3. CHHATTISGARH I. BACKGROUND CHARACTERISTICS

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1 The state of Chhattisgarh was carved out from the eastern part of Madhya Pradesh. The new state of Chhattisgarh came into existence on November 1, At the time of 1991 census when it was still a part of Madhya Pradesh, Chhattisgarh comprised only seven districts; by 2001 census it had sixteen districts, 97 Taluks 146 blocks, villages and 97 urban centres. Chhattisgarh has a population of 20.8 million (2001 census). The State constitutes 2.03% of the total population of the country and is ranked number 17 among all the states and UTs. The total area is 1,35,195 km 2. The land area share is 4.11% of India. The population of Chhattisgarh increased from 14.0 million in 1981 to 20.8 million in 2001 but population growth has begun to decline in the State. The population growth rate was 18.1% during , lower than the growth rate of 25.7% in the proceeding decade. The decadal growth rate of Chhattisgarh was also lower than the country growth of 21.3%. The population density is 154 per km 2 lower than the density rate of 324 per km 2 for all India. It is one of the more sparsely populated state in India, ranking 26. The sex ratio of 990 females for 1000 male and higher than the all India sex ratio of 933. Child population sex ratio(0-6 years) is 975 girls for 1000 boys much higher than the all India ratio of 927. The literacy rate for the population age 7 and above is 78% for males 52% for females and 65% for the total population. Chhattisgarh ranks 23 among 35 states of India and territories. I. BACKGROUND CHARACTERISTICS In Chattisgarh 81% of the population lives in rural areas. 37% of the population is below 15 years, and only 6% is 65 years and above. The sex ratio is 1031 in rural area and 929 in urban areas and 1011 for the State as a whole. 93% of the house-holds are Hindus, 5% Christians, one percent Muslims, one percent other religions. Mainly Jains and Muslims are more concentrated in urban areas where they comprise 5% whereas Christians are more concentrated in rural areas where they comprise 6% of the households. 37% of the population is (tribal) schedule tribes, 39% are OBCs, 15% schedule caste and 9% do not belong to any of the groups. 58% of the households have electricity compared with 60% in India as a whole and 72% in Madhya Pradesh. 38% of the households are within 15 minutes from the safe drinking water supply but much lower than the 3. CHHATTISGARH 25 national average of 62%, only 17% have piped water supply. 85% of Chattisgarh do not have toilet facility. Only 14% have toilet facility. 2/3 of households own some land, but only 27% own land that is irrigated; 2 in 5 households of Chattisgarh have a low standard of living. Only one in ten enjoy high standard of living, 77% of male and 48% of female age 6 and above are literate. Among children age 6-14 years only 79% are attending school, 84% boys and 75% girls. Ninty-two (92%) of women are involved in decision making. A much lower proportion however are involved in decision making about their own health care i.e. 49%, purchasing jewellery or other major household items; only 54% going with parents and staying with them. In Madhya Pradesh only 32% of women are involved in decision making about their own health. Women of Chattisgarh may enjoy somewhat more autonomy than Madhya Pradesh but their autonomy is still limited. Only 1/4 of women are allowed to visit friends or relatives without seeking permission. 64% of women in Chattisgarh do work outside other than house work, about half of employed women work for cash, 1/3 of women who earn cash can decide independently how to spend money that they earn. two out of five women who work for cash, their own earnings constitute half of their family total earnings. A. Marriage: Women in Chattisgarh tend to marry at an early age. 34% of women age are already married. The median age at marriage among women age is 15.4 only slightly higher than the marriage age in Madhya Pradesh (i.e. 14.9). 54% of women who are now age years married before they were 15 years. 3/4 of women in Chattisgarh still marry before they reach the legal minimum age at marriage of 18 years, average women are four years younger than the men they marry. B. Fertility: Women in Chattisgarh will have an average of 2.8 children each throughout their childbearing years. It is less than in Madhya Pradesh by 0.7 children; 0.8 children higher in rural areas than urban areas. 26% of births take place within 24 months in Chattisgarh of previous birth. Women belonging to schedule caste, schedule tribe and backward class have about one child more than women who do not belong to these categories. The median age for the first birth (women age 20-49) is 18.1 years. 16% of women have 3 living children and 11% of women with 4 or more living children. 9% of

