HIV AIDS -FACT SHEET,JHARKHAND

FACT SHEET, JHARKHAND
NATIONAL FAMILY HEALTH SURVEY, 1998–99
Sample Size
Households ......................................................................1,642
Ever-married women age 15–49......................................1,614
Characteristics of Households
Percent with electricity ......................................................23.6
Percent within 15 minutes of safe water supply1 ...............33.8
Percent with flush toilet .....................................................12.1
Percent with no toilet facility .............................................84.5
Percent using govt. health facilities for sickness................19.0
Percent using iodized salt (at least 15 ppm) .......................56.1
Characteristics of Women2
Percent urban .....................................................................17.2
Percent illiterate .................................................................76.3
Percent completed high school and above ...........................6.7
Percent Hindu ....................................................................82.6
Percent Muslim..................................................................11.7
Percent Christian..................................................................3.0
Percent regularly exposed to mass media ..........................28.8
Percent working in the past 12 months ..............................31.7
Status of Women2
Percent involved in decisions about own health ................66.8
Percent with control over some money..............................64.5
Marriage
Percent never married among women age 15–19 ..............62.3
Median age at marriage among women age 20–49............15.8
Fertility and Fertility Preferences
Total fertility rate (for the past 3 years) .............................2.76
Mean number of children ever born to women 40–49 .......4.83
Median age at first birth among women age 20–49 ...........19.0
Percent of births3 of order 3 and above .............................53.7
Mean ideal number of children4...........................................3.1
Percent of women with 2 living children wanting
another child ....................................................................48.4
Current Contraceptive Use5
Any method .......................................................................27.6
Any modern method ..........................................................24.9
Pill .....................................................................................1.5
IUD....................................................................................0.3
Condom .............................................................................1.1
Female sterilization..........................................................21.1
Male sterilization ...............................................................0.9
Any traditional method ........................................................1.1
Rhythm/safe period............................................................0.5
Withdrawal ........................................................................0.7
Other traditional or modern method.....................................1.6
Unmet Need for Family Planning5
Percent with unmet need for family planning ....................21.0
Percent with unmet need for spacing .................................11.1
1Water from pipes, hand pump, covered well, or tanker truck
2Ever-married women age 15–49
3For births in the past 3 years
4Excluding women giving non-numeric responses
5Among currently married women age 15–49
Quality of Family Planning Services6
Percent told about side effects of method...........................18.4
Percent who received follow-up services ...........................80.9
Childhood Mortality
Infant mortality rate7 ..........................................................54.3
Under-five mortality rate7 ..................................................78.3
Safe Motherhood and Women’s Reproductive Health
Percent of births8 within 24 months of previous birth ........25.2
Percent of births3 whose mothers received:
Antenatal check-up from a health professional ..................41.7
Antenatal check-up in first trimester ..................................18.0
Two or more tetanus toxoid injections ...............................50.6
Iron and folic acid tablets or syrup ....................................32.7
Percent of births3 whose mothers were assisted at
delivery by a:
Doctor ............................................................................11.7
ANM/Nurse/midwife/LHV ............................................. 5.3
Traditional birth attendant ..............................................64.2
Percent5 reporting at least one reproductive
health problem....................................................................44.7
Awareness of AIDS
Percent of women who have heard of AIDS ......................15.4
Child Health
Percent of children age 0–3 months exclusively
breastfed............................................................................ 2.2
Median duration of breastfeeding (months) .................... ≥36.0
Percent of children9 who received vaccinations:
BCG .................................................................................44.4
DPT (3 doses) ..................................................................21.7
Polio (3 doses) .................................................................36.5
Measles ............................................................................18.2
All vaccinations................................................................. 8.8
Percent of children10 with diarrhoea in the past
2 weeks who received oral rehydration salts (ORS)...........20.4
Percent of children10 with acute respiratory infection in
the past 2 weeks taken to a health facility or provider........41.1
Nutrition
Percent of women with anaemia11......................................72.9
Percent of women with moderate/severe anaemia11 ...........28.6
Percent of children age 6–35 months with anaemia11.........82.4
Percent of children age 6–35 months with moderate/
severe anaemia11...............................................................56.2
Percent of children chronically undernourished
(stunted)12.........................................................................49.0
Percent of children acutely undernourished (wasted)12 ......25.4
Percent of children underweight12............................54.3
6For current users of modern methods
7For the 5 years preceding the survey (1994–98)
8For births in the past 5 years (excluding first births)
9Children age 12–23 months
10Children under 3 years
11Anaemia–haemoglobin level < 11.0 grams/decilitre (g/dl)
for children and pregnant women and < 12.0 g/dl for
nonpregnant women. Moderate/severe anaemia
–haemoglobin level < 10.0 g/dl.
