural areas. The extent of institutional deliveries in India varies considerably across the states/union territories, from the lowest of 18 to 28 percent in Jharkhand, Chhattisgarh, Meghalaya, Uttar Pradesh and Bihar to the highest of 94 to 99 percent in Tamil Nadu, Goa and Kerala. In Punjab, Maharashtra, Karnataka, Delhi and Andhra Pradesh, 60 percent or more deliveries took place in institutions. The percent of institutional deliveries increases substantially with women s level of education and economic status of households. As in the case of antenatal care coverage, the extent of institutional and safe deliveries varies considerably across the surveyed districts of India. The lowest percentage of institutional deliveries was reported in Jharkhand (17.7 percent). In India, 61 and 35 percent of the women experienced delivery and post-delivery complications respectively. About 55 percent of the women sought treatment for pregnancy complications and 57 percent for post-delivery complications. In Bihar, Jharkhand, Himachal Pradesh, Sikkim, West Bengal, Tripura and Uttarakhand more than seventy percent of women had delivery complications. In Assam, Uttarakhand, Sikkim, Uttar Pradesh, West Bengal, Jharkhand, Bihar, Jammu and Kashmir and Madhya Pradesh 40 to 57 percent of women suffered from one of the post-delivery complications. The incidence of all the three types of complications seems to be linked with each other. In the states where the incidence of pregnancy complications is high, the incidence of delivery and post-delivery complications are also high. The practice of breastfeeding is universal in the country, but the initiation of early breastfeeding within one hour of the birth of the child is not common. Two-fifth of women started breastfeeding within one hour of birth and 71 percent breastfed within one day of birth. However, 29 percent of mothers started breastfeeding only after 24 hours. There is great deal of variation in the pattern of breastfeeding across the states/union territories. More than 70 percent of the children were put to the breast within one hour of birth in Mizoram, Tamil Nadu and Meghalaya. The extent of early breastfeeding ranges between percent in Uttarakhand, Sikkim, Assam, Orissa, Goa and Kerala. More than 90 percent children received colostrum in Himachal Pradesh, Rajasthan, Manipur, Mizoram, Kerala and Tamil Nadu. At the national level 87, 63, 66 and 69 percent of the children (aged months) received BCG vaccine, three doses of DPT, three doses of Polio and measles vaccine respectively. There is considerable drop from BCG to measles vaccine coverage. It means that large number of children who had initial contact with service providers are missed out of subsequent services. The complete schedule of immunization including BCG, three doses of DPT and Polio each, and measles was received by 54 percent of the children. Nearly 5 percent of the children did not receive a single recommended vaccine. About 57 percent of the children (aged months) received supplementation of at least one dose of Vitamin A and only 19 percent children received 3-5 doses of Vitamin-A. The coverage of complete immunization (consisting of BCG, three injections of DPT, xxiii

24 three doses of Polio and measles) is lowest in Arunachal Pradesh (13 percent) and highest in Goa (90 percent). In eight states of Assam, Bihar, Rajasthan, Uttar Pradesh, Tripura, Meghalaya, Manipur and Madhya Pradesh, the coverage of full immunization is below the national average (54 percent). In India, 78 percent of the women were aware of diarrhoea management. During the two-week period prior to the survey, 12 percent of children suffered from diarrhoea. In comparison to the awareness about diarrhoea management, the awareness about danger signs of Acute Respiratory Infection (ARI) is quite low. Only 57 percent of the women reported as having awareness about danger signs of ARI. Eleven percent of the women reported that their children suffered from ARI during the two-week period prior to the survey. Seventy-seven percent of the children who suffered from ARI or fever sought advice/treatment. Although the knowledge of diarrhoea management is quite high in almost all the states/union territories but the knowledge about ORS is relatively low in many states. Women in Assam, Uttar Pradesh, Rajasthan, Jharkhand, Haryana, Maharashtra, Tamil Nadu and Andhra Pradesh have relatively low levels of knowledge about ORS. The knowledge of family planning methods is almost universal in India, with 99 percent women reporting the knowledge of one method or the other. The knowledge of any modern method is also universal. Awareness about spacing method is important from the point of view of