Rch ii baseline survey-report

Baseline Survey on Reproductive and Child Health (RCH-II)
Andhra Pradesh
Key Findings
P. Satya Sekhar
V. Umadevi
N.V. Rajeswari
Ch.V.S. Sitarama Rao
Commissionerate of Family Welfare
GoAP., Hyderabad – 500 095
Indian Institute of Health and Family Welfare
Vengalrao Nagar, Hyderabad – 500 038
September, 2007

CONTENTS
Acknowledgements i
Organizations involved in Field Work iii
Objectives 2
Antenatal Care 3
Components of Antenatal Checkups 6
Problems Self Reported by Mothers 7
Delivery Care 8
Complications/Problems during Delivery 10
Post Natal Care 10
Birth Weight of Newborn 11
Breast feeding and supplementation 12
Child Morbidity and Treatment Patterns 14
Child Immunization 15
Infant Mortality 17
Reproductive Health Problems 19
RCH-II Intervention Programme
Janani Suraksha Yojana 20
Free Travel by the Public Transportation by Pregnant Women 21
Round-the-Clock MCH Centre 22
Women Health Volunteer Scheme (ASHA) 22
Conclusions 23
Notes 27
References 28

Fact Sheet
Andhra Pradesh 29
Coastal Andhra Region
Srikakulam 37
Vizianagaram 45
Visakhapatnam 53
East Godavari 61
West Godavari 69
Krishna 77
Guntur 85
Prakasam 93
Nellore 101
Rayalaseema Region
Kurnool 109
Anantapur 117
Kadapa 125
Chittoor 133
Telangana Region
Ranga Reddy 141
Hyderabad 149
Nizamabad 157
Medak 165
Mahabubnagar 173
Nalgonda 181
Warangal 189
Khammam 197
Karimnagar 205
Adilabad 213

i
ACKNOWLEDGEMENTS
India, as one of the signatory countries of ICPD Plan of Action has been
implementing the Reproductive and Child Health program since early 1997. The
RCH-I recorded marginal contribution in the State’s efforts to improve MCH indicators.
The RCH-II program adopted mission mode by using performance, benchmarking and
accountability tools and meeting long term health and population outcome goals. Until
now analysis of health status at the district and regional levels has been primarily
based on a single indicator, viz., infant mortality. In this backdrop, the State
Government had undertaken the Baseline survey to understand the reproductive
health status at the district level. The present Baseline Survey of Reproductive and
Child Health (RCH-II) was successfully completed thanks to the efforts and
involvement of numerous organizations and individuals at different stages of the
survey. The conduct and analysis of this large-scale survey by the nodal agency
required the cooperation and support of many people for its successful completion.
Although it is not possible to acknowledge each and every one associated with the
survey by name, some persons yet deserve special mention.
First of all, we would like to thank Dr. C.B.S. Venkataramana, IAS, Former
Commissioner (Family Welfare) and Ex-Officio Principal Secretary to Government
(HM & FW) and Mr. Anil Punetha, IAS, Present Commissioner (Family Welfare) and
Ex-Officio Secretary to Government (HM & FW) for their keen interest right from the
beginning of the project and for conducting several meetings to review the progress of
the project.
Special thanks are due to Dr. K. Balasubramanian, Consultant and Former
Director, Centre for Media Studies, Hyderabad, who continued to take an active
interest in the project and provided timely guidance and support. We wish to express
our thanks to Dr. C. Sulochana, Additional Director, Dr. R. Gopalakrishna Rao, Joint
Director, Dr. M.S. Srinivasa Rao, Joint Director and Mr. B. Brahmanandam, Deputy
Director (Demography) of the Commissionerate of Family Welfare for providing useful
comments to finalise the survey instruments and Fact Sheet in dissemination
workshop.

ii
Special mention and thanks are due to Dr. KVR Subrahmanyam and Mr. R.
Madhav Reddy of the Population Research Center, Andhra University,
Visakhapatnam for their participation as Resource Persons in the investigators
training. The hard work put in by the eleven research agencies (field investigators and
supervisors) in collecting data in about 1300 villages and 980 urban blocks of Andhra
Pradesh is gratefully acknowledged. Thanks are due to all District Medical and Health
Officers (DM & HOs) for providing assistance during the field operations.
We appreciate the immense help received from the computer staff (Mr. PVSN
Kumar and Mr. Wajahat Ali) of IIHFW for developing the software package and
carrying out the arduous task of data cleaning, data entry, data processing and
preparation of tables. We also thank Mr. D. Srinivasa Rao, Mrs. Sivaranjani and
Mr. G. Vara Prasad for their help in data analysis and finalization of district Fact
Sheet.
Finally, we would like to record a note of appreciation for all eligible women and
the household respondents who spent their valuable time in responding to the survey
questionnaire and extending co-operation to us to complete the field work.
- Authors

iii
BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH (RCH-II)
ANDHRA PRADESH
Nodal Agency : Indian Institute of Health and Family Welfare
Vengalrao Nagar, Hyderabad – 500 038
Andhra Pradesh
Principal Coordinator : Dr. P. Satya Sekhar
Coordinators : Dr. V. Uma Devi
Dr. N.V. Rajeswari
Mr. Ch.V.S. Sitarama Rao
ORGANIZATIONS INVOLVED IN FIELD WORK
Sl. No. Field Organization Districts
1. Administrative Staff College, Hyderabad
Bella Vista, Hyderabad
West Godavari, Kurnool,
Krishna, Hyderabad
2. AMR- A.P Academy of Rural Development
Rajendra Nagar, Hyderabad
Anantapur, Chittoor
3. Centre for Economic and Social Studies
Begumpet, Hyderabad
Khammam, Warangal
4. Centre for Media Studies
65 Jubilee Hills, Hyderabad
Karimnagar, Adilabad
5. Economics Dept, University of Hyderabad
Gatchibowli, Hyderabad
Mahabubnagar
6. Indian Institute of Health and Family Welfare
Vengalrao Nagar, Hyderabad
Medak, Nizamabad
7. Institute of Health Systems
HACA Bhavan, Hyderabad
Nellore, Prakasam, Kadapa
8. Nizam Institute of Medical Sciences
Panjagutta, Hyderabad
Ranga Reddy
9. Population Research Centre, Andhra University
Visakhapatnam
Srikakulam, Vizianagaram
10. SWC Consulting, Golkonda Cross Roads
Hyderabad
Visakhapatnam, East
Godavari
11. THRIVE, Volunteers for Rural Health & Education
Nalgonda
Nalgonda, Guntur

1
Baseline Survey on Reproductive and Child Health (RCH-II)
Andhra Pradesh
Key Findings
Promotion of maternal and child health has been one of the most important
objectives of the Family Welfare Programmes in India. Different interventions initiated
in the past, such as Maternal and Child Health, Universal Immunization Programme
(UIP), Child survival and Safe Motherhood (CSSM) emphasized either on antenatal
period of pregnant women or on child immunization and childhood diseases but little
stress was laid on natal care and effective safe motherhood aspects. After ICPD
(1994), MDG (2000) a greater emphasis in Reproductive and Child Health has been
placed the need to have safe delivery attended by a health personnel, need for
postnatal checkup, development of round the clock hospitals with blood banks and
blood storage in order to attend complicated deliveries. Only better access, availability
and quality health services to vulnerable groups can reduce the maternal mortality
ratio and infant mortality rate and effect a rise in institutional deliveries. The
Reproductive and Child Health (RCH-II) interventions like one Accredited Social
Health Activist (ASHA) per 1000 population, Janani Suraksha Yojana (JSY),
Emergency Health Transport of pregnant women for delivery, Free Bus Pass to
pregnant women to visit a PHC for antenatal checkup and Round-the-clock Mother
and Child Health Center and other innovative state-specific strategies were initiated
since late 2005 under the National Rural Health Mission (NRHM) in line with the
initiatives of the Government of India for reducing Infant mortality rate and Maternal
mortality ratio.
Responding to the growing need for data at district-level, the Indian Institute of
Health and Family Welfare (IIHFW), with the funding from Commissionerate of Family
Welfare, Government of Andhra Pradesh, conducted household survey at the district
level to obtain information on a number of policy relevant indicators relating to
reproductive and child health. The survey covered an overall sample of 59,117
households (where woman gave a child birth [alive or dead] since January/Sankranti
2004 to the date of survey 1
) and interviewed about 59,000 currently married women
in reproductive age period (15-49) in the state. In each of the 23 districts surveyed,
about 2500 households were selected randomly and around an equal number of
eligible women were interviewed.2
Immunization particulars of all children under 2
years of age were also obtained from mother or principal care takers of children. The
field work of the survey was conducted during July-October 2006 by eleven reputed
research organizations in the state. The projections carried out by the National
Commission on Population, 2006 has also emphasized that the number of people in

2
15-54 years will increase from 463 million in 2001 to 558 million by 2011, indicating
the growing number of women, married women and deliveries. The number of married
women (couples) aged 15-49 also increase between the period 2001-2011, indicating
the need for further strengthening and extension of RCH services to all sections of
people in the coming decades.
Objectives
The main objectives of the baseline study were:
1. to provide district level data on the key maternal and child health indicators
such as infant mortality rate, ANC coverage, delivery care, postnatal care,
breastfeeding practices, prevalence of diarrhea and child immunization
coverage
2. to identify regional imbalances in the current status of health and utilization
of reproductive and child health services
3. to formulate district specific interventions and for allocation of more
resources in the lagged and low performing districts
The highlights provide the broad findings of RCH indicators for all 23 districts
and also for the State as a whole by aggregating the district figures an exercise highly
useful for decentralized planning of services at district level. The survey results
provide key policy relevant indicators namely infant mortality rate, antenatal care
coverage, delivery care, postnatal care, breastfeeding practices, prevalence of
diarrhea and ARI, contraceptive use, child immunization and awareness of
interventional programmes - Janani Suraksha Yojana (JSY), Women Health Volunteer
Programme (WHV), Free Bus Pass to Pregnant Women, Round the Clock MCH
Centres etc.
Highlights of the findings
of the survey are presented in
the following paragraphs.
Empirical studies in India and
abroad have established that
the recently delivered mothers
are self selected for their higher
potential fertility in future years.
The main objective of the
Baseline study has been to
Details of Sample Coverage
No. of HHs interviewed in the state
Total - 59117
Rural - 33746
Urban - 25371
No. of Eligible women Interviewed in the state
Total - 59378
Rural - 33902
Urban - 25476
No. of Live births (during Sankranti / Jan 2004 to the
date of Survey)
Total - 65341
Rural - 37237
Urban - 28104

3
measure the infant mortality, neonatal mortality rate at district level and coverage
rates of prenatal, natal and postnatal care. The services of both Government (PHC /
Sub-centre) and private institutions are extensively utilized by the recently delivered
mothers and pregnant women. Hence the baseline survey adopted Birth based
approach and collected information from respondents. This approach allowed us to
analyze the information on 65,000 live births that occurred during the period from
January/Sankranti 2004 to the date of survey. In other words, the survey covered
about 1200-1300 children in each district based on births (with an exposure of child
before completing one year of age in estimating Infant mortality rate).
Antenatal Care
Antenatal Care (ANC) includes pregnancy related care provided by any health
personnel in a medical institution or at home by health staff. It is widely believed that
utilization of antenatal care services contributes to improved maternal health, because
the visits include advice on correct diet, the provision of IFA tablets, and tetanus
toxoid injection to pregnant women in addition to medical care.
Utilization of antenatal care is universal in the state and across background
characteristics (Social group, Mother’s education, Household assets measured
as Standard of Living Index). Nearly ninetyfour percent of mothers received 3
ANC checkups. The two lowest coverage rates of 83-85 percent were reported
from Anantapur and Kurnool districts.
About 94 percent of mothers received at least one ANC from a MBBS Doctor.
Eight out of ten (82 percent) mothers in Kurnool and Anantapur received at least
one ANC from a MBBS doctor. Four antenatal check-ups one each during third,
sixth, eighth and ninth month of pregnancy have recommended as the minimum
and necessary [Park, 2002]). In the end-line evaluation, the survey has to
incorporate the number of ANC visits by specific months and number of visits to
MBBS doctors in order to assess outcome indicators. The number of antenatal
checkups and the timing of the first check-up are important for health of the
mother and outcome of the pregnancy.
The median number of ANC visits in the state has been 5.8 visits (5.0 visits in
rural and 6.0 in urban areas). The median number of weeks a mother availed of
first antenatal care was 12 weeks i.e. only 50 percent of mothers initiated ANC
care in the 12th
week of their pregnancy. This has to be improved substantially
by the end of project period.

