India’s First-ever District Level Health Survey showed Higher Sex Ratio at Birth in Urban Areas

Annual Health Survey Bulletin 2010-11 was launched on 10 August 2011 by the Ministry of Home Affairs. The objective of the survey was to yield benchmarks of core vital and health indicators at the district level and to map changes therein on an annual basis. The survey was India’s first-ever district level health survey.

Annual health survey pointed out that sex ratio at birth, defined as the number of female live births per 1000 male live births was higher in urban areas than in rural areas.

The survey findings reported that the sex ratio at birth across nine states ranged between 764 in Pithoragarh district in Uttarakhand to 1,030 in Moradabad district in UP.

The survey identified 57 districts in the country with worst health indicators, including 34 in UP where it aims to have a special focus. India’s first-ever district level health survey showed 57 districts have the worst health indicators in terms of birth rate, infant mortality rate, maternal mortality rate and sex ratio.

The Annual Health Survey in nine states reported that districts of Uttar Pradesh, particularly Shrawasti, have the worst scenario while Rudraprayag and other districts of Uttarakhand have the best results.

These 9 states - Rajasthan, Uttar Pradesh, Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh, Chhattisgarh and Assam account for about 48% of the total population in the country, are the high focus states in view of their relatively higher fertility and mortality indicators. These states together constitute 48% of country’s population, 59% of total births, 70% of infant deaths, 75% of Under-5 deaths and 62% of maternal deaths.

Bageshwar in Uttarakhand reported Minimum Crude Birth Rate (CBR) of 14.7 while Dhemaji in Assam had the Minimum Crude Death Rate (CDR) of 4.5 in 284 districts of 9 states surveyed.

The CBR, which is measure of live births per 1000 population, was maximum at 40.9 in Shrawasti. The birth and death rates in rural areas of districts was found to be higher than the urban areas. CDR was highest in Shrawasti at 12.6.

Infant Mortality Rate (IMR) was least in Rudraprayag (19) while in Shrawasti it was highest (103). Six districts - Purbi.

Singhbhum and Dhanbad (Jharkhand); Chamoli, Rudraprayag, Pithoragarh and Almora (Uttarakhand) had already achieved the UN Millennium Development Goal (MDG) target of reducing child mortality of 28 by 2015. Another four districts - Bokaro and Ranchi (Jharkhand), Bageshwar and Nainital (Uttarakhand) are close to the target. Female infants in districts experienced a higher mortality than male infants and IMR in rural areas was significantly higher than that in urban.

Rudraprayag also reported the minimum Neo-Natal Mortality Rate (NNMR) at 11 while Balangir in Orissa had the maximum (75). NNMR measures the number of infant deaths (age below 29 days) per 1,000 live births. Out of every 10 infant deaths 6 -7 pertain to Neo Natal Deaths.

Under Five Mortality Rate (U5MR) was found to be minimum in Pithoragarh (24) and maximum in Kandhmal of Orissa (145). The minimum Maternal Mortality Ratio (MMR) of 183 was from Kumaon in Uttarakhand and the maximum 451 from Faizabad in UP

However, Sex Ratio at Birth (SRB) was reported lowest at 764 in Pithoragarh, Uttarakhand and maximum 1030 in Moradabad.

The survey highlighted the need to put in place a special health policy as well as the need to concentrate in these areas to ensure that the health schemes are implemented with more focus.