AHMEDABAD DISTRICT - Health and Family Welfare Department

REPRODUCTIVE AND CHILD HEALTH PROJECT 

DISTRICT LEVEL HOUSEHOLD SURVEY - 2002 

AHMEDABAD DISTRICT 

Sponsored by 

Ministry of Health and Family Welfare 

Government of India, New Delhi 

Centre for Operations Research and Training ( ) 

Vadodara, Gujarat 

2003

W 

Study Team 

Bella Patel Uttekar 

N ay an K u m ar 

H em lata S ad h w an i 

aj ah at Ullah K h an 

V as an t Uttekar 

J as h o d a S h arm a 

J aw ah ar V i s h w akarm 

Prem lata K s h atri y a 

a 

2

CONTENTS 

List of tables ................................................................................................................................ iii 

List of figures................................................................................................................................ v 

Preface and acknowledgement ................................................................................................ vi 

Key indicators............................................................................................................................... viii 

Salient findings ............................................................................................................................. xi 

CHAPTER-1 INTRODUCTION 

Page 

1.1 Background and objectives of the survey................................................................................... 1 

1.2 About the district......................................................................................................................... 1 

1.3 Survey design and sample size of the DLHS-RCH survey........................................................ 2 

1.4 House listing ............................................................................................................................... 2 

1.5 Questionnaires............................................................................................................................. 3 

1.6 Recruitment, training and fieldwork........................................................................................... 4 

1.7 Data processing and tabulation................................................................................................ 4 

1.8 Standard of living index (SLI)................................................................................................ 5 

CHAPTER-2 HOUSEHOLD CHARACTERISTICS 

2.1 Household population................................................................................................................. 7 

2.2 General characteristics................................................................................................................ 8 

2.3 Housing characteristics ............................................................................................................... 9 

2.4 Marital status of household population....................................................................................... 10 

2.5 Marriages and morbidity................................................................................................ 11 

2.6 Mortality................................................................................................................................ 12 

CHAPTER-3 CHARACTERISTICS OF THE WOMEN AND FERTILITY 

3.1 Characteristics of the currently married women ................................................................ 13 

3.2 Current fertility............................................................................................................... 14 

3.3 Children ever born and living ................................................................................................ 15 

3.4 Outcome of pregnancy................................................................................................................ 16 

3.5 Birth order ........................................................................................................................ 16 

CHAPTER-4 UTILIZATION OF MATERNAL HEALTH SERVICES 

4.1 Antenatal check-ups by service provider ................................................................ 17 

4.2 Antenatal check-ups at health facility................................................................................ 18 

4.3 Antenatal care ................................................................................................................... 19 

4.4 Pregnancy complications and treatment............................................................................. 22 

4.5 Place of delivery ............................................................................................................... 23 

4.6 Postnatal care .................................................................................................................... 26 

3

Page 

CHAPTER-5 CHILD CARE AND IMMUNIZATION 

5.1 Breastfeeding and weaning practices ................................................................ 29 

5.2 Immunization of children................................................................................................ 31 

5.3 Source of immunization................................................................................................ 33 

5.4 Awareness and treatment of diarrhoea................................................................ 34 

5.5 Awareness and treatment of pneumonia ................................................................ 35 

CHAPTER-6 FAMILY PLANNING 

6.1 Knowledge of contraceptive methods................................................................................ 37 

6.2 Knowledge of No-Scalpel Vasectomy (NSV)................................................................ 39 

6.3 Contraceptive prevalence rate ........................................................................................... 39 

6.4 Use of contraceptives................................................................................................41 

6.5 Source of modern methods of contraception................................................................ 41 

6.6 Side-effects of contraception and satisfaction with current use................................ 42 

6.7 Advice on contraception and intention to use family planning in the future....................... 43 

6.8 Future fertility intention................................................................................................ 45 

6.9 Reasons for discontinuation of use and non-use of contraceptives................................ 46 

6.10 Unmet need ...................................................................................................................... 48 