4
The number of antenatal
check-ups and the timing
of the first check-up are
important for health of
mother and outcome of
the pregnancy. The
NRHM identified the
proportion of women
registered in first trimester
as a process indicator of
reproductive and child
health. Sixtythree percent of women registered first antenatal check-up in the
first trimester (60 percent in rural areas and 67 percent in urban areas). Districts
reporting lower than 35 percent of ANC registration in first trimester are
Mahabubnagar and Ranga Reddy in Telangana region. More than half of the
women in scheduled caste and tribe (56 percent) sections registered in the first
trimester. The findings highlight that the need to educate the pregnant women
regarding the importance of early registration and motivate them for more than 4
visits in third, sixth, eighth and ninth months of pregnancy. In order to reach the
target of 95 percent by 2010, special emphasis and efficient monitoring are
required.
Nine out of ten mothers
received 2 or more
doses of tetanus toxoid
injection across
background variables.
63%
95%
34.8
35.8
63.0
82.7
94.8
0 20 40 60 80 100
Ranga Reddy
Mahabubnagar
State
Vizianagaram
Visakhapatnam
50
1000
ANC Registration in First Trimester
Target
Baseline
Percent
63%
95%
52.8
57.5
56.4
67.3
59.7
63.0
0 20 40 60 80
Low SLI
S.T
S.C
Urban
Rural
Total
50
1000
ANC Registration in First Trimester
Target
Baseline
Percent

5
Nutritional deficiencies in
women are often
exacerbated during
pregnancy because of
the additional nutrient
requirements for foetal
growth (NFHS-2, 1998-
99). For each birth
during the reference
period, the base-line
survey collected
information on whether the mother received or purchased IFA tablets or syrup
during pregnancy. About half (54 percent) of mothers received 100 IFA tablets
or syrup supplied by ANM or purchased from the market. The IFA coverage was
also lower in rural areas (52 percent) than in urban areas (56 percent).
The percentage of
mothers who consumed
all the IFA tablets
(supplied/purchased)
during ANC was only 33
percent. Marginal
variations are observed
across background
variables (Social group,
Rural/urban and BPL
groups) under RCH-II
project. It is necessary to
improve the management of supply of IFA tablets. Counseling is essential to
increase the consumption of all IFA tablets as anaemia during pregnancy has
been one of the major causes for low birth weight. According to NFHS-3 (2005-
06) survey about 39 percent (46 percent in rural and 36 percent in urban areas)
indicated lower IFA consumption in the reference period of 90 days or more
during pregnancy. The RCH-II programme needs to emphasize the advantages
of IFA to pregnant women and evolve strategies to overcome the problem.
Studies showed that anemia may be one of the important causes for low birth
weight of babies delivered.
54%
95%
32.3
32.4
54.0
75.1
80.6
0 20 40 60 80 100
Ranga Reddy
Kurnool
State
Nellore
East Godavari
50
1000
Women received/purchased 100 or more IFA tablets
Target
Baseline
Percent
33.2%
95%
16.5
18.1
33.2
49.8
55.5
0 10 20 30 40 50 60
Nellore
Kadapa
State
Guntur
Anantapur
50
1000
Women Consumed All IFA tablets
Target
Baseline
Percent

6
More than 75 percent of mothers reported the supply of 100 IFA tablets in East
Godavari, Nellore and Srikakulam districts but on the other hand, just one-third
of mothers received 100 IFA tablets in Ranga Reddy and Kurnool districts.
However those who consumed all tablets/syrup in the above districts are 29% in
East Godavari, 38% in Srikakulam districts and 17% in Nellore respectively.
The effectiveness of antenatal check-ups in ensuring safe motherhood depends
in part on the tests and measurements done and advice provided to pregnant
women during check-ups. About 90 percent of mothers reported that they
received at least once the general services like weight measurement, blood
pressure examination, urine examination and abdominal examination as a part
of antenatal checkup at the state level. Marginal variations are observed across
background variables.
Components of Antenatal Checkups
The effectiveness of antenatal check-ups in ensuring safe motherhood depends
in part on the tests and measurements done during and advice provided to pregnant
women during antenatal check-ups.
Among the births that occurred during survey period for which mothers received
antenatal check-ups, about 89-93 percent of mothers had an abdominal
examination, weight measurement, blood pressure examination as a part of the
antenatal checkup. Marginal variations are reported across background
variables.
Majority of mothers were
advised /counseled by
health personnel (public
and Private sector)
during their entire
pregnancy period about
newborn care, breast
feeding practice, family
planning, expected date
of delivery and need to
have a delivery at a
medical institution. About
seventysix percent of mothers were advised on expected date of delivery,
having delivery in a hospital and on breast feeding practices. About half of the
mothers reported that they were informed by the health personnel on the danger
Women advised/counseled at least once
60.8
77.0
50.7
76.0
76.0
0 10 20 30 40 50 60 70 80 90 100
Family Planning
Breastfeeding Practices
Information on danger
signs of Pregnancy
To have delivery in a
Hospital
Expected Date of Delivery
Percent

7
signs of pregnancy (Anaemia, short stature, hypertension etc). Six out of ten
mothers received advice on family planning. The proportion who received advice
on different topics varied little by background characteristics like education of
mother, social group and economic group (BPL and SLI).
Problems Self Reported by Mothers
Eligible women delivered in the reference period were asked to report any
pregnancy related problems. The information presented here was based on woman’s
self report and should be interpreted with care.
The problems most commonly reported are excessive fatigue/anemia (36
percent) followed by swelling of legs, body or face (24 percent).
The population projections of Andhra Pradesh indicate an increase in number of
women in 15-44 years in the coming years from 202 lakhs in 2001 to 239 lakhs
in 2011 and beyond due to past decadal population momentum. Hence the
findings suggest that, there is a need to cater to the needs of currently married
women in the next decade by extending quality RCH services like early
registration, promoting delivery at a medical institution, information on danger
sings of high risk pregnancy, advice on breast feeding and family planning in
order to achieve set goals by 2010 and beyond.
Overall, only 46 percent
of the mothers had
received full ANC care,
i.e. two doses of TT
injection, the required
number of IFA tablets
and at least 3 ANC
visits during their
pregnancy period. The
study indicates that
health workers have to
educate women on the
importance of all components of ANC and provide them quality services. The
urban areas recorded slightly higher full ANC coverage (49 percent) as
compared to 44 percent in rural areas.
46.5%
95%
1000
Women received full ANC (2 TT + IFA 100 tablets + 3 ANC)
Target
Baseline
25.8
26.2
46.5
67.1
68.6
0 20 40 60 80
Kurnool
Ranga Reddy
State
Visakhapatnam
Nellore
Percent

8
The full ANC coverage was above 60 percent in the districts Srikakulam,
Visakhapatnam, East Godavari, Guntur and Nellore. Special emphasis is
required in the districts namely Kurnool, Ranga Reddy, Mahabubnagar,
Nalgonda and Warangal districts which recorded below 35% of full ANC
coverage.
Delivery Care
Encouraging deliveries in proper hygienic conditions under the supervision of
trained health professional has been one of the major goals of NRHM for reduction in
MMR and IMR. Investing more funds to increase institutional deliveries in low
performing districts without quality health delivery system may yield lower results for
the resources spent under NRHM.
About 76 percent of births during the reference period of survey were delivered
in health facility and less than one-fourth of the mothers (24 percent) were
delivered at home. Overall, 82 percent of deliveries were attended by doctors or
nurses/ midwives.
Institutional deliveries
increased from 49.8 percent
in 1998-99 (NFHS-2) to 69
percent (based on last 2
births in the 3 years before
the survey) in 2005-06
(NFHS-3) and reached 76
percent in 2005-06. The log-
linear trend regression
equation fitted to the
institutional deliveries indicates that institutional deliveries could reach 90
percent by the end of 2010 as per the Goals set by the Government of Andhra
Pradesh.
The district differentials indicate that an overwhelming majority of mothers had
availed institutional deliveries in all districts except in Rayalaseema region.
The first two NFHS surveys conducted in the state during 1992 and 1998
indicated higher proportion of private institutional deliveries as compared to
deliveries conducted in public institutions (refer to deliveries of women in 15-49
years in the last three years reference period). The period exactly coincides with
the implementation of CSSM programme in Indian states with marginal impact
Trends in Institutional Deliveries in
Andhra Pradesh
76.0
32.9
49.8
61.4 63.7
69.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
1992 (NFHS-1) 1998 (NFHS-2) 2002-04(DLHS) 2003 (EC-
Survey)
2005-06
(NFHS-3)
2006
(Baseline)
Percent

9
on improving institutional deliveries conducted in public hospitals. One possible
explanation for higher private institutional deliveries during the period was the
improvement in socio-economic factors, availability of nursing homes in majority
of towns in the state. However, Balasubramanian and Satya Sekhar (2004) in
the Eligible Couple and Child Immunization study indicated that the deliveries in
public sector institutions improved due to implementation of ICPD initiatives and
RCH interventions. The baseline survey strengthens the argument and public
sector is playing a crucial role in delivery care in the state.
Mothers who had child birth at home indicated the following reasons for not
seeking institutional delivery care:
- Not necessary and not customary : 33%
- Costs too high in a health facility : 7%
- Lack of transport to shift : 5%
- Lack of time to reach a health facility : 28%
More than a quarter (27 percent) of deliveries were either by caesarian or other
interventions. The percentage of mothers who underwent caesarian section was
23 percent in rural and 32 percent in urban areas. Only 21 percent of mothers
belonging to Scheduled caste and Scheduled Tribe underwent caesarian
sections.
The top five districts
that recorded the
highest caesarian
section deliveries
were Warangal
(48%), Karimnagar
(47%), Hyderabad
(37%), Khammam
(36%) and
Nizamabad (35%).
Highly developed
districts in
Telangana region reported higher proportion of caesarian section deliveries
whereas it was below 30 percent in West Godavari, Krishna and East Godavari
districts of Coastal Andhra region.
Caesarian Section
Percent of births by Caesarian Section
Top 5 districts
Warangal - (47.8)
Karimnagar - (46.8)
Hyderabad - (36.7)
Khammam - (36.2)
Nizamabad - (35.2)
Bottom 5 districts
East Godavari - (17.5)
Kurnool - (16.0)
Anantapur - (11.8)
Chittoor - (11.3)
Visakhapatnam - ( 9.4)
State Average
Total : 26.5 Rural : 22.6 Urban : 31.6
S.C : 22.0 S.T : 18.4 BPL : 24.1