increasing birth spacing. Pill was the most popularly known method among the temporary modern methods of family planning. Among traditional methods, rhythm method is the most popular method of family planning. At the national level, 53.3 percent of currently married women were aware of rhythm method. In case of spacing methods, the awareness regarding IUD was low in Andhra Pradesh (37.2 percent), Assam (60.1 percent), Chhattisgarh (50.9 percent), Jharkhand (36.7 percent), Madhya Pradesh (56.5 percent), Meghalaya (43.6 percent), Orissa (52.2 percent) and Tripura (55.5 percent). For Pills, awareness was much lower than the national average in the states of Andhra Pradesh (46.3 percent), Jharkhand (64.9 percent) and Meghalaya (65.7 percent). Awareness about rhythm method was much higher in West Bengal (81.7 percent), Punjab (71.2 percent) and Uttar Pradesh (70.5 percent). Haryana, Assam, Jammu & Kashmir, Punjab, Rajasthan and Uttar Pradesh were ranked high in the awareness of withdrawal method. Almost half of the currently married women (48.2 percent) were using modern methods of family planning at the time of survey. Among the permanent modern methods, female sterilization was the most popular. Country as whole, 35.8 percent women opted for sterilization. Contraceptive prevalence rate (CPR) for any modern method was quite high in states like West Bengal (72 percent), Himachal Pradesh (71.4 percent), Punjab (69.3 percent), Andhra Pradesh (66.7 percent), Maharashtra (65.1 percent) and Kerala (64.4 percent). On the other hand, Meghalaya (22.7 percent), Bihar (33.3 percent) and Uttar Pradesh (38.4 percent) are lagging behind. More than 60 percent of the currently married women were using any modern method of family planning in states like Himachal Pradesh, Andhra Pradesh, Karnataka, Maharashtra and Punjab. In the case of permanent methods of family planning, prevalence of female sterilization was much higher in Andhra Pradesh (61.6 percent), Karnataka (58.3 percent), Tamil Nadu (55.5 percent), Maharashtra (53.0 percent). It is quite low in Assam (11.5 percent) and Uttar Pradesh (17.5 percent). The government health facilities (consisting of government/municipal hospitals, community health xxiv

25 centres, primary health centres and Sub-Centres are the major sources of contraception for current users of modern methods. The total unmet need for contraception was 20.5 percent at the national level comprising 13.3 percent for limiting and 7.2 percent for spacing. The unmet need for family planning was higher than the national average in states like Bihar (35.9 percent), Jharkhand (33.5 percent), Uttar Pradesh (32.5 percent), Assam (23.6 percent) and Orissa (23.0 percent). Unmet need for limiting is high in Bihar (22.6 percent), Uttar Pradesh (21.9 percent), Jharkhand (20.8 percent), Assam (18.2 percent) and Orissa (15.6 percent). Unmet need for spacing is higher than 10 percent in Bihar (13.3 percent), Meghalaya (13.4 percent), Jharkhand (12.7 percent) and Uttar Pradesh (10.7 percent). At the national level, 33 and 59 percent of women are aware of RTI/STI and HIV/AIDS respectively. The percent of women who are aware of RTI/STI is lowest in Meghalaya (8 percent) and highest in Kerala (76 percent). The awareness of HIV is lowest in Jharkhand (25 percent) and Bihar (29 percent) and highest in Kerala (98 percent). About 18 percent of women in India reported as having at least one symptom of RTI/STI. Survey on Unmarried Women: For the first time DLHS-3 covered unmarried women aged years. A total of 1,66,260 unmarried women were interviewed of which 1,21,569 are from rural areas. Around three-fourth of these women are in the age group of years. Information about family life education was obtained from respondents regarding the age and the standard from which the family life education should be introduced. Nearly 73 percent of the unmarried women are aware of family life education. Seventy-seven percent of women from rural areas and 85 percent from urban areas perceive that family life education is important. About 37 percent of the unmarried women were of the opinion that the appropriate age for initiating the family life education is years. However, about 33 percent of the women felt that family life education should be introduced during years. Fortyfour percent of the unmarried women were of the opinion that the best time for introducing family life education is when the children are in the tenth standard of school and above. Eighty-one percent of the women perceived that parents are the best source for family life education. Fifty-five percent also felt that teachers in schools and colleges can impart family life education. Among the sample respondents, 48 percent