CHAPTER-7 ACCESSIBILITY AND PERCEPTION ABOUT 

GOVERNMENT HEALTH SERVICES 

7.1 Home visit by health workers............................................................................................ 49 

7.2 Matter discussed with health workers................................................................................ 51 

7.3 Visit to government health facility .................................................................................... 52 

7.4 Client’s perception of quality of government health services................................ 52 

7.5 Reasons for not visiting the government health centre....................................................... 53 

CHAPTER-8 REPRODUCTIVE HEALTH 

8.1 Awareness about reproductive tract infection (RTI)/ 

Sexually transmitted infection (STI)................................................................................. 55 

8.2 Prevalence of RTI/STI among males and females ............................................................. 56 

8.3 Symptoms of RTI/STI................................................................................................ 57 

8.4 Knowledge of HIV/AIDS ................................................................................................ 59 

CHAPTER-9 NUTRITIONAL STATUS AND ANAEMIA 

9.1 Methodology .............................................................................................................................. 61 

9.2 Procedures ................................................................................................................................ 61 

9.3 Haemoglobin response rate................................................................................................ 62 

9.4 Weight for age of children................................................................................................63 

9.5 Anaemia among children, adolescent and pregnant women .................................................... 65 

9.6 Iodization of salt ................................................................................................ 68 

ANNEXURE I 

ANNEXURE II 

4

LIST OF TABLES 

Page 

Table 1.1 

Table 1.2 

Basic demographic indicators......................................................................................... 2 

Standard of living index................................................................................................ 6 

Table 2.1 Household population by age and by residence and sex ................................ 7 

Table 2.2 Household characteristics ...................................................................................... 8 

Table 2.3 Housing characteristics.......................................................................................... 9 

Table 2.4 Marital status of the household population............................................................. 10 

Table 2.5 Marriage and morbidity rates................................................................................. 11 

Table 2.6 Vital rates................................................................................................ 12 

Table 3.1 Background characteristics of eligible women ....................................................... 14 

Table 3.2 Current fertility................................................................................................ 15 

Table 3.3 Fertility ................................................................................................................. 15 

Table 3.4 Outcome of pregnancy........................................................................................... 16 

Table 3.5 Birth order................................................................................................16 

Table 4.1(A) Antenatal check-up................................................................................................ 18 

Table 4.1(B) Antenatal check-up................................................................................................ 19 

Table 4.2(A) Antenatal care ................................................................................................ 20 

Table 4.2(B) Antenatal care ................................................................................................ 21 

Table 4.3 Pregnancy complications ....................................................................................... 22 

Table 4.4(A) Delivery characteristics ......................................................................................... 24 

Table 4.4(B) Delivery characteristics ......................................................................................... 25 

Table 4.5 Postnatal care ................................................................................................ 27 

Table 5.1 Breastfeeding ................................................................................................ 30 

Table 5.2(A) Vaccination of children......................................................................................... 31 

Table 5.2(B) Vaccination of children ......................................................................................... 32 

Table 5.2(C) Childhood vaccinations received by 12 months of age................................ 33 

Table 5.3 Source of vaccinations........................................................................................... 33 

Table 5.4 Awareness of diarrhoea ......................................................................................... 34 

Table 5.5 Awareness of pneumonia....................................................................................... 36 

5

Table 6.1 Knowledge of contraceptive methods................................................................ 38 

Table 6.2 No-scalpel vasectomy (NSV) ............................................................................................ 39 

Table 6.3 Contraceptive prevalence rate............................................................................................ 40 

Table 6.4 Use of contraceptives ................................................................................................ 41 

Table 6.5 Source of modern contraceptive methods ................................................................ 42 

Table 6.6 Health problems and satisfaction with current use of contraceptives................................ 42 

Table 6.7 Advice on contraceptive use and future intention to use..................................................... 44 

Table 6.8 Future fertility intention ................................................................................................ 45 

Table 6.9 Reasons for discontinuation of use and non-use of contraceptive methods......................... 47 

Table 6.10 Unmet need....................................................................................................................... 48 

Table 7.1 Home visits by health worker ............................................................................................ 50 