10
Complications/Problems during Delivery
Out of those who had reported complications/ problems during last delivery
14.1 percent had premature labour, 9.8 percent had obstructed labour, 9.9 percent
prolonged labour, 6.9 percent excessive bleeding and 2.4 percent breach
presentation. The percentages were marginally lower in urban areas as compared to
rural areas and also higher among background characteristics.
Post Natal Care
Health of a mother and her new born child depends not only on the health care
she received during her pregnancy and delivery, but also on continued care that she
and the infant received during first few weeks after delivery.
Three out of four mothers who delivered in a medical institution availed postnatal
checkup within one week of birth.
Sixty percent of non institutional births were followed up by a post natal checkup
within one week of delivery (59 percent in rural and 63 percent in urban areas)
either the mother visited the health facility or a health personnel visited the
home. Among non-institutional deliveries, mothers percentage who availed
postnatal check-up within two months was 64 percent (64 percent in rural and 67
percent in urban areas).
64.1%
95.2
93.8
20.1
64.1
25.2
0 20 40 60 80 100
Kadapa
Anantapur
State
Khammam
Warangal
50
1000
Postpartum check-up within two months in Non-institutional deliveries
Target
Baseline
Percent
Contrary to the expectation, mothers are less likely to have received post natal
checkup even though they have had continuous interaction with health provider
through their pregnancy and delivery at medical institution or at home.
Six out of ten (64 percent) of scheduled caste and scheduled tribe mothers who
delivered at home availed post natal care within one week of delivery.

11
Out of those mothers who received post natal checkup, about 77 percent (71
percent in rural and 84 percent in urban) received checkup from M.B.B.S doctor.
Around 67 percent of scheduled caste and scheduled tribe mothers availed of
post natal checkup from a doctor. Across districts the postnatal care below 40
percent were recorded in Kurnool, Kadapa and Anantapur districts.
There is urgent need to have a total coverage of postnatal checkup by a MBBS
Doctor or a trained medical professional in order to reduce the Neonatal
mortality rate by the end of the NRHM project period. New interventions and
packages need to be introduced with better monitoring of local health personnel
by the PHC medical officer. Mothers have to be educated through IEC
campaigns on the importance of postnatal care.
Birth Weight of New Born
Irrespective of primary
causes, over 2/3 of neonatal
deaths occur among infants
who weighed less than 2500
grams at birth. The low birth
weight may be due to poor
nutritional status,
hypertension, anaemia,
malaria and other infections
during pregnancy. Among
social and economic factors,
low maternal education, pregnancy at young age, frequent pregnancies and poor care
during pregnancy add greatly to the risk of low birth weight.
About 77 percent of infants
were weighed at birth.
Nearly half (49 percent) of
the newborn were weighed
at births in Kurnool district.
More than 85 percent of
children weighed at birth
are in Hyderabad (urban)
Visakhapatnam, Chittoor,
Nizamabad and Warangal
districts. The proportion of
Low Birth Weight in Andhra Pradesh
NA
23.3%
NA
MICS *
(2000)
0.4%NA
Percent of children weighed less
than 1500 grams
17.0%7.3%
Percent of children weighed less
than 2500 grams
76.9%39.0%Percent of Children weighed at birth
Baseline +
(2006)
NFHS-2
(1998-99)
MICS * : Includes all children below age 5 years
+ : Subject to reporting errors by mothers
Birth Weight Measurement
Percent of children weighed at birth
Above 85%
Hyderabad (91.1) Visakhapatnam (87.8) Nizamabad (87.3)
Warangal (87.0) Chittoor (85.4)
_____________________________________________________________
70 % to 84%
Nellore (84.4) Nalgonda (84.4) Adilabad (82.5) Khammam (82.4)
Kadapa (82.2) Karimnagar (82.0) Guntur (81.8) Krishna (81.4)
East Godavari (75.7) Ranga Reddy (74.2) Medak (73.7) West Godavari (71.9)
______________________________________________________________
Below 70%
Vizianagaram (68.3) Anantapur (67.0) Prakasam (64.3)
Srikakulam (62.2) Mahabubnagar (61.6) Kurnool (49.8)
______________________________________________________________
State Average
Total: 76.9 Rural: 69.9 Urban: 86.1

12
infants weighed at birth was 70 percent in rural and 86 percent in urban areas.
About 70 percent of scheduled caste and scheduled tribe mothers reported that
their infants were weighed at birth. Less than 70 percent of newborns were
weighed at birth in the districts of Vizianagaram, Srikakulam, Prakasam,
Anantapur, Kurnool and Mahabubnagar
Slightly less than one fifth
(17.5) of newborn babies
weighed less than 2500
grams in the state (18
percent in rural and 16
per cent in urban areas).
About 19 per cent of
newborns among
scheduled caste and
scheduled tribe
communities weighed
less than 2500 grams. As compared to the UNICEF MICS study (2000), the
proportion of low birth weight babies reduced from 23 percent to 17 percent
between 2000 and 2006. Developed districts namely Krishna, West Godavari
and Chittoor recorded about 20-23 percent of low birth weight babies which was
higher than state average. Backward districts namely Visakhapatnam, Kurnool
which recorded lower than state average may require further insights and
explanation.
With the WHV (ASHA) in every village and collaborative work with AWWs and
ANMs, there is further scope to weigh all the new born babies. Appropriate
strategies to improve nutritional status and identification of high risk pregnancies
require immediate attention to further reduce low birth weight in newborn babies
in the state.
Breast feeding and Supplementation
The Government of India recommends that breast feeding should begin
immediately after childbirth and that infants should be exclusively breastfed for the first
four months of life. It is recommended that colostrums the first milk, should be given to
infants because it provides natural immunity and important nutrients.
23.6
21
19.7
17
14.1
13.6
12.8
0 5 10 15 20 25
West godavari
Chittoor
Krishna
State
Nizamabad
Kurnool
Visakhapatnam
There is a 11
point differential
between the
highest and
lowest district
level children’s
birth weight less
than 2500 grams
Percent of children with birth weights less
than 2.5 kgs

13
Breast feeding is nearly universal
in Andhra Pradesh and four-fifths
(81 percent) of all infants born in
the reference period preceding
the survey had been breastfed.
Breastfeeding was lower in urban
areas (76 percent) than in rural
areas (84 percent). More than 85
percent of mothers among SC
and ST and lower SLI breastfed
their infants.
Initiation of breastfeeding immediately after childbirth is important because it
benefits both mother and the infant. It is recommended that the first breast milk
(colostrum) should be given to the child rather than squeezed out from the
breast and discarded. Less than one-third mothers (28 percent) mothers
squeeze the first milk from the breast before they start breast feeding their
babies (31 percent in rural and 26 percent in urban areas). The recorded
percentage was higher among Scheduled caste (30 percent) and Scheduled
tribe (35 percent) respectively.
A substantial proportion (38-42 percent) of women squeeze out the first milk
containing colostrum from the breast before breastfeeding their infants in
Srikakulam, Vizianagaram, Guntur, Nalgonda and Ranga Reddy districts.
One-third (32 percent) of infants in the state were reported to be breastfed within
one hour of birth. Less than one-fifth of infants were reported to be breastfed
within one hour in Ranga Reddy, Nalgonda, Kadapa, Medak and Mahabubnagar
districts. The Baseline survey results reveal the urgent need for an intensive IEC
campaigns on the importance of breastfeeding immediately after birth and
colostrum feeding in all campaigns undertaken under NRHM.
More than half (54 percent) of
infants were breastfed
exclusively for four months.
About 34-49 percent of
mothers reported exclusive
breast feeding for four months
in Vizianagaram,
Visakhapatnam, East
Breast fed within one hour of birth
10.3
31.8
22.4
0 5 10 15 20 25 30 35
RCH Baseline
Survey
NFHS-3 (2005-06)
NFHS-2 (1998-99)
31.8
50.2
76.5
15
16.7
0 20 40 60 80 100
Mahabubnagar
Medak, Kadapa
State
Vizianagaram
Visakhapatnam
Percent
Percent
54.4%
90%
33.9
35.2
41.4
54.4
74.5
79.5
0 20 40 60 80 100
Hyderabad
Warangal
Visakhapatnam
State
Kadapa
Anantapur
50
1000
Infants Exclusively Breastfed Atleast Four Months
Target
Baseline
Percent

14
Godavari, Chittoor, Hyderabad, Nizamabad, Mahabubnagar and Warangal
districts.
Mean time after birth when baby was put to breast was 3.6 hours (3.2 hours in
rural and 4.1 hours in urban)
At the age 6-9 months, all infants should be given solid or mushy food in addition
to breast milk to provide sufficient nutrients. However, only 61 percent of
children age 6-9 months (58 percent in rural and 66 percent in urban) received
the recommended combination of breast milk and solid or mushy food.
WHO recommended an outcome indicator namely continued breast feeding for
one year for children in 12-15 months age who are still breastfed. The survey
revealed that about eightynine percent of infants were breastfed for more than
one year (92 percent in rural and 86 percent in urban).
The practice of breastfeeding within one hour of birth was lower among the
mothers who had not received ANC (27 percent) as compared to mothers with 3
or more ANC visits (32 percent).
Child Morbidity and Treatment Patterns
An attempt has been made to arrive at the proportion of children who suffered
from diarrhoea and Acute Respiratory Infection (ARI). Mothers of children born since
January/Sankranti 2004 till the date of survey were asked if their infants suffered from
diarrhoea and ARI during the two weeks preceding the survey, and if so, the type of
treatment given.
Early diagnosis and treatment with antibiotics can prevent a large proportion due
to ARI/pneumonia. During the two weeks preceding the survey, 18.2 percent of
children under two and half years (January/Sankranti 2004 to Survey date) had
symptoms of Acute respiratory infection (cough accompanied by fast breathing).
The NFHS-2 (1998-99) reported that 19 percent of children under age three
years in Andhra Pradesh suffered from ARI.
Only 32.5 percent of the women are aware of danger signs of pneumonia (30
percent in rural areas and 35 percent in urban areas). About 31-32 percent of
mothers among SC and ST community are aware of pneumonia. Higher
awareness of ARI (more than 35 percent) were recorded in Kurnool (37%),
Chittoor (38%), Ranga Reddy (36%), Hyderabad Urban (43%) and more than 50
percent in Khammam and Nalgonda districts.