12Stunting assessed by height-for-age, wasting assessed by
weight-for-height, underweight assessed by weight-for-age
SUMMARY OF FINDINGS
The second National Family Health Survey (NFHS-2), conducted in 1998–99, provides
information on fertility, mortality, family planning, and important aspects of health, nutrition,
and health care. The International Institute for Population Sciences (IIPS) coordinated the
survey, which collected information from a nationally representative sample of more than 90,000
ever-married women age 15–49. The NFHS-2 sample covers 99 percent of India’s population
living in 26 states. As a part of NFHS-2 in the state of Bihar, the survey covered the region of
Jharkhand, which became the new state of Jharkhand on 15 December 2000.
IIPS also coordinated the first National Family Health Survey (NFHS-1) in 1992–93.
Most of the types of information collected in NFHS-2 were also collected in the earlier survey,
making it possible to identify trends over the intervening period of six and one-half years. In
addition, the NFHS-2 questionnaire covered a number of new or expanded topics with important
policy implications, such as reproductive health, women’s autonomy, domestic violence,
women’s nutrition, anaemia, and salt iodization. One health investigator on each survey team
measured the height and weight of women and young children and took blood samples to assess
the prevalence of anaemia.
NFHS-2 field staff collected information from 1,642 households in Jharkhand between 25
December 1998 and 26 March 1999 and interviewed 1,614 eligible women in these households.
In addition, the survey collected information on 562 children born to eligible women during the
three years preceding the survey. After discussing briefly the basic socio-demographic features
of Jharkhand on the basis of the 2001 Census data, this report presents the main findings of the
NFHS-2 survey for the state of Jharkhand.
Basic Socio-Demographic Features of Jharkhand
The state of Jharkhand is a land-locked territory bound by the districts of Rohtas, Aurangabad,
Gaya, Nawada, Jamui, Banka, Bhagalpur, and Katihar of Bihar on the north, the districts of
Malda, Murshidabad, Birbhum, Barddhaman, Puruliya, and Medinipur of West Bengal on the
east, the districts of Mayurbhanj, Kendujhargarh, and Sundergarh of Orissa on the south, the
districts of Raigarh and Surguja of Madhya Pradesh, and the district of Mirzapur of Uttar
Pradesh on west. Jharkhand contains 18 districts divided into 4 divisions, distributed over an area
of 79,714 km2. The state has 152 towns and 32,615 villages.
Jharkhand has some of the richest deposits of iron and coal in the world and it is in one of
the most industrialized regions in the country. The state is also endowed with a rich forest cover.
It has a vast potential for generating hydroelectric power, as is exemplified by the location of the
famous Damodar Valley Corporation in the state (Director of Census Operations, Jharkhand,
2001a).
According to the provisional population totals of India, Jharkhand has a population of
26.9 million. The population growth rate was 23.2 percent in 1991–2001, which is much lower
than the growth rate for Bihar (28.4 percent) but much higher than the growth rate for the
country as a whole (21.3 percent). The population density per km2 is 338, which is less than half
the population density of Bihar (880). As compared with the previous decade, the state registered
a slightly lower decadal growth rate (24.0 percent in 1981–91 and 23.2 percent in 1991–2001),
but a higher population density (274 in 1991 and 338 in 2001). The sex ratio of 934 is close to
2
the all-India average (933), but is higher than that for Bihar (921). The literacy rate for Jharkhand
is 67.9 percent for males, 39.4 percent for females, and 54.1 percent for the total population.