of them received family life education of which 80 percent of them had from schools/colleges. The unmarried women were asked their opinion regarding the ideal age of marriage for boys and girls. Ninety percent of the women reported that the ideal age of marriage for boys as 21 years and above. Almost all the women felt that for girls, the ideal age for marriage is 18 years and above. About 87 percent of the unmarried women are aware about the legally prescribed minimum age at marriage for boys and girls in India. Nearly 94 percent of the unmarried women are aware about the modern methods of contraception. The awareness level is high among the women from urban areas, having higher levels of education and belonged to higher wealth quintile households. Ninety percent of the unmarried women have knowledge about female sterilization and 79 percent of them knew about oral pills. The knowledge of other contraceptive methods varies considerably condoms (70 percent), IUD (53 percent) and xxv

26 injectable (43 percent). The knowledge regarding rhythm method (17 percent) and emergency contraception (30 percent) is relatively low. The unmarried women were further asked if they had ever discussed about family planning with anyone and who provided them with the required information. Nearly 23 percent of the women had discussed about the family planning with someone, and most of them preferred to discuss with friends. Twenty-two percent of unmarried women also stated that their source of information on family planning was parents. One-third of the unmarried women had heard of RTI/STI. The level of awareness is more among the urban, educated and those belong to higher wealth quintile households. Television emerged as a major source of information for the young women (57 percent). The other sources of information on RTI/STI are print media (47 percent), radio (27 percent), relatives and friends (39 percent) and adult education programs and teachers (32 percent). Four out of five among surveyed women had heard of HIV/AIDS. The major sources of information are television (78 percent), print media (53 percent), radio (38 percent) and health personnel (11 percent). However, young women also have many misconceptions about the transmission of HIV/AIDS. 18 percent of them believed that HIV/AIDS can be transmitted through bites of mosquito or bedbug and 10 percent even felt that AIDS can be transmitted through kissing and sharing of food. About 66 percent of the unmarried women knew the place where one can get tested for HIV/AIDS. Health Facilities: Availability and Quality DLHS-3 also collected information regarding facilities available at the Sub-Centre, Primary Health Centre (PHC), Community Health Centre (CHC) and District Hospital. The main objectives of the health facility survey are to assess the facilities having critical inputs as per the norms, and to know the extent of utilization of facilities at various levels. The health facility survey has been conducted as a companion survey of the household survey in DLHS-3. There were separate questionnaires for each category of health facility, including questions on infrastructure, human resources, supply of drugs and instruments, and performance. According to this survey, the average population covered by a Sub-Centre is 8,372 and for PHC, it is 49,193. About 91percent of the Sub-Centres have ANM in position and in 58 percent of the cases, ANM is residing in Sub-Centre quarter. The Percentage of Sub-Centres having basic infrastructure like water (73 percent), toilet (65 percent) and regular electricity (23 percent) vary considerably. The survey found that nearly 84 percent of the Sub- Centres are adequately equipped (60 percent of the required instruments and facility). Under the National Rural Health Mission (NRHM), many new initiatives have been introduced at the Sub- Centre level. In 83 percent of the villages, the Village Health and Sanitation Committees (VHSCs) were formed and 81 percent of the Sub-Centres received untied funds. The facility survey also observed that 76 percent of the PHCs have Medical Officer in position. However, the lady medical officer is available only in 24 percent and AYUSH doctor in 19 percent of the sampled PHCs. Nearly 67 percent of the PHCs have at least four beds, 37 percent have functioning vehicles and 36 percent have regular electricity supply. The functional Operation Theatre (OT) is available in 61 percent of the PHCs and new born care equipments are available in 28 percent of the PHCs. About 76 percent of the PHCs have constituted Rogi Kalyan Samiti (RKS) and 78 percent of the PHCs received untied fund. Interestingly, only 70 percent of the PHCs could utilize the untied fund. xxvi