15
The important danger signs of pneumonia as reported by mothers were ‘difficulty
in breathing’ (76 percent), ‘wheezing/whistling’ (41 percent), ‘Pain in the chest
and productive cough with fever’ (40 percent) and ‘Chest in-drawing’ (35
percent).
About 12 percent of children suffered from diarrhea (12 percent in rural areas
and 11 percent in urban areas) in the two-week period before the interview. Due
to seasonal variations in the prevalence of diarrhea, this cannot be assumed to
reflect the situation throughout the year.
Knowledge and use of Oral Rehydration Salt (ORS) packets for the treatment of
diarrhea was not widespread. Children with diarrhea in the previous two weeks
who received ORS were 49 percent (47 percent in rural and 51 percent in urban
areas) as compared to 36 percent reported in the NFHS-3 (2005-06) survey
(based on the information on the last 2 births in the 3 years before the survey).
The use of antibiotics and other anti-diarrhoeal drugs is not generally
recommended for the treatment of childhood diarrhea. About 86 percent of
children who had diarrhea in the last two weeks were treated through pills and
syrup, and 34 percent received an injection. Marginal variations were reported
between rural and urban and background variables.
Across the districts, the usage of ORS by mothers was below 35 percent in
Krishna, Mahabubnagar and Nalgonda districts respectively. Under the NRHM,
there is a need for intensive and effective IEC campaigns on diarrhea disease
emphasizing the importance of ORT, increased fluid intake and continued
feeding and discouraging the use of drugs/injections.
Child Immunization
Immunization particulars of children under 2 years were obtained from mothers
or principal care takers. Children in the age span 12-23 months who received BCG,
three doses of DPT and OPV and measles are considered to be fully immunized.
Coverage of full immunization was 80 percent or more in the coastal districts
with the exception of Nellore (79 percent) and Prakasam (77 percent). In the
Rayalaseema region, Kurnool reached 87 percent, whereas Kadapa, Anantapur
and Chittoor reached a coverage level of around 71-80 percent. In the
Telangana region, immunization coverage varied from 73-77 percent in the
districts of Mahabubnagar and Adilabad to 90 percent in Khammam district. In

16
the district of Hyderabad, which is entirely urban, the coverage of full
immunization was 82.7 percent.
For the state as a whole, the
coverage of full
immunization was 82.7
percent. As compared to the
Eligible Couple and Child
Immunization Survey
(IIHFW, 2004), full
immunization coverage has
become more uniform
throughout the state and
among different back
ground variables. The full immunization among Scheduled caste and Scheduled
tribe communities was lower (78 percent) than the state average.
The utilization level of individual vaccines was higher than the percentage fully
vaccinated. Ninetyeight percent of children had been vaccinated against
tuberculosis, 92 percent received all three doses of polio, same percentage
received all three doses of DPT injections and 88 percent had all three doses of
Hepatitis-B injection. The measles vaccine coverage was 88 percent at the state
level.
The coverage rate of full immunization was comparatively better among children
(87 percent) of literate mothers than in children (76 percent) of illiterate mothers.
Percentage of children (12-23 months) fully immunized
(BCG+DPT(1-3)+OPV(1-3)+Measles)
Coverage rates 85% or more
Krishna (92.3) Khammam (90.2) West Godavari (88.7) Guntur (88.0)
Kurnool (87.2) Warangal (86.7) Karimnagar (86.9) Srikakulam (86.0)
Medak (84.5)
________________________________________________________________
Coverage rates 75% to 84%
Vizianagaram (84.3) Visakhapatnam (83.9) Hyderabad (82.9)
East Godavari (82.7) Ranga Reddy (80.7) Nalgonda (80.2)
Chittoor (76.4) Nellore (79.7) Kadapa (79.7) Prakasam (77.3)
Adilabad (76.8)
________________________________________________________________
Coverage rates <75%
Mahabubnagar (72.8) Anantapur (71.3)
____________________________________________________________
State Average
S.C : 80.2 S.T : 72.8 BPL : 82.5
The dropout rate from DPT3 to measles declined from 9 percent in Eligible
Couple and Child Immunization Survey, 2003 to below 5 percent in the Baseline
survey (2006).
Child Immunization
84.2
57.2
81.5
42.9
82.7
46.0
Baseline
2006
NFHS-3
73.470.371.4EC 2003
% Fully immunized4.
90.087.388.5
Baseline
2006
30.521.124.4EC 2003
% received Hep – B3 vaccine3.
88.188.588.3
Baseline
2006
EC 2003
Baseline
2006
EC 2003
78.076.877.3
% received measles vaccine2.
60.058.659.2
50.245.947.4% of children whose
vaccination card that was
shown to the interviewer
1.
UrbanRuralTotalChild Immunization
Sl.
No.

17
The percentage of children in 12-23 months who were not immunized at all
remained at 1.1 percent having declined from 2.3 percent reported in Eligible
Couple and Child Immunization Survey (Balasubramanian and Satya Sekhar,
2004). There is a need to identify and convert partial immunization cases to
complete immunization in moping up Annual Census Surveys as proposed in the
RCH-II PIP document (CFW, 2005). Further, the dropout rate declined from 24
percent from 2003 to 17 percent in the present baseline survey.
At the district level, full immunization coverage was almost on par with the PATH
study conducted in 2005 by the Government of Andhra Pradesh.
Infant Mortality
Infant mortality rate is a
sensitive indicator of the socio-
economic development of any
country/region. This rate reflects
the quality of life and is also used
for monitoring and evaluating
population and health related
programmes and policies. The
Sample Registration System is
the only source in the country
providing time series estimates of
IMR on an annual basis for India and its states. The Millennium Development Goals
(MDG, 2000) and the national and state population policies set the target of 30 per
1000 live births by 2010. The availability of IMR data at district level and by social
group provides ample information for preparation of district health action plans.
The baseline survey adopted birth
based approach methodology to
estimate infant mortality rate at
district level. The infant mortality
rate was worked out based on the
probabilities of dying before first
birthday. IMR was calculated
based on all births occurred during
January 2004 to July 2005 but not
surviving till their first birth day. The neonatal mortality rates (the probabilities of
dying in the first month of life) for all districts of Andhra Pradesh are also worked
IMR – Trends in Andhra Pradesh
Need to accelerate Decline
46
26
30
75 72
66
52
20
30
40
50
60
70
80
1989-91 1994-96 1999-01 2003-05 2010 2015
Log-Linear trend fitted to the data
R2 = .953 Rr = .949, F=261.2
77.981 -1.189 t
Triennial averages
58
52%
30%
26.4
36.3
32.7
52.8
65.0
72.0
40.3
62.3
55.3
92.9
111.0
0 20 40 60 80 100 120
Hyderabad
West Godavari
Krishna
State
Medak
Mahabubnagar
Rural
Urban
BPL group
Scheduled Caste
Scheduled Tribe
1000
Infant Mortality Rate (per 1000 live births)
Target
Baseline
Districts

18
out. The total number of births within 12 months of age varied from 1390 in
Anatapur district to 1876 in Chittoor district.
The neonatal mortality
comprises about 70
percent of all infant
deaths in the state.
One in 16 infants in rural
areas and one in 26
infants in urban areas
die before celebrating
their first birth day.
The baseline survey estimated IMR as 52.2 deaths per 1000 live births in 2005
which is on par with the SRS estimate of 57 per 1000 live births in 2005 and 53
per 1000 live births as reported by NFHS-3 (2005-06) study.
Trend analysis of infant mortality over the period 1989-91 to 2003-05 indicates
that special emphasis and effective monitoring of different RCH-II interventions
are required to bring down IMR to 30 per 1000 live births by 2010 and 26 per
1000 live births by 2015.
The reduction in IMR in Andhra Pradesh mostly depends on the reduction of
high IMR levels in rural areas and among Scheduled caste and Scheduled tribe
categories.
Districts which recorded the
highest infant mortality rate
between 72-63 deaths per 1000
live births were in
Mahabubnagar, Medak,
Adilabad, Nizamabad, Nalgonda
and Khammam districts in
Telangana regions, Srikakulam
and Vizianagaram districts in
Coastal Andhra and Anantapur
in Rayalaseema region.
36.9%
15%
20.3
20.5
21.3
36.9
48.0
52.5
43.2
28.6
38.2
59.5
70.6
0 10 20 30 40 50 60 70 80
Hyderabad
Krishna
West Godavari
State
Nizamabad
Mahabubnagar
Rural
Urban
BPL group
Scheduled Caste
Scheduled Tribe
1000
Neonatal Mortality Rate (per 1000 live births)
Target
Baseline
Districts
50
Infant Mortality Rate
(All births since January 2004 to July 2005)
IMR above 60 (per 1000 live births)
Mahabubnagar (72) Medak (65) Adilabad (64)
Nizamabad (63) Nalgonda (63) Srikakulam (62)
Vizianagaram (60) Anantapur (60) Khammam (60)
______________________________________________
IMR between 50 to 60 (per 1000 live births)
Kurnool (58) Visakhapatnam (52) Warangal (52)
Kadapa (51) Prakasam (50) Karimnagar (50)
______________________________________________
IMR below 50 (per 1000 live births)
Nellore (48) Chittoor (46) East Godavari (45)
Ranga Reddy (44) Guntur(42) West Godavari (36)
Krishna (33) Hyderabad (26)
______________________________________________
State Average

19
The most challenging part of infant mortality is the large proportion of neonatal
deaths contributing to 60-70 percent of all infant deaths. This stresses the need
to increase the efforts in order to meet the IMR goal of NRHM by allocating
higher number of CEMONC and BEMONC centers with quality delivery care
from specialist medical personnel.
Rural infant mortality rates are
considerably higher than urban
infant mortality rates. Infant
mortality seems to be relatively
higher among infants of scheduled
castes and scheduled tribes.
Neonatal and infant mortality
declined substantially with increase
in the household standard of living.
Male infants have a higher risk of
dying than female infants.
The infant mortality rate decline consistently with increasing education of mother
as expected, ranging from a high of 99.2 deaths per 1000 live births for illiterate
mothers to a low of 14.2 deaths per 1000 live births for mothers who have had
high school and above education.
Reproductive Health problems
In order to assess the prevalence of reproductive tract infection among
respondents a few questions were put in privacy during interview time. Respondents
were assessed whether they contacted a disease through sexual contact, experienced
bad smelling, and abnormal genital discharge or had a genital sore or ulcer.
Sixteen percent of
respondents reported
reproductive tract infection.
Higher prevalence was
reported in Medak,
Nizamabad and Ranga Reddy
districts. As per RCH-II norms,
it is required to reduce the RTI
incidence to a half from its
current level and this needs
special emphasis.
16%
8%
2.9
4.7
16.0
26.5
29.6
35.1
0 10 20 30 40
Kurnool
Kadapa
State
Ranga Reddy
Nizamabad
Medak
50
1000
Reproductive Tract Infections* (halved by end of RCH-II)
Target
Baseline
Percent
* Women who contacted a disease through sexual contact, experienced bad smelling abnormal
genital discharge and had a genital sore or ulcer.
Infant Mortality Rate in Andhra Pradesh by
Background Characteristics
52.2
39.1
62.2
92.9
111
85.1
55.3
20
30
40
50
60
70
80
90
100
110
120
Total
U
rban
Rural
S.C
S.T
Low
SLI
BPL
RCH-II Baseline
Survey, 2006
Based on births occurred during January 2004 to July 2005 before a child completing one year