2 births in the 3 years proceeding NFHS-2 mothers report that they did not want the pregnancy at all and another 9% of the births mothers say that they would have preferred to delay the pregnancy. This gap between women s actual fertility experience and what they want or would consider ideal indicates that there is a need for expanded or improved family welfare services to help women achieve their fertility goals. C. Family Planning: Many women in Chattisgarh are not using family planning. It is not due to lack of knowledge. Knowledge of contraception is nearly universal. 98% of currently married women know at least one modern family planning method. Women are most familiar with female sterilization 97%, fallowed by male sterilization 86%, the pill 68%, condom 55%, IUD 40%; 2 out of 5 women have knowledge of at least one traditional method. Only 45% of married women in Chattisgarh are currently using some method of contraception but in Madhya Pradesh also it is only 44% less than the national average of 48%. Contraceptive prevalence in Chattisgarh is 59% in urban and 42% in rural areas. 35% of currently married women are sterilized. By contrast only 3% husbands are sterilized; over- all 85% of sterilization accounts for contraceptive use. Use rate for pill only 1%, IUD 1% and condom 2%. Use of officially sponsored spacing methods in Chhattisgarh is only 4% and is lower than the all India percentage of 7%; women tend to adopt family planning only after they have achieved their desired family size. As a result; contraceptive use can be expected to rise steadily with age and number of children living. Women with two living children using contraceptives is only 19%, if both children are daughters 44% use contraceptives; if one son and daughter is living, 51% use if both children are sons. 14% of women in Chattisgarh have an unmet need for family planning compared with 17% in Madhya Pradesh. Government of India has been using electronic and other mass media to promote family planning. Exposure to mass media is fairly good in Chattisgarh. 85% rural houses have electricity and 20% have a cable connection. 56% ever married women in Chattisgarh saw or heard a family planning message in the media. Only 20% of currently married women in Chhattisgarh have discussed family planning with their husbands. 89% of women use contraceptives from Government hospitals or other sources in the public sector. Only 3% obtained from private medical sector. 82% of contraceptive users in Chattisgarh received followup services after adopting this method. It is only 76% in Madhya Pradesh. The median age for female 26 sterilization is now 26 years. Table-1 shows the current fertility. Table 1: Current fertility NFHS Age Urban Rural Total Total Fertility Rate(TFR) TFR Crude birth rate(cbr) II. INFANT AND CHILD MORTALITY The infant mortality rate was 81 deaths of infants per 1000 live births, much higher than the infant mortality rate of 68 in India as a whole. But some- what lower than the infant mortality rate of 88 in Madhya Pradesh. The child mortality rate in Chattisgarh was 45 (age 1-4 years) per 1000 children reaching age one. In all, 123 children die before reaching age 5. Infant mortality is 70% higher among children born to mothers under 20 years of age. Infant mortality among children born less than 24 months after a previous birth is 27-55% higher. This has resulted in the use of contraceptive methods (temporary) for delaying and spacing birth which would help reduce infant mortality as well as fertility. Table 2 shows the infant and child mortality rates. III. REPRODUCTIVE HEALTH Promotion of maternal and child health has been one of the most important components of the Family Welfare Programme. For each pregnant woman to receive at least 3 antenatal care check ups and 2 tetanus toxoid injections and a full course of Iron and folic acid supplementation. In Chattisgarh mothers of 58% of children, received at least one antenatal check up compared with 65% in India as a whole. 58% of mothers received tetanus toxoid compared with 54% in Madhya Pradesh, 55% of mothers received Iron and Folic acid supplementation in Chattisgarh compared with 47% in Madhya Pradesh. Coverage for all the three interventions is much lower for illiterate women and with low standard of living. Table 3 shows antenatal care service received. The Family Welfare Programme encourages women to deliver in a medical facility or if at home with assistance from a trained health professional and to receive at least 3 postnatal check ups. Table 4 shows place of delivery and the percentage. Only 14% of births delivered in a medical facility in Chattisgarh and only one in three births assisted by health professional. 43% were assisted by