More than one-fifth of the state population (22.3 percent) lives in urban areas, indicating that
Jharkhand has a higher degree of urbanization than Bihar (10.5 percent) but a lower level of
urbanization than the all-India average of 27.8 percent. As per the provisional population totals
of the 2001 Census, the state has five cities with a population of 100,000 and above (Director of
Census Operations, Jharkhand, 2001b).
Background Characteristics of the NFHS-2 Survey Population
According to the NFHS-2 survey, 80 percent of the population of Jharkhand lives in rural areas.
The age distribution is typical of high fertility populations that have recently experienced some
fertility decline, with a slightly lower proportion of the population in the 0–4 age group than in
the 5–9 age group and declining proportions thereafter. Forty percent of the population is below
age 15, and only 3 percent is age 65 and above. The sex ratio is 947 females for every 1,000
males in rural areas but only 904 females for every 1,000 males in urban areas, suggesting that
more men than women have migrated to urban areas. The sex ratio for the total population (938)
is close to the sex ratio of the state population as per the 2001 Census (934).
The survey provides a variety of demographic and socioeconomic background
information. In the state as a whole, 83 percent of household heads are Hindu, 11 percent are
Muslim, and 4 percent are Christian. Muslims are more concentrated in urban areas, where they
comprise 21 percent of household heads. Fifteen percent of household heads belong to scheduled
castes, 32 percent belong to scheduled tribes, and 39 percent belong to other backward classes
(OBCs). Fifteen percent of household heads do not belong to any of these groups.
Housing conditions and the standard of living of household members are generally poor
in Jharkhand. Twenty-four percent of households in Jharkhand have electricity (compared with
60 percent in India as a whole and 16 percent in Bihar). Only one-third of households are within
15 minutes from a safe water supply that they use for drinking water, compared with 62 percent
in India as a whole and 77 percent in Bihar. Only 14 percent have piped drinking water. Eightyfive
percent of households in Jharkhand do not have any toilet facility.
Nearly two-thirds (66 percent) of males but only two-fifths (39 percent) of females age
six and above are literate, estimates which are very close to the 2001 census literacy rates
mentioned above. Sixty-four percent of children age 6–14 are attending school (71 percent of
boys and 56 percent of girls). The disparity in school attendance by sex grows with increasing
age of children. At age 15–17, 64 percent of boys attend school, compared with 42 percent of
girls.
As a part of an increasing emphasis on gender issues in NFHS-2, the survey asked
women about their participation in household decisionmaking. In Jharkhand, 95 percent of
women are involved in decisionmaking on at least one of four selected topics. A much lower
proportion, however, are involved in decisionmaking about their own health care (67 percent),
purchasing jewellery or other major household items (65 percent), or going and staying with
parents or siblings (66 percent). In Bihar, in contrast, only 42 percent women are involved in
decisions about their own health. Women in Jharkhand enjoy somewhat more autonomy than
women in India as a whole, but their autonomy is still limited. Only one-third of women are
allowed to visit friends or relatives without getting permission and about one-third of women
3
reported that they do not have access to any money that they can use as they wish. Only 32
percent of women in Jharkhand do work other than housework, and almost 7 out of 10 of these
women work for cash. Fifty-four percent of women who earn cash can decide independently how
to spend the money that they earn. More than half of working women (52 percent) have earnings
that contribute half or more than half to the total family earnings.
Marriage Patterns
Women in Jharkhand tend to marry at an early age. Thirty-eight percent of women age 15–19 are
already married (including 3 percent who are married but for whom gauna has not yet been
performed), compared with 49 percent in Bihar. The median age at marriage among women age
20–49 in Jharkhand is 15.8, about one year later than the median age in Bihar. The age at
marriage is much lower in rural areas (where 44 percent of women age 15–19 are married) than
in urban areas (where only 20 percent of women age 15–19 are married). Older women are more
likely than younger women to have married at an early age: 48 percent of women who are now
age 45–49 married before they were 15, compared with 15 percent of women who are currently
age 15–19. Although this indicates that the proportion of women who marry young is declining
rapidly, the majority of women in Jharkhand still marry before reaching the legal minimum age
of 18 years. On average, women are nearly five years younger than the men they marry.