20
Women who sought advice/treatment for RTI problems were only 46 percent (48
percent in rural and 45 percent in urban areas). No variation was recorded
between background variables. Majority of women availed of the services from
private sector and NGO as compared to Government doctor/health personnel.
46.6%
30.0
30.8
46.6
55.0
57.2
58.2
0 20 40 60 80
Anantapur
Kurnool
State
Kadapa
Visakhapatnam
Karimnagar
1000
Women seeking Advice/Treatment for RTI Problem
Baseline
Percent
RCH-II Intervention Programme
The Department of Family Welfare, Government of Andhra Pradesh has
formulated various interventions under NRHM (Reproductive and Child Health Project-
II). The major objectives of these interventions are to improve health conditions of
women and children and increase institutional deliveries. Some of the interventions
which are being implemented in the state are (1) Janani Suraksha Yojana (2) Free
Bus Pass to Pregnant Women (3) Women Health Volunteer (ASHA / WHVs) and (4)
Round the Clock Mother and Child Health Centre. Information was collected from all
the respondents about the awareness of these RCH-II interventions initiated under
NRHM.
Janani Suraksha Yojana
Government of India
launched the scheme ‘Janani
Suraksha Yojana’ in modification
of the National Maternity Benefit
Scheme. This 100 percent
centrally sponsored scheme
provides Rs.700/- as an
incentive to all women (both in
rural and urban areas) aged 19
Knowledge of Janani Suraksha Yojana
Scheme (District wise)
Above 76%
Khammam (81.3) Srikakulam (80.7) Vizianagaram (79.9)
West Godavari (77.9) Prakasam (76.1)
_________________________________________________
65% to 75%
Medak (74.3) Nizamabad (71.8) Chittoor (71.6)
Nalgonda (71.1) Guntur (71.0) Visakhapatnam (66.3)
Mahabubnagar (65.8) Krishna (65.2) Kadapa (65.2)
_________________________________________________
Below 65%
Warangal (62.2) Anantapur (51.7) Karimnagar (50.1)
Ranga Reddy (49.6) East Godavari (48.0) Kurnool (41.8)
Adilabad (38.3) Nellore (33.4) Hyderabad (21.9)
_________________________________________________
State Average
Total : 61.6 Rural: 65.6 Urban: 56.3

21
years and more, women belonging to households below poverty line are eligible for
availing the benefit. The Government of Andhra Pradesh added Rs.300/- (under
Sukhibhava Scheme) and used to release Rs.1000/- to the beneficiary
About 62 percent of mothers were aware of the JSY intervention. The
awareness levels appear to be better in rural areas (65 percent) as compared
to urban areas (56 percent).
Out of those women aware of JSY scheme, about 31 percent have benefited
from the scheme. Among the beneficiaries, 17 percent of mothers faced
problems in realizing the scheme incentive. Extensive IEC activities are
required to propagate the benefits of the scheme to the public and consistent
and timely flow of funds will definitely improve the institutional deliveries among
vulnerable groups in the state.
Districts which reported below state average were East Godavari and Nellore
from Coastal Andhra region, Anantapur and Kurnool from Rayalaseema region
and Ranga Reddy, Karimnagar, Adilabad from telangana region.
Free Travel by the Public Transportation by Pregnant Women
Every pregnant woman will have to have at least one antenatal checkup by
PHC medical officer for screening of high-risk cases and receive advice for
institutional delivery. The scheme provides for free travel by the public transportation
for pregnant women from their village to the nearest PHC or FRU help in achieving the
goal.
Twentyseven percent of
respondents were aware of
the free bus pass scheme
(35 percent in rural areas
and 18 percent in urban
areas) and 21 percent
availed the facility at state
level.
The proportion aware of
free bus pass facility to
pregnant women varied from 10 percent in East Godavari district and more than
40 percent in West Godavari, Kadapa and Khammam districts.
Knowledge of Free Bus Pass to Pregnant
Women Scheme
Top 5 districts
Khammam - (43.5)
West Godavari - (43.1)
Kadapa - (40.4)
Krishna - (38.5)
Nizamabad - (36.8)
Bottom 5 districts
Karimnagar - (16.8)
Ranga Reddy - (16.5)
Nellore - (14.6)
Adilabad - (12.0)
East Godavari - (10.0)
State Average
Total : 27.5 Rural : 34.9 Urban :17.6
S.C : 31.2 S.T : 28.2 BPL :28.2

22
Round-the-Clock MCH Centre
In order to promote institutional deliveries at PHCs, the existing 470 units of 24
hour Maternal and Child Health Centers have to ensure the availability of one basic
emergency obstetric care facility per 1,00,000 rural population in the state. The
intervention was initiated under RCH-I programme and strengthened in RCH-II.
Less than one-fifth (15
percent) of respondents
indicated the awareness of
a RCMCHC in their village/
Mandal. The awareness
level was below seven
percent in West Godavari,
Vizianagaram, Guntur,
Kadapa and Warangal
districts.
Among those who visited the MCH centre, only one-third (34 percent) of
respondents or their relatives visited the RCMCMC for services particularly at
night time.
Out of the respondents or their relatives who visited RCMCHC at night time,
about 77 percent received services from hospital staff.
Women Health Volunteer Scheme (ASHA)
The Woman Health Volunteer scheme (ASHA under the NRHM) has been one
of the major interventions introduced under RCH-II. This scheme seeks to identify,
train and position women health volunteers in the Gram Panchayat in the state to act
as health resource persons-of-first-resort in all maternal and child health matters in the
villages and act as link-persons between the community and the service providers in
the village. Out of 52,000 volunteers, more than half of the ASHAs were functioning in
different districts. An evaluation of the scheme strengthens the programme which is
powered by the AP Government.
A quarter (24 percent) of respondents were aware of the WHV scheme in their
villages. Excluding Hyderabad urban district, the awareness of WHV was
reported to be below 15 percent in Nellore, Kurnool, Kadapa, Khammam, and
Adilabad districts.
Knowledge of Round the Clock Mother & Child
Health Centers
Top 5 districts
Nizamabad - (43.8)
Mahabubnagar - (35.2)
Visakhapatnam - (29.9)
Srikakulam - (29.7)
Prakasam - (24.7)
Bottom 5 districts
West Godavari - (7.0)
Warangal - (7.0)
Kadapa - (5.1)
Vizianagaram - (4.9)
Guntur - (3.7)
State Average
S.C : 13.6 S.T : 10.5 BPL : 14.7

23
Conclusions
Responding to the
growing need for
generating district-level
data, Indian Institute of
Health and Family
Welfare (IIHFW), with
the funding from
Commissionerate of
Family Welfare
conducted the
household survey at
district level to obtain the
baseline information on a number of policy relevant indicators relating to Reproductive
and child health. The log frame of sampling, methodology, questionnaire preparation,
training of investigators, analysis was carried out by the Nodal agency (IIHFW) and
the data collection and data entry undertaken by eleven research agencies in Andhra
Pradesh. It is also proposed to conduct mid-term and end line surveys in order to
assess the impact of various interventions formulated under NRHM and in particular
on RCH-II interventions. The population projections for Andhra Pradesh indicate that
the women in 15-49 year would increase from 209 to 239 lakhs between 2001 and
2011. Hence there will be a continuous and sustainable demand for the reproductive
and child health services in the years to come. The conclusions of the study are given
below.
The interventions introduced require intertwining of direct and indirect
interventions to achieve NRHM goals of IMR and MMR. The quality care health
facilities in CEMONC and BEMONC centres with efficient blood banks and broad
storage centres in the mandals of different districts (with high IMR and MMR) are
crucial. The indirect interventions like Emergency health transport, Free bus pass to
pregnant women, Janani suraksha yojana and ASHA programme will be effective only
if health care delivery system are strengthened. The success of direct and indirect
interventions will be crucial for the overall health care delivery of NRHM/RCH
services.
1. Three ANC checkups is Universal across regions and background variables.
2. About sixtythree percent of mothers received ANC in the first trimester of their
pregnancy. Districts indicating lower than 35 percent of ANC in the first trimester
Knowledge of Women Health Volunteer Scheme
(District wise)
Above 35%
Mahabubnagar (53.2) Visakhapatnam (52.1) Chittoor (41.9)
Nizamabad (37.8)
_________________________________________________
20% to 34%
Srikakulam (33.6) Krishna (30.1) Vizianagaram (28.8)
Warangal (28.3) West Godavari (26.4) Ranga Reddy (25.6) Guntur (24.7)
East Godavari (24.3) Medak (22.1) Prakasam (20.8)
_________________________________________________
Below 20%
Anantapur (17.9) Karimnagar (16.7) Kadapa (13.1)
Khammam (11.7) Adilabad (11.0) Nalgonda (10.4)
Nellore (9.3) Kurnool (7.2) Hyderabad (2.6)
_________________________________________________
State Average
S.C : 27.0 S.T : 27.9 BPL : 25.4

24
were Mahabubnagar and Ranga Reddy districts. In order to reach 95 percent of
target by the end of project period, strengthening of monitoring by PHC medical
officer and substantial improvement in low performing districts are essential.
3. Even though 94 percent of mothers received at least one ANC from a MBBS
doctor, there is a need to increase the AN checkups to a minimum of four by a
MBBS doctor in the months of third, sixth, eighth and ninth months as per the
Safe Motherhood norms.
4. Slightly more than a half (54 percent) of mothers received/ purchased IFA
tablets. There is a need to streamline the supply of IFA tablets from district level
to sub-centre village. Less than 40 percent of mothers in Warangal,
Mahabubnagar, Ranga Reddy and Kurnool districts had received/ purchased
100 or more IFA tablets during the pregnancy pertaining to the last child.
5. About half of mothers received/purchased IFA tablets at state level but the
consumption was below 33 percent. Marginal variations were reported across
background variables. Mother’s education, standard of living and occupation do
not appear to have played any role in consuming of IFA tablets.
6. Eightynine percent of mothers received the general services (weight
measurement, blood pressure, blood examination and abdominal checkup) at
least once during ANC.
7. About seventysix percent of mothers were advised on expected date of delivery,
having delivery in a hospital and on breastfeeding practices. Only a half of the
mothers reported receiving advice/ counseling from health personnel on the
danger signs of pregnancy. More emphasis has to be given to these aspects
during IEC activities by the field level staff and PHC personnel.
8. Less than a half (46 percent) of mothers received full ANC care, i.e. two doses
of TT injection, required number of IFA tablets and at least 3 ANC visits during
their pregnancy period. There is a need to strengthen the full ANC coverage in
the districts of Kurnool, Ranga Reddy, Mahabubnagar, Nalgonda and Warangal
districts.
9. About 76 percent of mothers delivered in a health facility and 82 percent of
deliveries were attended by a doctor or nurse/midwives
10. The survey results point to the need to a) strengthen the JSY, Free bus pass to
pregnant women and other RCH interventions and b) improvement of
institutional deliveries in low performing districts.