3 a traditional birth attendant. Births delivered at home only 1 in 4 assisted by a health professional. Only one out of 8 births outside a medical facility were followed by a postpartum check up within two months of delivery utilisation of MCH services in Chattisgarh remains very low. The traditional birth attendant role is more in large majority of births that occur at home. than 80% in any sub group of population. Most children who are anaemic have moderate to severe anaemia. Anaemia among children is common in Chattisgarh 88%, than in Madhya Pradesh 71% and all India average 74%. Female children are moderately to severe anaemic than male children. Table 7 shows anaemia among children. Table 5 shows the assistance received during delivery. 37% of currently married women in Chattisgarh report some type of reproductive health problem. An abnormal vaginal discharge, symptoms of a urinary tract infection, pain or bleeding associated with intercourse. The situation in Chattisgarh is better than Madhya Pradesh where 47% report some reproductive health problem. In Chattisgarh 68% have not sought any advice or treatment for reproductive health problem. Those who sought advice or treatment are likely to go to private sector health facility. These results suggest a need to expand reproductive health services and information programmes that encourage women to discuss their problem with a health care provider. IV. NUTRITION OF CHILDREN AND WOMEN The Government of India recommends that breast feeding should begin immediately after birth and that infants should be exclusively breastfed for the first four months of life. It is also recommended that the first breast milk (colostrum) should be given to the child rather than squeezed from the breast and discarded, because it provides immunity to the child. Although breast feeding is nearly universal in Chattisgarh, most children do not begin breast feeding immediately after birth. Only 14% begin breast feeding in the first hour and 30% do so within one day of birth. More over for 75% of children, mothers squeezed the first milk from the breast before feeding the baby contrary to recommended feeding practices. 82% of the children under four months of age are exclusively breastfed and the median duration of any breast feeding is 36 months or more. At age 6-9 months all children should be receiving solid or mushy food in addition to breast milk. Only 41% of children age 6-9 months receive the recommended combination of breast milk and solid or mushy foods. Table 6 shows breast feeding of children. Based on international standards 61% of children aged 3 years in Chattisgarh are under weight, 58% are stunted, 19% are wasted. In Madhya Pradesh the percentage of under weight, stunted and wasted children are 53%, 49% and 20% respectively. In Chattisgarh almost 9 out of 10 children age 6-35 months are anaemic and this proportion is never less 27 48% of women in Chattisgarh are under nourished. Nutritional deficiency is more prevalent in Chattisgarh in rural areas and among SC and ST women and illiterate women. Overall 69% of women in Chattisgarh have some degree of anaemia compared to all India rate of 52% and 49% in Madhya Pradesh. 23% of women in Chattisgarh are moderately to severe anaemic compared with 15% in Madhya Pradesh. Anaemia is a serious problem among women in every population group in Chattisgarh with prevalence rates ranging from 54 to 86 percent across groups. Pregnant women are more 43% than non pregnant women 20-22% anaemic. Table 8 shows anaemia prevalence. Table 13 shows food consumption of women. In Chattisgarh 91% of women consume green leafy vegetables at least once a week. 88% consume other vegetables at least once a week. 84% consume pulses or beans. Only 24% consume fruits once in a week, 23% consume milk or curd at least once a week. 15% of women eat chicken, meat or fish at least once a week. 20% women never eat chicken, meat or fish. 60% of households in Chattisgarh use iodized salt at recommended level of 15 parts per million (ppm). Iodine deficiency disorders are likely to be a problem in Chattisgarh. SC and ST households and rural households are less likely to use than other households. Table 12 shows food consumption. V. CHILDREN S IMMUNIZATION Children s immunization is an important component of child survival programme in India with efforts focussing on six serious, but preventable diseases, Tuberculosis, Diphtheria, pertusis, tetanus, polio and measles. The object of UIP launched in was to extend immunization coverage to at least 85% of infants by And the target now is 100%. In Chattisgarh only 22% of children aged months, are fully immunized, 73% have received some, not all recommended vaccinations. The fully vaccinated 22% is much lower than the average India percentage of 42%. Only 40% children received measles vaccine, 41% received all 3 doses of DPT. The drop out rates are very high for the vaccinations. The public sector is the major source of childhood vaccinations in Chattisgarh. 92% of children