Fertility
At current fertility levels, NFHS-2 estimated that women in Jharkhand will have an average of
2.8 children each throughout their childbearing years. However, it is clear that the survey
substantially underestimated the level of fertility in the state, largely due to errors in the recorded
timing of births in the birth history as well as omission of recent births. The percentage of
higher-order (3+) births is about the same in Jharkhand and Bihar (54–55 percent). One-quarter
of births in both Jharkhand and Bihar take place within 24 months of the previous birth.
Efforts to lower fertility might usefully focus on groups within the population that have
higher fertility than average. In Jharkhand, illiterate women, women from households with a low
or medium standard of living, women from scheduled castes or other backward classes (OBC),
and Muslim women have much higher fertility than other women. A more striking feature is the
substantial level of childbearing among young women. The median age at first childbirth is 19
years, which is the same as in Bihar. Women age 15–19 account for 17 percent of total fertility.
Studies in India and elsewhere have shown that health and mortality risks increase when women
give birth at such young agesboth for the women themselves and for their children. Family
planning programmes focusing on women in this age group could make a significant impact on
maternal and child health as well as reducing overall fertility in the state.
The appropriate design of family planning programmes depends, to a large extent, on
women’s fertility preferences. Women may have large families because they want many
children, or they may prefer small families but, for a variety of reasons, may have more children
than they actually want. For 10 percent of births over the three years preceding NFHS-2, mothers
report that they did not want the pregnancy at all, and for another 16 percent of these births,
mothers say that they would have preferred to delay the pregnancy. When asked about their
preferred family size, 28 percent of women who already have three children and 21 percent of
women with four or more children respond that they consider the two-child family ideal. This
4
gap between women’s actual fertility experience and what they want or would consider ideal
suggests a need for expanded or improved family welfare services to help women achieve their
fertility goals.
Family Planning
Knowledge of contraception is nearly universal: 99 percent of currently married women know at
least one modern family planning method. Women are most familiar with female sterilization (98
percent), followed by male sterilization (96 percent), the pill (68 percent), the condom (56
percent), and the IUD (48 percent). More than one-third of women (38 percent) have knowledge
of at least one traditional method.
Only 28 percent of married women in Jharkhand are currently using some method of
contraception, compared with 48 percent at the national level and 24 percent in Bihar.
Contraceptive prevalence is considerably higher in urban areas (40 percent) than in rural areas
(25 percent). Female sterilization is by far the most popular method: 21 percent of currently
married women are sterilized. By contrast, only 1 percent of women reported that their husbands
are sterilized. Overall, sterilization accounts for 80 percent of total contraceptive use. Use rates
for the pill (2 percent), IUD (0.3 percent), and condom (1 percent) remain very low. One percent
use traditional methods of family planning.
Contraceptive prevalence varies widely among socioeconomic groups. Rural women,
illiterate women, Muslim women, scheduled-tribe women, and women belonging to households
with a low standard of living have much lower levels of contraceptive use than other women.
Urban women, women with at least a high school education, and women from households with a
high standard of living are all more likely than other women to use the three modern spacing
methods (pill, IUD, and condom), but the use of these methods does not exceed 16 percent in any
group.
Given the near-exclusive emphasis on sterilization, women tend to adopt family planning
only after they have achieved their desired family size. As a result, contraceptive use can be
expected to rise steadily with age and with the number of living children. In Jharkhand,
contraceptive use does indeed go up with age, peaking at 44 percent for women age 35–39 and
45–49. Use also goes up with the number of children, peaking at 41 percent for women with
three living children. It is the highest (55 percent) among women having three children of which
two are sons. Son preference has a considerable effect on contraceptive use. Among women who
have two or more living children, those who have one or more sons are more likely to use
contraception than are those who have the same number of children but have only daughters.
Among women with two living children, contraceptive use is only 14 percent if both children are
daughters, 23 percent if there is one daughter and one son, and 41 percent if both children are
sons.