25
11. More than a quarter (27 percent) of deliveries were either caesarian or other
interventions. Twentyone percent of mothers belonging to Scheduled caste and
Scheduled tribe underwent Caesarian section. Highly developed districts in
Telangana region reported higher proportion of caesarian section deliveries as
compared to the West Godavari, Krishna and East Godavari districts of Coastal
Andhra region.
12. Ninety percent of mothers who delivered in a medical institution availed post
natal checkup within one week of birth. Only sixty percent of non institutional
births were followed up by a post natal checkup within one week of delivery (59
percent in rural and 63 percent in urban).
13. Out of those mothers who received post natal checkup, about 77 percent
received checkup from MBBS doctor. Keeping the high neonatal mortality in the
state, there is a need to strengthen the monitoring of the field health
functionaries to educate the pregnant mothers during ANC counseling.
14. With the WHV in every village and collaborative work with AWWs and ANMs, it
is possible to increase the proportion of newborns weighed from 70 percent at
state level. The low birth weight (below 2500 grams) reduced from 23 percent to
17 percent during 2000-2006 period. It is surprising to note that the developed
districts of Krishna, West Godavari and Chittoor recorded higher proportion of
newborns with low birth weight than the state aggregate.
15. About 21 percent of mothers squeeze out the first milk from the breast before
they start breast feeding their babies. One-third of the infants were reported to
be breastfed within one hour of birth. Less than 20 percent of infants were
reported to have been breastfed within one hour in Ranga Reddy, Nalgonda,
Kadapa, Medak and Mahabubnagar districts.
16. More than a half (54 percent) of infants were breastfed exclusively for four
months. Among infants in age 6-9 months, only 61 percent received the
recommended combination of breast milk and solid or mushy food.
17. The full immunization (BCG + OPV 1-3 + DPT 1-3 + Measles) at the state level
recorded 82.7 percent. The inter-district variations of full immunization were
marginal.
18. Infant mortality rate was calculated based on all births that occurred during
January 2004 to July 2005 and not surviving till their first birth day. Neonatal
mortality accounts for 70 percent of infant deaths that occurred in the reference

26
period. The reduction in infant mortality depends on reduction in neonatal
mortality among rural, Scheduled caste and Scheduled tribe categories.
19. There is a need to increase the efforts in order to meet the IMR goal of NRHM
by allocating higher number of CEMONC and BEMONC centers with quality
delivery care from specialist medical personnel.
20. Male infants have higher risk of dying than female infants. The infant mortality
rate declines consistently with increasing education of mother
21. Sixtytwo percent of mothers were aware of the Janani Suraksha Yojana
scheme. The awareness is more in rural areas (66 percent) as compared to
urban areas (56 percent). The awareness was 63 percent among Scheduled
caste and 62 percent in Scheduled tribe. Out of those women who were aware
of JSY scheme, only a half (31 percent) benefited from the scheme. Among the
beneficiaries, 17 percent of mothers faced problems in realizing the incentive.
22. Twentyseven percent (35 percent in rural and 18 percent in urban) of
respondents were aware of the free bus pass scheme and 21 percent availed
the benefit.
23. A quarter (24 percent) of respondents were aware of the WHV scheme in their
villages. Excluding Hyderabad urban district, the awareness of WHV was
reported below 15 percent in Nellore, Kurnool, Kadapa, Khammam, and
Adilabad districts.

27
Notes:
1. Empirical research studies (Srinivasan and Rajaretnam, IDPAD study, 2006)
indicated that the recently delivered mothers are self-selected for higher potential
fertility. Women who have recently delivered (within one year) have 35% high fertility
in the future years as compared to other women who have not recently delivered.
Majority of these women demand the services related to reproductive and child health
and family planning services.
2. Sampling Details
The sampling adopted a two-stage stratified systematic random sampling method. In the
first stage, primary sampling units or clusters (Villages in rural areas and blocks in urban
areas) were selected by probability proportional to size (PPS) method. The second stage
involved the selection of secondary sampling units, i.e. households within each selected
cluster.
Rural sampling
A list of villages in the district with their population from the 2001 census served as the
sampling frame in rural areas. A sample size of between 25-28 households was thought to be
adequate to represent the village population. Accordingly it was decided to select 60 villages
and 25 households in each selected village in order to achieve a minimum sample of 1800
households on the assumption that the non-response rate would be around 10%.
All villages in the district were classified into three strata based on 2001 census population
figures.
Stratum 1 : population < 1500
Stratum 2 : population 1500 – 2500
Stratum 3 : population > 2500
It was decided to exclude all small villages with population size of less than 100 from the
frame. Sample villages were allocated to three strata (20 villages from each stratum) using
PPS method.
Selection of Households
A house-listing operation was carried out in each of the selected village prior to the data
collection, which provided the necessary frame for the selection of households. All
households with eligible women (i.e., women who delivered birth during the last two years and
all currently pregnant women) were identified. This provided the necessary frame for the
selection of households.
A complete house listing was carried out in the villages with the estimated households of
up to 500. In case of villages with the estimated number of households above 500, the village
was divided into 3 or more number of segments of about same size and 2 segments selected
randomly. Lastly, with systematic random sampling procedure, a sample of 25 households
was selected from each of the sample villages to arrive at the required number of households
in rural areas of the district.
Urban sampling
A three stage systematic random sampling design was used to obtain urban sample of
households, the wards being the unit of selection at first stage, census enumeration blocks at
the second stage and households within the selected block at the third stage.
All wards in the district according to 2001 census frame were arranged and 20 wards will
be selected by PPS method. Two blocks from each of the selected wards were selected again
by PPS method. All the households in the selected blocks were listed and 25 households in
each block were selected by systematic random sampling method.

28
The survey was designed and conducted by the collaborating institute namely the Indian
Institute of Health and Family Welfare, Hyderabad, under the guidance of the
Commissionerate of Family Welfare. Eleven research agencies with experience in conducting
health surveys were selected by the Commissionerate of Family Welfare. The Log frame of
the survey, initiation of background seminars, preparation and finalization of questionnaires,
printing and supply to the research agencies, training of 320 investigators from 11 research
agencies, development of software and data entry training were undertaken by Indian Institute
of Health and Family Welfare (Nodal Agency). The data CDs after data entry were brought
back to IIHFW and scrutinized for data inconsistencies, data validation, data cleaning and final
data preparation was done using EPI-Info and SPSS Package. The analysis and preparation
of Fact Sheet for all districts were submitted in record time of 5 months to the funding agency
for policy interventions.
Household Standard of Living Index (SLI)
The household standard of living index (SLI) has been calculated by summing the
individual scores assigned to each of the household items: 4 for car; 3 each for TV, telephone,
motor cycle/scooter; 2 each for fan/radio/transistor, sewing machine, bicycle, water pump,
bullock cart, thresher; type of house (4 for pucca, 2 for semi-pucca and 1 for kachcha type);
ration card (4 for pink card, 2 for white card and o for no card). Index scores range from 0-14
for a low SLI (13.1%), 15-23 for a medium SLI and 24 and above for a high SLI.
References
Balasubramanian, K and P. Satya Sekhar (2004), Sample Survey of Eligible Couples and
Child Immunization Coverage in Andhra Pradesh: Fact Sheet-2003, (Mimeo), Indian
Institute of Health and Family Welfare, Hyderabad.
International Institute for Population Sciences (1995): National Family Health Survey (1992-
93), Andhra Pradesh State. International Institute for Population Sciences, Mumbai.
International Institute for Population Sciences (1995): National Family Health Survey (1998-
99), Andhra Pradesh State. International Institute for Population Sciences, Mumbai.
International Institute for Population Sciences (2006): ‘Key Findings for Andhra Pradesh from
NFHS-3’ (Fact Sheet).
Park (2002), Text Book of Preventive and Social Medicine (17th
edition), M/S Banarsidas
Bhanot Publishers, Jabalpur
PATH (2005), Andhra Pradesh Progress in Immunization Performance, Government of
Andhra Pradesh.
Srinivasan K, C.P. Prakasam, T. Rajeretnam and Puruhit Praharaj (2006), Expanding Basic
Maternal and Child Health Services: An Operations Research Project with Birth-based
Approach, International Institute for Population Sciences, Mumbai.

29
BASELINE SURVEY ON REPRODUCTIVE AND CHILD HEALTH
(RCH-II), ANDHRA PRADESH 2006
ANDHRA PRADESH
FACT SHEET
INDICATOR TOTAL RURAL URBAN SC ST SLI(Low) BPL
Sample Population
• Number of households interviewed 59117 33746 25371 13128 4371 7724 45119
• Number of eligible women interviewed1
59378 33902 25476 13162 4385 7745 45302
• Number of live births2
65341 37237 28104 14467 4856 8485 49895
• Population in the sample 310881 179111 131770 13128 4371 59117 239544
Population and Household Characteristics3
• Mean household size 5.2 5.3 5.1 5.1 5.0 5.2 5.3
• Percent of pucca houses 48.5 37.1 63.6 42.9 31.8 5.8 45.5
• Percent of households with separate kitchen 54.8 46.0 66.4 42.9 37.1 18.3 52.7
• Percent of households with electricity 91.8 88.2 96.5 88.1 76.1 54.8 91.6
• Percent of households using piped water as main source of drinking 94.2 91.3 98.1 94.6 90.2 89.6 94.1
• Percent of households using cleaner cooking fuels (LPG, Electricity
and Kerosene)
38.6 16.0 68.6 26.5 18.9 1.5 34.3
• Percent of households with no toilet / latrine facility 49.5 71.9 19.8 60.3 70.8 94.0 53.1
• Percent of households with white ration card 76.3 78.5 73.4 82.4 74.5 73.0 -
• Percent of scheduled caste households 22.2 25.8 17.4 - - 33.0 24.0
• Percent of scheduled tribe households 7.4 9.9 4.1 - - 17.9 7.2
• Percent of backward caste households 46.9 46.9 46.9 - - 39.6 48.0

30
Maternal Health Care4
• Percent of mothers received any ANC 96.8 95.3 98.7 96.1 92.7 91.1 96.6
• Percent of mothers received at least 3 ANC checkups 93.6 91.5 96.4 91.5 87.3 85.1 93.3
• Percent of mothers registered in first trimester 63.0 59.7 67.3 56.4 57.5 52.8 61.8
• Percent of women received check up at least once by a M.B.B.S
doctor
94.3 92.1 97.3 93.0 88.6 86.0 94.1
• Percent of mothers received 2 or more TT injections 95.3 95.0 95.7 94.4 91.6 91.7 95.3
• Percent of mothers received 100 or more IFA tablets 54.0 52.4 56.0 51.4 53.5 50.2 54.1
• Percent of mothers consumed all the IFA tablets received 33.2 32.5 34.1 30.7 31.6 31.8 32.4
Components5
of Antenatal Checkup/Advice
• Weight measured 96.2 95.2 97.6 95.6 93.1 91.7 96.1
• Blood pressure checked 95.4 93.7 97.6 94.5 91.2 89.4 95.2
• Blood sample examined 94.2 92.1 96.9 92.8 89.5 87.1 93.9
• Urine sample examined 93.3 91.2 96.0 92.0 88.6 86.3 93.0
• Abdomen examined 95.4 94.2 96.9 94.5 91.9 90.7 95.2
• Informed about expected date of delivery 76.1 75.0 77.6 73.2 70.8 68.3 75.4
• Advised to have delivery in a health facility 76.6 77.7 75.2 75.8 70.8 73.1 76.7
• Advised about proper nutrition during pregnancy 87.8 88.4 87.0 87.1 84.5 85.6 87.5
Percent of Women Reporting health complications
• Worms in intestines 3.1 3.5 2.4 3.3 4.5 3.1 3.1
• Difficulty of vision during day light 2.6 2.9 2.1 2.8 6.0 3.5 2.6
• Suffered from night blindness 2.2 2.8 1.4 2.9 4.7 3.8 2.3
• Suffered with convulsions but not due to fever 4.0 4.3 3.6 3.9 6.0 4.6 3.9
• Swelling of legs, body or face 24.4 24.1 24.9 24.5 29.3 23.0 24.0
• Felt excessive fatigue/anemic 36.0 35.5 36.7 38.0 36.6 32.3 36.0

