The first ever annual health survey (AHS) released by the Ministry of Health and Family Welfare on May 3 rates Uttarakhand as the safest state in India for child to be born in, given its relatively low infant mortality rate. The survey helps to compare health indicators of select states over two years the baseline survey was conducted in 2010-11. Within Uttarakhand, three districts—Pithoragarh, Rudraprayag and Almora—are safest for new borns as they have the lowest infant mortality rate (IMR), neo-natal mortality rate (NNMR) and under-5 mortality (U5MR) rate. Uttarakhand as a whole has the lowest maternal mortality ratio (MMR), too, at 162 per 100,000 live births. It also happens to have the lowest sex ratio at birth (SRB) with only 866 girls being born for every 1,000 boys.

AHS is a district-wise database for select states on nine crucial health parameters. The survey contains data for 284 districts of eight Empowered Action Group States: Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Odisha and Rajasthan and Assam. These nine states account for about 50 per cent of the total population, 60 per cent of births, and over 70 per cent infant mortality, under-5 mortality and maternal mortality in the country. They are the high focus states in view of their relatively higher fertility rate as well as mortality.

Explaining the importance of the survey, spokesperson for the health ministry said that for micro-level planning, disaggregated data at the district level is needed. However, in the absence of such data, state-level estimates were being used by the policy-makers for formulating district plans and setting milestones. AHS was conceived in 2005 in a meeting of the National Commission of Population. The meeting decided that ?there should be an annual health survey of all districts which could be published/monitored and compared against benchmarks.?

This is the first survey after the baseline survey which was conducted in 2010-2011. Fieldwork for the current updation was carried out during November, 2011 to April, 2012. It covered a representative sample of about 20.61 million population and 4.28 million households. The bulletin contains district level data on birth rate, death Rate, IMR, NNMR, U5MR, MMR, sex ratio at birth, for 0-4 years and the sex ratio for all ages.

The survey shows that the birth rate  has declined in 261 (91.9 per cent) districts compared to the baseline and remained same in 10 (3.5 per cent) districts (see table). Birth rate across 284 districts ranges between 14.5- 40.2 number of births per 1,000 people per year. Bageshwar (14.5) in Uttarakhand has the lowest birth rate, while  Shraswati (40.2) in Uttar Pradesh has the highest.

IMR (number of deaths of children less than one year of age per 1000 live births), too, shows a decline. It declined in 230 (81 per cent) districts and remained same in 30 (10.6 per cent). In all, 248 (87.3 per cent) districts have an IMR of 45 or more. IMR across all the districts ranges between 20 to 100 with Almora (20), Pithoragarh (20) and Rudraprayag (20) in Uttarakhand having the lowest IMR and Shraswati (100) in Uttar Pradesh having the highest.

NNMR (children dying within the first month of birth) has declined in 186 districts (65.5 per cent) districts and remained same in 55 (19.4 per cent) district. As many as 238 (83.8 per cent) districts have an NNMR of 30 or more. NNMR across 284 districts ranges between 12-72 with Rudraprayag and Pithoragarh(12) in Uttarakhand having the the lowest NNMR and Balangir (72) in Odisha having the highest NNMR.

The U5MR has declined in 249 (87.7 per cent) districts and remained same in 10 (3.5 per cent) districts. As many as 242 (85.2 per cent) districts have an U5MR of 60 or more. U5MR across 284 districts ranges between 23-142 with Pithoragarh (23) in Uttarakhand having the lowest U5MR and Kandhamal (142) in Odisha having the highest. The number of districts which have achieved Millennium Development Goal national-level target of 42 U5MR increased from 7 to 12 compared to the baseline.

Among the states, Chhattisgarh has the highest female sex ratio at birth (951 girls per 1,000 boys) and Uttarakhand has the lowest SRB (866). Further, Assam has recorded the highest rise in SRB (12) while Madhya Pradesh, Uttrakhand and Chhattisgarh retained their base line level. SRB declined marginally by 2 points in Odisha. SRB across 284 districts ranges between 766-1,050 with Pithoragarh (766) in Uttarakhand having the lowest SRB and Moradabad (1,050) in Uttar Pradesh having the highest SRB.