Among currently married women who have never used contraception, the main reason
for not currently using contraception is the desire for more children, which is reported by 42
percent. Eleven percent of currently married women are not using contraception but say that they
want to wait at least two years before having another child. Another 10 percent are not using
contraception although they do not want any more children. These women are described as
having an ‘unmet need’ for family planning. One-fifth of women in Jharkhand (21 percent) have
an unmet need for family planning, compared with one-quarter in Bihar (26 percent). The unmet
5
need for spacing declines from 24 percent among women age 15–24 to less than 2 percent among
women age 35–39. Women age 40 and above have no unmet need for spacing. The unmet need
for limiting increases with age to a peak of 19 percent among women age 30–34 and declines
among older women. These results underscore the need for strategies that provide spacing as
well as terminal methods in order to meet the changing needs of women over their lifecycle.
For many years, the Government of India has been using electronic and other mass media
to promote family planning. Exposure to mass media is quite low in Jharkhand, where only 32
percent of rural residents live in villages that are electrified and only 3 percent live in villages
that have a cable connection. Overall, only 18 percent of ever-married women listen to the radio
at least once a week and only 20 percent watch television at least once a week. As in Bihar,
almost three-quarters of women in Jharkhand are not regularly exposed to radio, television, or
other types of media. Exposure to each type of media is much higher among urban women,
more-educated women, women not belonging to a scheduled caste, scheduled tribe, or other
backward class, and women from high standard of living households. Thirty-seven percent of
women saw or heard a family planning message in the media during the few months preceding
the survey. In addition to radio and television, wall paintings and hoardings are important
sources of exposure to family planning messages in Jharkhand. As with the exposure to mass
media itself, exposure to family planning messages is much lower among rural women, illiterate
women, women belonging to scheduled tribes, and women from households with a low standard
of living. Only 13 percent of currently married women in Jharkhand have discussed family
planning with their husbands and very few women have discussed family planning with other
relatives, friends, or neighbours.
More than four-fifths (78 percent) of women who use modern contraception obtained
their method from a government hospital or other source in the public sector. Only 18 percent
obtained their method from the private medical sector. The private medical sector, along with
shops, is the major source of pills and condoms, however. The private medical sector plays a
larger role in urban areas (where it is the source of modern methods for 30 percent of users) than
in rural areas (where it is the source of modern methods for 13 percent of users).
An important indication of the quality of family planning services is the information that
women receive when they obtain contraception and the extent to which they receive follow-up
services after accepting contraception. In Jharkhand, only 13 percent of users of modern
contraceptives who were motivated by someone to use their method were told about any other
method. Only 18 percent of women were told by a health or family planning worker about
possible side effects of the method they adopted at the time of adopting the method. Eighty-one
percent of contraceptive users, however, received follow-up services after adopting the method.
From the information provided in NFHS-2, a picture emerges of women marrying early,
having their first child soon after marriage, and having about two more children by the time they
reach their mid-20s. At that point, about one-fifth of women get sterilized. The median age for
female sterilization is now 27.3 years. Very few women use modern spacing methods that could
help them delay their first births or increase the interval between pregnancies.
6
Infant and Child Mortality
NFHS-2 provides estimates of infant and child mortality and factors associated with the survival
of young children, although there is some indication that the mortality rates on the survey are
likely to be underestimated. During the five years preceding the survey, the infant mortality rate
was 54 (deaths of infants per 1,000 live births), much lower than the infant mortality rate of 78 in
Bihar. The child mortality rate in Jharkhand was 25 (deaths of children age 1–4 years per 1,000
children reaching age one). In all, among 1,000 children born, 78 die before reaching age five.
Expressed differently, 1 in 19 children die in the first year of life, and 1 in 13 die before reaching
age five. Child-survival programmes might usefully focus on specific groups of children with
particularly high infant and child mortality rates, such as children who live in rural areas,
children whose mothers are illiterate, children belonging to scheduled castes and tribes, and
children from poor households.
