New Delhi: Sex ratio at birth and in all ages
in rural areas is better than in urban areas, according to the
first district-wise annual health survey (AHS) of nine states
released on Wednesday.
Only six districts out of 284 accounting for half of the
country`s population have a positive sex ratio, according to
the AHS, described as the largest demographic survey in the
Pithoragarh district of Uttarkhand reported the lowest sex
ratio of 764 girls to 1000 boys at birth, while Moradabad
district of Uttar Pradesh had the highest of 1,030.
The Sex Ratio at Birth (SRB), denoting the number of
female live births per 1000 male live births, was lowest in
the state of Uttarakhand while Chhattisgarh recorded the
Morena district of Madhya Pradesh had lowest child sex
Ratio of 787 as well as lowest sex ratio of 818 for all ages,
but Kawardha district of Chhattisgarh recorded the highest
child sex ratio of 1,076 for 0-4 years and Tehri Garhwal
district of Uttarakhand recorded the highest sex ratio of
1,220 for all ages.
Across all the nine AHS states, sex ratio at birth,
between children of 0-4 years and for all ages in rural areas
is significantly higher than that of urban areas, as per the
The health survey for 2010-2011, carried out in 284
districts of the states of Rajasthan, Uttar Pradesh,
Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh,
Chhattisgarh and Assam is representative of half the country`s
population and would help enumerate health policies at the
While there are only six district having a positive sex
ratio, four districts in Uttarakhand, Uttar Pradesh and
Rajasthan had sex ratio at birth lower than 800.
Another 29 district in these states alongwith Assam,
Madhya Pradesh and Orissa had the sex ratio less than 850. 44
per cent of total districts surveyed had sex ratio at birth
lower than 900.
The survey carried out by Registrar General and Census
Commissioner of India is aimed at yielding benchmarks of core
vital and health indicators at the district level and to map
changes therein on an annual basis was conceived at the behest
of National Commission on Population, PMO and Planning
Commission and sponsored by Ministry of Health and Family
While the sex ratio is better in rural areas, the infant
mortality rate there is much higher and in all the nine states
more female infants die than males.
As per the Survey, the Crude Birth Rate (CBR), denoting
the number of live births per 1,000 population, was lowest ub
Uttarakhand while Bihar had the highest.
States of Uttarkhand, Orissa, Assam and MP, UP, Bihar
constitute two extremes of the spectrum.
CBR across 284 districts ranges between 14.7 (Bageshwar
and Pithoragarh in Uttarakhand) and 40.9 (Shrawasti, UP) ? a
variability of almost 3 times. Among the average of states,
Uttar Pradesh has the highest of 22.9 CBR.
On Crude Death Rate (CDR), denoting the number of Deaths
per 1,000 population, Jharkhand records the lowest while,
UP has the highest.
The CDR ranges between 4.5 in Dhemaji district of Assam)
and 12.6 in Shrawasti district of Uttar Pradesh - a
variability of almost 3 times. CDR in rural areas of districts
is significantly higher than in urban areas.
For the Infant Mortality Rate (IMR), denoting the number
of infant deaths (less than one year of age) per 1,000 live
births, Jharkhand and Uttarakhand are at the bottom of the
list whereas MP and UP are the top.
IMR across 284 districts ranges between 19 for Rudraprayag
in Uttarakhand) and 103 for Shrawasti in Uttar Pradesh.
Six districts of Purbi Singhbhum and Dhanbad (Jharkhand);
Chamoli, Rudraprayag, Pithoragarh & Almora (Uttarakhand) have
already achieved MDG-4 National target of 28 by 2015. Another
four districts of Bokaro & Ranchi (Jharkhand) and Bageshwar &
Nainital (Uttarakhand) are in closer vicinity, the survey
For the Neo-Natal Mortality Rate (NNMR), denoting the
number of infant deaths (of age less than 29 days) per 1,000
live births, Jharkhand and Uttarakhand records NNMR under 30
whereas for MP and UP, it is 44 & 50 respectively.
NNMR across 284 districts ranges between 11 (Rudraprayag
in Uttarakhand) and 75 in Balangir of Orissa ? a variability
of seven times, the survey points out. Out of every 10 infant
deaths, 6-7 pertains to neonates and NNMR in rural areas of
districts is significantly higher than that in urban areas.
The Under-5 Mortality Rate (U5MR), denoting the number of
children (0-4 years) who died before reaching their fifth
birthday per 1000 live births, was lowest in Uttarakhand in
the 50s, while for UP, it is the highest in the 90s.
Across all nine AHS states, U5MR in rural areas is
significantly higher than that of urban areas. In UP, rural
U5MR is 101 compared to 68 in urban areas.
U5MR ranges between 24 in Pithoragarh district of
Uttarakhand and 145 in Kandhamal district of Orissa - a
variability of seven times, the survey states.
At least seven districts of Pithoragarh, Almora,
Rudraprayag, Chamoli, Nainital and Bagheswar (Uttarakhand) and
Purbhi Singhbum (Jharkhand) have already achieved MDG National
level target of 42 and Another 10 districts viz.
Dhanbad, Bokaro, Kodarma, Hazaribagh & Giridih (Jharkhand)
and Kota (Rajasthan) and Champawat, Udham Singh Nagar,
Dehradun & Uttarakashi are in closer vicinity. More number of
females die before reaching age 5 years than males.
The Mother Mortality Rate (MMR), denoting the proportion
of Maternal Deaths per 1 lakh Live Births, was recorded lowest
in Uttarakhand, while Assam recorded the highest MMR.
MMR, published for 62 administrative divisions
(Commissionerates) in nine states, ranges between 183 for
Kumaon HQ in Uttarakhand and highest of 451 recorded in
Faizabad Mandal district of UP.
MMR for Uttarakhand along with its two divisions is lower
than the National Average of 212.
The survey results were released by Health Secretary K
Chandramouli in the presence of Special Secretary (Health) P K
Pradhan and Registrar General and Census Commissioner of India
These nine states, which account for about 48 per cent of
the total population in the country, are high focus states in
view of their relatively higher fertility and mortality
indicators, said Chandramouli while detailing survey results.
A representative sample of 18 million population and 3.6
million households is to be covered in 20,694 statistically
selected PSUs (Census Enumeration Blocks in case of urban aras
and villages or a segment thereof in case of villages in rural
areas) in these nine AHS states every year, he said.
AHS is the largest demographic survey in the world and is
two-and-half times that of the Sample Registration System used
in the past, he claimed.
The Survey objective is to monitor the performance and
outcome of various health interventions of the Government,
including those under the National Rural Health Mission (NRHM)
of the Ministry of Health and Family Welfare.