Table 7.2 Matters discussed during contact with a health or 

family planning worker ................................................................................................ 51 

Table 7.3 Visit to health facility................................................................................................ 52 

Table 7.4 Quality of government health facility ................................................................ 53 

Table 7.5 Reasons for not preferring government health facility........................................................ 53 

Table 8.1 Knowledge of reproductive tract infection (RTI)/ 

sexually transmitted infection (STI)................................................................................... 56 

Table 8.2 Prevalence of symptoms of RTI/STI among women/ men ................................................. 57 

Table 8.3 Symptoms of RTI/STI................................................................................................ 58 

Table 8.4 Knowledge of HIV/AIDS................................................................................................ 60 

Table 9.1 Haemoglobin response rate ............................................................................................... 63 

Table 9.2 Weight for age of children................................................................................................ 64 

Table 9.3 Anaemia among children................................................................................................ 66 

Table 9.4 Anaemia among adolescent girls ....................................................................................... 67 

Table 9.5 Anaemia among pregnant women...................................................................................... 68 

Table 9.5 Iodization of salt ................................................................................................ 69 

6

LIST OF FIGURES 

Page 

Figure 4.1 Sources of antenatal care ................................................................................................ 

17 

Figure 4.2 Percentage of women with pregnancy complications ........................................................ 

23 

Figure 4.3 Place of delivery and assistance during delivery................................................................ 

23 

Figure 4.4 

Institutional delivery by some selected 

background characteristics of women................................................................ 25 

Figure 5.1 Initiation of breastfeeding ................................................................................................ 

29 

Figure 5.2 Vaccination of children................................................................................................ 31 

Figure 6.1 Knowledge of family planning.......................................................................................... 

37 

Figure 6.2 Practice of family planning methods ................................................................ 39 

Figure 6.3 Fertility preference among men and women................................................................ 45 

Figure 7.1 Home visits of health workers by residence ................................................................ 49 

Figure 7.2 Visit to government health facility by residence................................................................ 

52 

Figure 8.1 Awareness of RTI/STI by sex and residence ................................................................ 55 

Figure 8.2 Knowledge of HIV/AIDS by sex and residence ................................................................ 

59 

Figure 9.1 Anaemia among children, adolescent girls and pregnant women................................ 68 

7

Preface and Acknowledgement 

The need for a person centered quality driven reproductive health programme is now well 

accepted all over the world. The Government of India (GoI) has recently launched the 

Reproductive and Child Health (RCH) programme to ensure that men and women have 

access to adequate information and services for reproductive health care. As a first step, 

family planning targets have been withdrawn and an effort is being made to provide a 

package of reproductive services at different levels of health care centers. 

Monitoring of the services is also being improved. New indicators are being added to 

assess the quality of services and provision of an integrated reproductive health care 

service. Thus, to assess the quality of services, district level household surveys have been 

initiated by the Government of India, which are financed by the World Bank, to cover all 

the districts in phases i.e. fifty percent of the districts each in the Phase I and Phase II 

respectively. Estimates of critical reproductive health indicators for each district were first 

obtained during 1998-99 and it is now the second time that such estimates of reproductive 

health indicators would be obtained during the period 2002-03. Such an exercise would 

help in assessing a change, if any, in the level of district wise health indicators in the area 

under study. These are important initiatives and are certainly quite satisfying for all those 

who are concerned with taking ICPD reproductive health agenda ahead. The project is 

being coordinated by International Institute for Population Sciences (IIPS), Mumbai and 

implemented by a number of consulting agencies. Centre for Operations Research and 

Training (CORT), a multi disciplinary social science research and training organisation 

having its headquarters at Baroda, administered this project in various districts of Gujarat. 

The present report provides salient findings of selected important indicators of 

reproductive and child health services covered in the first phase of the survey 2002 

collected from the district Ahmedabad in Gujarat. We hope these findings would be useful 

to the policy makers and researchers alike. 