Along with various socioeconomic groups, efforts to promote child survival need to
concentrate on very young mothers and mothers whose children are closely spaced. Infant
mortality is more than 68 percent higher among children born to mothers under age 20 than
among children born to mothers age 20–29 (102 deaths, compared with 61, per 1,000 live births).
Infant mortality is more than 11 times as high among children born less than 24 months after a
previous birth as among children born after a gap of 48 months or more (118 deaths, compared
with 10, per 1,000 live births). Clearly, efforts to expand the use of temporary contraceptive
methods for delaying and spacing births would help reduce infant mortality as well as fertility.
Reproductive Health
Promotion of maternal and child health has been one of the most important components of the
Family Welfare Programme of the Government of India. One goal is for each pregnant woman to
receive at least three antenatal check-ups plus two tetanus toxoid injections and a full course of
iron and folic acid supplementation. In Jharkhand, mothers of only 42 percent of the children
born in the three years preceding NFHS-2 received at least one antenatal check-up, compared
with 65 percent in India as a whole and 35 percent in Bihar. Mothers of only 24 percent of these
children in Jharkhand received at least three antenatal check-ups. Mothers received the
recommended number of tetanus toxoid vaccinations for 51 percent of children in Jharkhand
(compared with 60 percent in Bihar). Mothers received iron and folic acid supplementation for
33 percent of children in Jharkhand (compared with only 22 percent in Bihar). Coverage by all
three interventions is much lower for rural women and women in disadvantaged socioeconomic
groups than for other women.
The Family Welfare Programme encourages women to deliver in a medical facility or, if
at home, with assistance from a trained health professional and to receive at least three check-ups
after delivery. During the three years preceding NFHS-2, only 14 percent of births in Jharkhand
were delivered in a medical facility. Among births delivered at home, only 4 percent were
assisted by a health professional (76 percent were assisted by a traditional birth attendant). Only
one out of seven births outside a medical facility were followed by a postpartum check-up within
two months of delivery. Overall, these results show that utilization of health services in
Jharkhand during pregnancy, during delivery, and after childbirth remains very low. They also
point to the important role of traditional birth attendants for the large majority of births that occur
at home.
7
Forty-five percent of currently married women in Jharkhand report some type of
reproductive-health problem, including abnormal vaginal discharge, symptoms of a urinary tract
infection, and pain or bleeding associated with intercourse. The situation is similar to Bihar,
where 44 percent report some reproductive health problem. Among women in Jharkhand with a
reproductive health problem, 74 percent have not sought any advice or treatment and only 4
percent sought advice or treatment at a government medical facility. These results suggest a need
to expand reproductive-health services and information programmes that encourage women to
discuss their problems with a health-care provider.
Nutrition of Children and Women
The Government of India recommends that breastfeeding should begin immediately after
childbirth and that infants should be exclusively breastfed for the first four months of life.
Although breastfeeding is nearly universal in Jharkhand, very few children begin breastfeeding
immediately after birthonly 9 percent in the first hour and 31 percent in the first day.
Moreover, for 62 percent of children, mothers squeezed the first milk from the breast before
feeding the baby, contrary to recommended feeding practices. Fifty-six percent of children under
four months of age are exclusively breastfed. The median duration of breastfeeding is more than
three years, but the median duration of exclusive breastfeeding is only 2.3 months. At age 6–9
months, all children should be receiving solid or mushy food in addition to breast milk.
However, only 26 percent of children age 6–9 months receive the recommended combination of
breast milk and solid/mushy foods.
NFHS-2 uses three internationally recognized standards to assess children’s nutritional
statusweight-for-age, height-for-age, and weight-for-height. Children who are more than two
standard deviations below the median of an international reference population are considered
underweight (measured in terms of weight-for-age), stunted (height-for-age), or wasted (weightfor-
height). Stunting is a sign of chronic, long-term undernutrition, wasting is a sign of acute,
short-term undernutrition, and underweight is a composite measure that takes into account both
chronic and acute undernutrition.