31
Percent of women received advise/counseling at least once on the
following aspects:
• About additional diet 94.2 93.8 94.7 93.8 93.2 91.3 94.0
• Necessity of adequate rest / sleep 90.6 90.6 90.5 90.5 90.5 87.5 90.5
• Information about danger signs of pregnancy 50.7 51.0 50.3 50.7 44.6 48.7 50.9
• About breast feeding practice 77.0 76.6 77.7 76.3 76.1 74.2 76.7
• Need to keep the new born warm 67.0 67.6 66.2 66.7 67.3 66.4 66.6
• About cleanliness during delivery time 67.5 68.1 66.6 68.1 64.0 66.3 67.2
• About family planning 60.8 59.5 62.5 60.6 54.7 56.3 61.0
Delivery Care6
• Percent of deliveries in public hospitals 34.7 33.1 36.7 39.0 34.5 33.3 36.7
• Percent of deliveries in private hospital/NGO/Trust/Clinic 41.3 34.1 50.8 32.2 25.1 22.9 37.7
• Percent of domiciliary/Other deliveries 24.1 32.8 12.5 28.8 40.4 43.7 25.6
Percent of women who had
• Normal delivery 72.7 76.6 67.5 77.4 80.8 84.6 75.1
• Caesarian section 26.5 22.6 31.6 22.0 18.4 14.7 24.1
• Other intervention 0.8 0.8 0.9 0.6 0.8 0.7 0.8
• Safe deliveries7
81.6 74.2 91.4 76.7 67.6 63.7 80.5
Main reason reported by women for not going to health facility for
delivery8
• Not necessary 31.1 31.8 28.2 30.9 25.3 27.2 30.5
• Not customary 1.3 1.2 1.7 1.1 1.4 1.4 1.2
• Costs too high in a health facility 7.4 7.6 6.7 7.4 9.5 10.6 7.6
• Too far/Inconvenient 2.3 2.3 2.2 2.4 2.6 2.0 2.2
• Transport not available 5.1 5.9 2.1 4.2 11.8 7.1 5.2

32
• Poor quality service 1.6 1.6 1.9 2.2 2.1 2.9 1.5
• Due to lack of time to reach a health facility 28.2 27.5 31.0 31.1 21.0 25.6 28.0
• Husband/Family did not allow 0.6 0.6 0.5 0.9 0.6 0.6 0.6
• Family felt better care at home 19.7 18.9 22.7 17.5 22.4 19.8 20.4
• Lack of knowledge 1.2 1.3 1.2 1.1 2.6 1.4 1.3
• Other 1.4 1.3 1.7 1.2 0.8 1.4 1.4
Use of Safe delivery practices9
• Disposable delivery kit 44.6 44.4 45.6 46.3 49.6 40.2 44.2
• Clean blade to cut umbilical cord 91.3 91.5 90.8 92.5 90.4 91.6 91.4
• Baby immediately wiped dry and wrapped without being bathed 80.0 80.0 79.8 82.1 82.6 80.7 79.6
Percent of women reported complications / problems during last
delivery
• Pre-term labour 14.1 16.3 11.1 15.4 20.8 17.9 14.1
• Excessive bleeding 6.9 7.7 5.7 7.2 13.0 8.3 6.7
• Prolonged labour 9.9 10.2 9.6 10.0 9.7 9.1 9.7
• Obstructed labour 9.8 9.4 10.3 8.3 8.1 6.4 9.3
• Breach birth 2.4 2.3 2.7 2.3 2.3 1.9 2.4
Birth Weight
• Percent of children weighed at birth 76.9 69.9 86.1 72.7 65.0 56.4 75.4
• Percent of children weighed less than 2500 grams at birth 17.0 17.6 16.3 19.1 16.9 22.8 17.2
Post natal Checkup
• Percent of mothers received first postnatal checkup within a day 87.6 83.4 93.1 85.9 84.3 75.8 86.7
• Percent of mothers received first postnatal checkup within a week 90.2 86.8 94.8 88.9 89.1 80.5 89.6

33
• Among those with post partum checkups (non-institutional births)
1. Percent seen within one week of birth 60.3 59.5 63.1 60.2 73.4 56.6 60.4
2. Percent of mothers received post partum
checkup within 2 months of birth
64.2 63.5 66.9 64.8 75.8 60.5 64.3
• Out of those women who received post natal check up, percent of
women received checkup from a doctor
76.9 71.0 84.1 73.6 60.8 61.9 75.5
Breast Feeding Practices
• Percent of children ever breastfed 98.0 98.3 97.7 98.5 98.3 98.6 98.1
• Percent of children who were currently breastfed 80.6 83.8 76.3 84.4 85.0 86.1 81.5
• Percent of children started breastfeeding within half an hour 11.7 12.1 11.3 14.0 14.8 12.1 12.4
• Percent of neonates started breastfeeding within one hour of birth 31.6 32.8 30.0 35.7 37.0 33.8 33.0
• Percentage of children started breastfeeding within one day of birth 68.5 68.2 68.8 72.6 73.9 66.8 69.3
• Percentage of children whose mother squeezed out the first milk
from breast
28.5 30.7 25.7 28.7 33.0 34.7 28.7
• Percent of children exclusively breastfed for 4 months 54.4 56.5 51.6 57.6 54.2 58.0 55.2
Childhood Diseases (Diarrhoea and ARI)10
• Percent of children who had diarrhea during last two weeks prior to
the survey
11.7 11.9 11.4 11.5 12.2 11.7 11.5
• Among the children who had diarrhea in the past two weeks,
percentage received
1. Oral rehydration therapy (ORS packet) 48.8 47.4 50.6 49.0 43.5 41.6 48.9
2. Gruel made from rice or other cereal 14.4 15.2 13.1 13.3 17.2 13.6 14.5
3. Pill / syrup 85.9 84.6 87.5 84.5 81.7 82.7 86.6
4. Injection 34.0 36.8 30.4 35.9 39.2 35.5 34.8
5. Intravenous (I.V / Drip / Bottle) 8.2 8.8 7.4 8.5 11.7 9.5 7.7

34
• Percent women aware of danger signs of Pneumonia 32.5 30.4 35.2 31.0 32.2 25.1 31.2
• Percent of children suffering from Pneumonia during last two weeks
preceeding the survey
18.2 18.0 18.3 18.4 20.6 18.1 17.8
Child Rights Indicators
• Percent of births registered with civil authority 57.0 52.7 62.6 54.8 47.1 41.9 56.7
• Percent of births possessing birth certificates 46.2 40.3 53.9 44.5 34.2 31.4 45.4
• Percent of children with vaccination card shown to interviewer 59.1 58.4 60.0 57.3 54.2 51.6 59.0
Child Immunization
Among Children Age 12-23 months
• Percent received BCG 98.1 98.1 98.1 97.9 95.6 95.3 98.1
• Percent received OPV 1 97.9 98.1 97.7 98.0 95.8 95.8 97.9
• Percent received DPT 1 97.9 98.1 97.6 97.9 95.4 95.5 97.9
• Percent received Hepatitis- B1 97.0 97.1 96.8 97.1 93.4 94.3 97.0
• Percent received Measles vaccine 87.9 88.0 87.8 85.8 81.6 82.2 87.7
• Percent fully immunized (BCG + OPV 1-3 + DPT 1-3 + Measles) 82.7 81.5 84.2 80.2 72.8 73.6 82.5
• Percent received Vitamin A dose at least once 87.0 87.6 86.2 86.9 83.3 82.7 87.1

35
Pregnancy11
• Percent of current pregnancies among currently married women
(CMW ) interviewed
12.5 12.6 12.3 12.4 11.8 11.9 12.6
• Number of currently pregnant women 4149 2408 1741 933 312 540 3178
1. Percent of pregnant women below 20 weeks of pregnancy 34.1 34.6 33.5 36.5 36.5 36.7 33.8
2. Percent of pregnant women 20-32 weeks of pregnancy 57.0 65.4 57.8 55.3 54.2 54.1 57.0
3. Percent of pregnant women 33+ weeks of pregnancy 8.9 9.0 8.7 8.1 9.3 9.3 9.2
Contraceptive Use
• Percent of CMW using any method of contraception 43.2 42.8 43.8 42.0 38.8 39.9 43.8
• Percent of CMW using permanent method of contraception 41.3 41.5 40.9 40.3 37.8 39.5 42.2
• Percent of CMW using spacing method of contraception 1.9 1.3 2.9 1.6 1.0 0.5 1.6
• Place of providing sterilization services
1) Govt. hospital 78.8 84.1 71.5 84.6 87.5 91.2 81.8
2) Private hospital/NGO/Trust hospital/clinic/other 21.2 15.9 28.5 15.4 12.5 8.8 18.2
Childhood Mortality
• Neonatal Mortality rate 36.9 43.2 28.6 59.5 70.6 57.5 38.2
• Post neonatal mortality rate 15.9 19.0 11.8 33.4 40.3 27.6 17.1
• Infant mortality rate 52.8 62.3 40.4 92.9 111.0 85.1 55.3
Awareness of Health Interventions under RCH-II12
Percent of women who are aware of
• Janani Suraksha Yojana 61.6 65.6 56.3 62.8 62.0 59.0 63.0
• Rural Emergency Health Transport System 13
10.6 12.1 8.4 10.0 7.9 5.5 9.9
• Free Bus Pass to Pregnant Women 27.5 34.9 17.6 31.2 28.2 26.5 28.2
• Women Health Volunteer Scheme 23.9 31.5 13.8 27.0 27.9 26.9 25.4
• Round-the-Clock-Mother and Child Health Centre 14.5 13.0 16.4 13.6 10.5 11.9 14.7

36
Reproductive Tract Infections14
• Percent of women who contracted a disease through sexual contact 7.4 8.3 6.3 8.0 9.4 8.7 7.5
• Percent of women who experienced a bad smelling abnormal genital
discharge
12.6 13.7 11.1 12.8 16.4 14.6 12.7
• Percent of women who had a genital sore or ulcer 2.2 2.4 1.8 2.5 3.1 2.6 2.2
• Percent of women who had any one of the above three problems 16.1 17.8 14.0 16.8 20.4 18.4 16.4
Of those who had RTI problem
• Percent of women who sought advice / treatment 46.6 47.6 45.0 46.0 45.8 46.0 46.3
Source of taking advice or treatment
• Government doctor 29.9 29.2 31.2 32.5 45.1 40.5 31.3
• NGO worker 16.8 16.5 17.2 15.1 12.5 12.8 16.0
• Private doctor 38.1 35.2 43.3 33.0 26.5 29.8 36.5
SC : Scheduled Caste
ST : Scheduled Tribe
SLI(Low) : Standard of Living Index Lower group
BPL : Below Poverty Level (white ration card) households
Notes
1) Eligible women are those who had a delivery during the period from January/Sankranti, 2004 to the date of survey.
2) Live births occurred during the period from January / Sankranti 2004 to the date of survey.
3) The estimates do not represent the district since the sample was not drawn from the general population
4) Based on last pregnancy of all eligible women.
6) Based on last delivery of all eligible women.
7) Deliveries attended by Doctor/ Nurse/ Mid-wife/ANM.
8) Based on non-institutional deliveries.
9) Percentages based on all domiciliary deliveries.
10) Based on children born during the period from January / Sankranti 2004 to the date of survey.
11) Based on all eligible women who are currently married.
12) Based on all eligible women interviewed.
13) Based on all eligible women from four districts Mahbubnagar, Nizamabad, Kurnool and Cuddapah districts.
14) Based on all eligible women.