We would like to take this opportunity to thank Shri A.R. Nanda, former Secretary, 

Department of Family Welfare, GoI, who gave us an opportunity to participate as one of 

the regional agencies in the survey of national importance. We further acknowledge 

Shri J.V.R. Prasada Rao, former Secretary, GoI, Shri P. K. Hota, Secretary, Department of 

Family Welfare, GoI, for their continuous help and encouragement. We are also thankful 

to Dr. K.V. Rao, Chief Director, Shri S.K. Das, Chief Director, Shri S.R. Singh, Director, 

Shri Manoj Kumar, Assistant Director, Ministry of Health and Family Welfare, GoI. Our 

special thanks are due to Prof. T.K. Roy, Director and Senior Professor, IIPS, for his 

timely advice and valuable guidance. We also acknowledge the contributions of 

Prof. F. Ram, Dr. B. Paswan, Dr. L. Ladu Singh, coordinators of the project at IIPS. Our 

thanks are due to Prof. Sulabha Parasuraman, Ex. Coordinator of the RCH project at IIPS 

and Prof. K. Srinivasan, Ex. Director of IIPS and presently Consultant RCH project, for 

supervising the task of the survey right from the beginning of the project. 

8

Our special thanks are due to Shri S.K. Nath, Addl. D.G. of NSSO, Kolkata, Census 

and NSSO officials at the state and district level for providing all necessary supports. We 

wish to put on record our deep sense of appreciation and special thanks to 

Ms. S.K. Verma, Additional Chief Secretary and Principal Secretary (Family Welfare), 

Government of Gujarat, Dr. S.S. Vaishya, Director, Medical and Health Services, Union 

Territory of Daman and Diu, Director, State Institute of Health and Family Welfare, 

Gujarat, Dr. P. M. Parmar, District Health Officer (DHO) of Ahmedabad district and other 

District authorities without whose help and co-operation this study would have not been 

feasible. This facilitated us in the smooth and timely completion of the data collection. 

Thanks are due to UNICEF for funding the health component of survey. We are 

especially thankful to Dr. C. Chandrasekar and Dr. V. Jayachandran, for their keen interest 

and timely supply of necessary inputs for the successful completion of the health 

component of the survey. We also thank Dr. Prema Ramchandran, Advisor, Planning 

Commission, for her keen interest in the subject. 

We thank Dr. K. Vijayaraghavan, Deputy Director, National Institute of Nutrition, 

Hyderabad for training the health investigators. 

Thanks are also due to Mr. Nizamuddin Khan, Research Officer, IIPS, for his 

assistance at various stages of the project. 

Our special thanks are due to the team of supervisors and investigators who took all 

the pain in collecting the data and completing the project well in time. Last but not the 

least, the credit goes to the respondents in the district who spared their valuable time and 

provided key information for the RCH-DLHS project. 

This work would not have been completed without the full organizational support and 

help from all our colleagues. We are thankful to all of them. 

Prof. M. M. Gandotra November 2003 

Director 

Centre for Operations Research 

and Training (CORT), Vadodara 

9

KEY INDICATORS FOR DLHS-RCH - 2002 

AHMEDABAD DISTRICT OF GUJARAT STATE 

1. Population data, 2001 census 

Population 2001 Census (in thousand) 

Percentage of urban population 

Annual exponential population growth rate (1991-2001) 

5808 

80.1 

2.36 

Indicators 

2. Sample population 

Number of households interviewed 

Number of eligible women interviewed 

Number of husbands interviewed 

3. Background characteristics of households interviewed 

Percentage Hindu 

Percentage Muslim 

Percentage Jain 

Percentage scheduled caste 

Percentage scheduled tribe 

Percentage other backward class 

Percentage with low standard of living index (SLI) 

Percentage with high standard of living index (SLI) 

4. Background characteristics of eligible women interviewed 

Percentage below age 30 

Percentage with age at first cohabitation below age 18 

Percentage Illiterate 

Percentage having 10+ years of schooling 

Percentage with Illiterate husband 

Percentage with husband having 10+ years of schooling 

5. Marriages (after 1-1-1999) 

Mean age at marriage for boys 

Mean age at marriage for girls 

Percentage of boys married at age less than 21 

Percentage of girls married at age less than 18 

6. Fertility 

Mean children ever born to women age 40-44 

Crude birth rate (CBR) 