4 received vaccinations from public sector. Children under 5 years age should receive oral doses of vitamin A even six months starting at the age of 9 month. In Chattisgarh only 35% of children received (12-35 months) vitamin A supplementation and only 22% received a dose of vitamin A in the six months proceeding the survey. Table 9 shows immunization status. Childhood diseases: Three health problems that cause (diseases) mortality in children are fever, acute respiratory infection(ari) and diarrhea. In Chattisgarh 26% of children under age 3 years were ill with fever, the same 26% children with ARI and 21% had diarrhoea. 62% ill with ARI were taken to health facility compared with 57% in Madhya Pradesh. 59% of children ill with diarrhoea were taken to health facility or health care provider. Table 10 shows the percentage ARI, fever, diarrhoea. Knowledge of treatment of diarrhoea remains inadequate. 59% of mothers know about ORS packets and 20% mothers incorrectly believe that children with diarrhoea should be given less to drink than usual. 48% of children with diarrhoea received some form of oral dehydration therapy (ORT) including 30% who received ORS. Table 11 shows children who received treatment of diarrhoea. VI. DOMESTIC VIOLENCE In Chattisgarh there is a widespread acceptance among ever married women that the beating of wives by husbands is justified. 62% accept at least one of the six reasons why husbands beat their wives. 17% married women experienced beatings or physical mistreatment; 15.9% experienced such violence in the past 12 months proceeding the survey. Most of these women have been beaten or physically mistreated by their husbands. VII. MORBIDITY The survey found that 2% of the population in Chattisgarh suffer from Asthma, 11% from malaria, 1% from Jaundice and the prevalence of tuberculosis 0.6% and medically treated TB 0.5% in marginally higher than average India percentage of 0.5 and 0.4. The prevalence of Tuberculosis, Jaundice and Malaria is much higher in rural areas than urban areas. The prevalence of Asthma is the same in urban and rural areas. Men are more likely than women to suffer from each of the diseases. Life Style Indicators: 15% of adult men and 1% of adult women smoke, 27% of adult men and 7% of adult women drink alcohol, 34% of adult men and 16% of adult women chew pan masala or tobacco. VIII. QUALITY OF HEALTH CARE 45% of households in Chattisgarh use the private medical sector mainly private doctors or private hospitals or clinics for treatment when a family member is ill. 47% normally use the public medical sector. Use of private sector medical is higher in urban households than rural households most respondents are generally satisfied with the health care they receive. The medium waiting time to receive the service was about 15 minutes. 53% rated the facility they visited as very clean, 65% said that the staff spoke nicely to them, 73% said that their need for privacy was respected on the quality of service on public sector are much lower than private sector medical facility. Only 7% of women received at least one home visit from a health or family planning worker during the 12 month proceeding the survey and the few who did receive home visits were not visited regularly. Majority of women who received home visit expressed satisfaction with the amount of time that the worker spent with them and with the way the worker talked to them. IX. HIV-AIDS The spread of HIV-AIDS is a major concern in India. 4 out of 5 in Chattisgarh (80%) have not heard of AIDS. The all India average is 60%. Awareness of AIDS particularly low among women who are not regularly exposed to media and SC women, illiterate women, women living in rural area. Women who heard about AIDS. 93% received information about the disease from television, 47% from radio, 30% from newspapers or magazines. Women who heard of AIDS 55% do not know of any way to avoid infection. 21% of women mentioned use of condoms as a way of avoiding the disease. NFHS-2 results suggest that health personnel could play a larger role in promoting AIDS awareness. In Chattisgarh only 4% of women who know about AIDS received information about the disease from a health worker. REFERENCES a) Indian Society of Health Administrators, Strengthening Health Systems in North Eastern States, b) International Institute of Population Sciences, National Family Welfare Survey, , Mumbai, India, October

5 Table 2: shows the infant and child mortality rates NFHS Years Proceeding Neonatal Post Neonatal Infant Child Under five the survey mortality mortality mortality mortality mortality Rates are per thousand Table 3: Antenatal Care - Antenatal Received antenatal % who % who check up check up from received 2 received Number only at home or more Iron and of Births from health Doctor Other tetanus folic acid worker health toxoid tablets or professional syrup - Birth Order Total Table 4: Place of delivery Health facility Home institution Public NGO Private Own Parents Others Total Number of trust home home percent Births ANC Check up Total

6 Table 5: Assistance during Delivery Attendant assisting during delivery Place of Doctor ANM Other Dai Delivery Nurse health TBA Other Missing Total Number of LHV professional Births Public health facility Own home Parents home Total Table 6: Initiation of Breastfeeding Background % started breast % started breast % whose mother Number of Characteristics feeding within feeding within squeezed first milk children Residence one hour of birth one day of birth from breast Urban Rural Public healthfacility Own home Parents home Total Table 7: Anaemia among children Percentage of Percentage of Children with children with Mild Moderate Severe Number any anaemia anaemia anaemia anaemia of children Age of child 6-11 months months months Total Table 8: Anaemia among women Background Percentage of women with Characteristics Any Mild Moderate Severe Number Age Anaemia anaemia anaemia anaemia of women Total

7 Table 9: Childhood vaccination by source of information Source of Percentage Vaccinated Information BCG Polio DPT Polio Measles All None Number of children - Vaccination Card Mothers report Either source Vaccinated by 12 month of age Table 10: Percentage of ARI, fever, and Diarrhoea - Background % of children suffering in past two weeks from Characteristic Cough Number of accompanied Fever Any Diarrhoea children by fast breathing Diarrhoea with blood Age of Child ARI months months months months Total Table 11: Treatment of Diarrhoea Treatment Percent Taken to health facility or provider 59.3 Oral Rehy: Oral dehydration salt ORS packets 29.7 Gruel 12.6 Home made sugar salt water solution 4.6 Increased fluids 31.1 ORT not given 51.6 Other treatment: Pill or Syrup 45.2 Injection 12.5 Intravenous IV drip bottle 6.3 Home remedy herbal medicine 7.8 No treatment 28.3 Number of children with diarrhoea 64 31

8 Table 12: Iodization of Salt Type of Not 7 ppm 15 ppm 30 ppm Missing Total Number of Place Iodized percent households City Town Rural Area Total Table 13: Women s food consumption Frequency of consumption Type of Food Daily Weekly Occasions Never Total percent Milk or Curd Pulses or Beans Green leafy vegetable Other Vegetables Fruits Eggs Chicken, meat, fish