Based on international standards, 54 percent of children under age three years are
underweight, 49 percent are stunted, and 25 percent are wasted. In Bihar, the percentages of
underweight, stunted, and wasted children are 54, 55 and 20, respectively. In Jharkhand,
undernutrition is higher in rural areas than in urban areas and is particularly high among children
from disadvantaged socioeconomic groups such as children from schedule tribes, children of less
educated mothers, and children from households with a low standard of living. The percentage of
underweight children is about the same for girls as for boys, but girls are somewhat more likely
to be stunted while boys are somewhat more likely to be wasted. More than four out of five
children age 6–35 months are anaemic, including a large majority of children in every subgroup
of the population. The percentage of children who are anaemic is very high (96 percent) among
scheduled tribes, while urban children, older children, and children whose mothers have
completed at least high school are less likely to be anaemic.
Based on a weight-for-height index (the body mass index), two out of five women in
Jharkhand (41 percent) are undernourished. Nutritional deficiency is somewhat more serious for
working women who are employed by someone else, women from households with a low
standard of living, women from scheduled castes, and Muslim women. Women who are
8
undernourished themselves are also much more likely than other women to have children who
are undernourished. Overall, 73 percent of women in Jharkhand have some degree of anaemia,
compared with 60 percent in Bihar. Twenty-nine percent of women in Jharkhand are moderately
to severely anaemic, compared with 18 percent of women in Bihar. Anaemia is a serious
problem among women in every population group in Jharkhand, with prevalence rates ranging
from 56 to 87 percent. Pregnant women are more likely than nonpregnant women to be
moderately to severely anaemic.
In Jharkhand, 85 percent of women eat pulses or beans at least once a week and 97
percent eat green, leafy vegetables at least once a week, but less than one woman in five eats
fruit at least once a week. Eighteen percent of women eat chicken, meat, or fish at least once a
week, but only 8 percent of women never eat chicken, meat, or fish.
Only 56 percent of households in Jharkhand use cooking salt that is iodized at the
recommended level of 15 parts per million (ppm), suggesting that iodine deficiency disorders are
likely to be a serious problem in the state. In Bihar, 44 percent households use cooking salt
iodized at the recommended level. Rural households, tribal households, and households with a
low standard of living in Jharkhand are much less likely than other households to be using
adequately iodized cooking salt.
Children’s Immunizations
Immunization of children is an important component of child-survival programmes in India, with
efforts focussing on six serious but preventable diseasestuberculosis, diphtheria, pertussis,
tetanus, polio, and measles. The objective of the Universal Immunization Programme (UIP),
launched in 1985–86, was to extend immunization coverage against these diseases to at least 85
percent of infants by 1990, and the target now is to achieve 100 percent immunization. However,
in Jharkhand, only 9 percent of children age 12–23 months are fully vaccinated (compared with
12 percent in Bihar), 64 percent have received some but not all of the recommended
vaccinations, and 27 percent have not been vaccinated at all.
One reason that full immunization coverage is so low is that only 18 percent of children
have been vaccinated against measles. Dropout rates for the series of DPT and polio vaccinations
are also a problem. Forty-four percent of children received the first DPT vaccination, but only 22
percent received all three doses; 70 percent received the first polio vaccination, but only 36
percent received all three doses. The percentage of children receiving all three doses of DPT and
polio vaccine was slightly higher in Bihar (25 and 42 percent, respectively). It is also
recommended that children under age five years should receive oral doses of vitamin A every six
months starting at age nine months. However, in Jharkhand, only 12 percent of children age 12–
35 months have received any vitamin A supplementation and only 10 percent received a dose of
vitamin A in the six months preceding the survey.
Childhood Diseases
NFHS-2 collected information on the prevalence and treatment of three health problems that
cause considerable mortality in young childrenfever, acute respiratory infection (ARI), and
diarrhoea. In Jharkhand, 28 percent of children under age three were ill with fever during the two
weeks preceding the survey, 22 percent were ill with ARI, and 22 percent had diarrhoea. Only 41
percent of children who were ill with ARI were taken to health facility, compared with 63
9
percent in Bihar. Among children in Jharkhand who were ill with diarrhoea, 34 percent were
taken to a health facility or health-care provider. Knowledge of the appropriate treatment of
diarrhoea remains low. Only 41 percent of mothers of children age less than three years know
about oral rehydration salt (ORS) packets and 31 percent of mothers incorrectly believe that
when children are sick with diarrhoea, they should be given less to drink than usual. Fifty-three
percent of children with diarrhoea received some form of oral rehydration therapy (ORT),
including 20 percent who received ORS.