37
DISTRICT: SRIKAKULAM
FACT SHEET
INDICATOR TOTAL RURAL URBAN SC ST
SLI
(Low)
BPL
Sample Population
2575 1536 1039 341 97 443 2242
2870 1716 1154 374 112 490 2500
• Percent of households using cleaner cooking fuels ( LPG, Electricity and
Kerosene)
28.0 14.0 49.0 11.4 16.0 1.1 21.9

38
SLI
(Low)
BPL
• Percent of women received check up at least once by a M.B.B.S doctor 96.4 95.1 98.3 93.8 79.4 91.0 96.0
Components5
• Weight measured 96.4 96.1 96.9 95.6 91.5 92.5 96.0

39
SLI
(Low)
BPL
Percent of women received advise/counseling at least once on the following
aspects:
Delivery Care6
• Normal delivery 72.3 74.6 68.8 78.6 83.5 84.7 74.1
73.0 66.2 83.2 64.2 53.6 55.8 70.6
Main reason reported by women for not going to health facility for delivery8
• Not necessary 23.8 23.3 25.2 19.4 16.4 23.6 23.1
• Not customary 1.3 1.6 0.7 1.2 1.8 2.7 1.4

40
SLI
(Low)
BPL
• Other 2.8 2.4 3.7 1.2 3.6 3.8 2.9
Percent of women reported complications / problems during last delivery
• Pre-term labour 3.3 2.9 3.8 3.5 4.1 2.3 3.2
• Breach birth 1.6 1.4 2.0 2.9 2.1 1.8 1.5
Birth Weight
Post natal Checkup

41
SLI
(Low)
BPL
• Among those with post partum checkups (non-institutional births)
1. Percent seen within one week of birth 62.5 61.7 64.6 57.0 58.2 51.0 62.2
2. Percent of mothers received post partum checkup within 2 months of
birth
65.8 65.5 66.3 59.4 60.0 54.4 65.7
• Out of those women who received post natal check up, percent of women
received checkup from a doctor
69.8 63.4 78.5 64.8 56.2 55.4 67.6
Breast Feeding Practices
• Percent of children ever breastfed 99.0 99.1 98.7 98.8 99.0 98.6 99.1
• Percent of children who were currently breastfed 77.1 81.5 70.6 82.5 83.3 86.5 79.9
• Percent of children started breastfeeding within half an hour 14.0 17.3 9.2 16.9 18.8 16.5 14.6
• Percent of neonates started breastfeeding within one hour of birth 36.8 38.7 33.9 49.3 52.1 40.0 37.7
• Percentage of children started breastfeeding within one day of birth 58.9 58.7 59.2 72.4 77.1 61.8 59.0
• Percentage of children whose mother squeezed out the first milk from breast 37.6 37.1 38.3 40.1 45.8 41.0 38.3
• Percent of children exclusively breastfed for 4 months 50.6 55.0 44.1 61.1 57.3 59.0 52.1
Childhood Diseases (Diarrhoea and ARI)10
• Percent of children who had diarrhea during last two weeks prior to the survey 19.0 17.1 21.8 16.1 20.6 17.2 18.8
• Among the children who had diarrhea in the past two weeks, percentage
received
1. Oral rehydration therapy (ORS packet) 62.6 65.4 59.3 45.5 60.0 52.6 61.8
2. Gruel made from rice or other cereal 14.1 15.2 12.8 14.5 5.0 6.6 14.0
3. Pill / syrup 94.0 93.2 95.0 93.5 94.7 84.8 93.9
4. Injection 37.8 38.9 36.7 50.0 42.1 39.4 39.4
5. Intravenous (I.V / Drip / Bottle) 6.0 9.0 2.8 10.9 0.0 7.6 6.1
• Percent women aware of danger signs of Pneumonia 19.7 22.5 15.5 17.3 10.3 14.9 19.2
• Percent of children suffering from Pneumonia during last two weeks
preceeding the survey
15.6 13.2 19.2 15.0 11.3 14.4 15.9

42
SLI
(Low)
BPL
Child Rights Indicators
• Percent of births registered with civil authority 69.9 71.1 68.0 66.5 65.1 62.8 68.8
• Percent of births possessing birth certificates 49.4 46.9 53.1 50.1 49.5 48.0 48.0
• Percent of children with vaccination card shown to interviewer 64.0 63.8 64.4 62.4 57.8 62.6 63.6
Child Immunization
Among Children Age 12-23 months
• Percent received BCG 99.2 99.7 98.7 98.4 100.0 98.8 99.1
• Percent received Measles vaccine 94.4 95.5 93.0 90.7 91.9 92.5 95.1
• Percent fully immunized (BCG + OPV 1-3 + DPT 1-3 + Measles) 86.0 90.2 80.5 82.2 89.2 86.0 86.7
• Percent received Vitamin A dose at least once 88.9 88.1 89.9 86.0 89.2 88.9 89.8
Pregnancy11
• Percent of current pregnancies among currently married women (CMW )
interviewed
15.9 15.9 15.9 17.4 12.3 12.7 16.0
• Number of currently pregnant women 203 124 79 34 7 28 178
1. Percent of pregnant women below 20 weeks of pregnancy 31.0 31.5 30.4 26.5 28.6 21.4 28.7
2. Percent of pregnant women 20-32 weeks of pregnancy 60.1 58.1 63.3 55.9 71.4 64.3 61.8
3. Percent of pregnant women 33+ weeks of pregnancy 8.9 10.5 6.3 17.6 0.0 14.3 9.6

43
SLI
(Low)
BPL
Contraceptive Use
• Percent of CMW using any method of contraception 49.9 48.6 51.8 41.8 40.6 50.3 49.8
• Percent of CMW using permanent method of contraception 46.8 46.6 47.1 40.0 39.6 49.2 47.8
• Percent of CMW using spacing method of contraception 3.1 2.0 4.8 1.8 1.0 1.1 2.1
• Place of providing sterilization services
1) Govt. hospital 88.9 91.4 85.0 90.4 93.5 96.7 91.1
2) Private hospital/NGO/Trust hospital/clinic/other 11.1 8.6 15.0 9.6 6.5 3.3 8.9
Childhood Mortality
• Neonatal Mortality rate 43.0 48.4 35.6 49.5 62.5 69.1 46.0
• Post neonatal mortality rate 19.0 25.3 10.4 49.5 46.9 21.8 20.4
• Infant mortality rate 61.9 73.7 46.0 99.0 109.4 90.9 66.4
Awareness of Health Interventions under RCH-II12
Percent of women who are aware of
• Janani Suraksha Yojana 80.7 79.6 82.3 80.9 61.9 77.7 81.5
• Free Bus Pass to Pregnant Women 30.8 39.3 18.2 27.9 27.8 23.9 31.9
• Women Health Volunteer Scheme 33.6 46.2 14.9 36.1 30.9 38.8 35.4
• Round-the-Clock-Mother and Child Health Centre 29.7 26.4 34.5 28.4 27.8 27.8 29.7
Reproductive Tract Infections13
• Percent of women who contracted a disease through sexual contact 5.8 5.9 5.6 7.6 5.2 5.0 6.2
• Percent of women who experienced a bad smelling abnormal genital discharge 7.1 7.7 6.3 7.3 10.3 5.6 7.5
• Percent of women who had a genital sore or ulcer 1.6 2.0 1.0 1.8 3.1 1.1 1.6
• Percent of women who had any one of the above three problems 9.6 10.3 8.7 10.0 12.4 8.1 10.3

44
SLI
(Low)
BPL
Of those who had RTI problem
• Percent of women who sought advice / treatment 38.3 35.4 43.3 32.4 41.7 36.1 36.5
Source of taking advice or treatment
1. Government doctor 34.7 30.4 41.0 54.5 60.0 23.1 35.7
2. NGO worker 4.2 5.4 2.6 0.0 0.0 0.0 4.8
3. Private doctor 54.7 55.4 53.8 54.5 20.0 46.2 53.6
SC : Scheduled Caste
ST : Scheduled Tribe
SLI (Low): Standard of Living Index Lower group
BPL : Below Poverty Level (white ration card) households
Notes
1) Eligible women are those who have delivery during the period from January/Sankranti, 2004 to the date of survey.
2) Refers to the period from January / Sankranti 2004 to the date of survey.
3) The estimates do not represent the district since the sample was not drawn from the general population.
5) All eligible women who are currently married.
8) Based on last delivery of all eligible women.
9) Deliveries attended by Doctor/ Nurse/ Mid-wife/ANM.
10) Based on non-institutional deliveries.
11) Percentages based on all domiciliary deliveries.
12) Based on children born during the period from January / Sankranti 2004 to the date of survey.

45
DISTRICT : VIZIANAGARAM
FACT SHEET
SLI
(Low)
BPL
Sample Population
2479 1486 993 299 87 500 2142
2738 1649 1089 330 101 540 2370
• Percent of households using cleaner cooking fuels ( LPG, Electricity and
Kerosene)
31.2 12.3 59.5 17.1 8.0 2.0 24.3

46
SLI
(Low)
BPL
• Percent of women received check up at least once by a M.B.B.S doctor 95.6 94.6 97.2 93.6 78.2 88.4 95.5
Components5
• Weight measured 97.7 97.2 98.5 97.0 85.7 94.0 97.5

47
SLI
(Low)
BPL
Percent of women received advise/counseling at least once on the
following aspects:
Delivery Care6
• Normal delivery 81.6 86.8 73.8 90.3 93.1 89.8 83.9
80.4 72.6 91.9 72.2 58.6 67.8 78.3
Main reason reported by women for not going to health facility for
delivery8
• Not necessary 11.9 11.3 13.9 8.1 6.0 9.1 11.8
• Not customary 1.6 1.1 3.3 1.6 2.0 2.1 1.2

48
SLI
(Low)
BPL
• Other 2.5 2.4 2.8 1.6 2.0 1.7 2.2
Percent of women reported complications / problems during last
delivery
• Pre-term labour 8.0 5.2 12.1 9.0 4.6 9.4 7.4
• Breach birth 1.7 1.6 1.7 1.0 1.1 1.4 1.6
Birth Weight
Post natal Checkup

Rch ii baseline survey-report

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