Domestic Violence
In recent years, there has been growing concern about domestic violence in India. NFHS-2 found
that in Jharkhand there is widespread acceptance among ever-married women that the beating of
wives by husbands is justified under some circumstances. Almost two-fifths (38 percent) of evermarried
women accept at least one of six reasons as a justification for a husband beating his wife.
Domestic violence is also fairly common. Twenty-two percent of ever-married women in
Jharkhand have experienced beatings or physical mistreatment since age 15, and 16 percent
experienced such violence in the 12 months preceding the survey. Most of these women have
been beaten or physically mistreated by their husbands. Domestic violence against women is
more prevalent in rural areas, among illiterate women, among women from households with a
low standard of living, and among working women.
Morbidity
The survey collected information on the prevalence of tuberculosis, asthma, malaria, and
jaundice among all household members. Disease prevalence based on reports from household
heads must be interpreted with caution, however. The survey found that about 1 percent of the
population in Jharkhand suffers from tuberculosis, 1 percent suffers from asthma, 8 percent
suffered from malaria during the three months preceding the survey, and 2 percent suffered from
jaundice during the 12 months preceding the survey. The prevalence of asthma, tuberculosis, and
malaria is much higher in rural areas than in urban areas, but the prevalence of jaundice is higher
in urban areas. Men are more likely than women to suffer from tuberculosis and jaundice, but
women are slightly more likely to suffer from asthma and malaria.
Quality of Health Care
Most households in Jharkhand (70 percent) use private doctors or private hospitals or clinics for
treatment when a family member is ill. Only 19 percent normally use the public medical sector.
Even among households with a low standard of living, only 16 percent normally use the public
medical sector when members become ill. Most respondents are generally satisfied with the
health care they receive. Ratings on the quality of services are lower for public-sector facilities,
where at least half of respondents are somewhat critical of staff attitudes and the cleanliness of
the facilities.
Overall, only 4 percent of women received home visits from health or family planning
workers during the 12 months preceding the survey and the few who did receive home visits
were not visited regularly. A large majority of the women who received a home visit expressed
satisfaction with the amount of time that the worker spent with them and with the way the
worker talked to them.
10
Lifestyle Indicators
NFHS-2 also collected information on selected lifestyle indicators for household members.
According to household respondents, 17 percent of adult men and 3 percent of adult women
smoke, 29 percent of adult men and 12 percent of adult women drink alcohol, and 49 percent of
adult men and 11 percent of adult women chew paan masala or tobacco.
HIV/AIDS
Although the spread of HIV/AIDS is a major concern in India, nearly 9 out of 10 women in
Jharkhand (85 percent) have not heard of AIDS, compared with 60 percent for India as a whole.
In fact, knowledge of AIDS is lower in Jharkhand than in any other state except Bihar.
Awareness of AIDS is particularly low among women in rural areas and among women who are
socioeconomically disadvantaged. Among women who have heard of AIDS, 83 percent received
information about the disease from television and 49 percent from radio. Among women who
have heard of AIDS, however, one-half (49 percent) do not know of any way to avoid infection.
Survey results suggest that health personnel could play a much larger role in promoting AIDS
awareness. In Jharkhand, only 1 percent of women who know about AIDS received information
about the disease from a health worker.
REFERENCES
Director of Census Operations, Jharkhand. 2001a. Census of India 2001, Series 21, Jharkhand
Provisional Population Totals, Paper –1 of 2001: Provisional Population Totals. Patna: Director
of Census Operations, Jharkhand.
Director of Census Operations, Jharkhand. 2001b. Census of India 2001, Series 21, Jharkhand
Provisional Population Totals, Paper–2 of 2001: Rural-Urban Distribution of Population. Patna:
Director of Census Operations, Jharkhand.