Total fertility rate (TFR) 

Birth order 

1 

2 

3 

4+ 

7. Mortality and Morbidity 

Crude death rate (CDR) 

Infant mortality rate (IMR) 

Prevalence** of complete blindness 

Prevalence** of partial blindness 

Prevalence** of tuberculosis 

Prevalence** of malaria 

8. Knowledge of Family Planning 

Percentage of eligible women knowing 

Any modern method 

Any modern spacing method 

All modern methods 

Percentage of husbands knowing No-Scalpel Vasectomy (NSV) 

Note: ** Prevalence rate per 100000 population 

1007 

769 

404 

90.2 

3.2 

5.6 

10.1 

2.5 

43.2 

10.2 

59.3 

48.1 

32.9 

32.9 

34.6 

10.7 

54.3 

20.9 

17.5 

28.8 

32.5 

3.3 

23.3 

2.1 

51.9 

18.4 

21.0 

8.7 

4.94 

47.63 

255 

3146 

85 

506 

100.0 

99.1 

81.9 

52.9 

10

Indicators 

9. Current users of family planning 

Percentage of eligible women/husbands using 

Any method 


Female sterilisation 

Male sterilisation 

IUD 

Pills 

Condom 

Any traditional method 

10. Unmet Need 

Percentage of women having unmet need for 

Limiting 

Spacing 

Total 

11. Maternal Health Care 

Percent of eligible women with last live/still birth after 01-01-1999 

A. ANC check-up 

(i) No ANC check-up 

(ii) Who had ANC check-up 

(iii) Who had three or more ANC check-up 

(iv) Who had ANC at home 

B. T.T. injection during pregnancy 

(i) Who had no TT injection 

(ii) Who had one TT injection 

(iii) Who had two or more TT injections 

C. IFA tablets during pregnancy 

(i) Who consumed two or more tablets regularly 

(ii) Who had received 100 or more tablets 

D. Received full ANC 

(3 ANC check-ups and at least one TT and 100+ IFA tablets) 

E. Institutional delivery 

(i) Government health facility 

(ii) Private health facility 

F. Home delivery 

(i) Attended by Doctor/ ANM/ Nurse/TBA 

G. Safe delivery : 

(Either Institutional delivery or home delivery attended by Doctor/ ANM/ Nurse/TBA) 

12. Child Care 

A. Percentage of women who started breastfeeding immediately/within 2 

hours of the birth to their children 

B. Percentage of women who gave exclusive breast milk for at least 4 months to their children 

(A and B relate to the youngest child born after 1-1-1999 ) 

C. Percentage of children (born after 1-1-1999 and age 12 months and older at the time of survey) 

who received 

(i) BCG 

(ii) DPT (Three injections) 

(iii) Polio (Three doses) 

(iv) Measles 

(v) Complete immunizations (BCG + 3 DPT + 3 Polio + measles) 

D. Percentage of eligible women whose children (born after 1-1-1999) had diarrhoea and who were 

treated with ORS 

(i) Had Diarrhoea 

(ii) Given ORS 

56.3 

50.2 

26.8 

1.0 

5.6 

8.1 

8.7 

6.1 

9.9 

2.4 

12.3 

39.1 

8.2 

91.8 

77.6 

6.3 

10.6 

5.7 

83.7 

20.4 

29.1 

28.3 

12.3 

59.4 

45.5 

84.6 

22.9 

5.0 

93.3 

74.4 

72.4 

76.7 

64.2 

4.8 

7.5 

11

Indicators 

13. Awareness of RTI/STI and HIV/AIDS 

(i) Percentage of eligible women aware of RTI/STI 

(ii) Percentage of husbands aware of RTI/STI 

(iii) Percentage of eligible women aware of HIV/AIDS 

(iv) Percentage of husbands aware of HIV/AIDS 

14. Reproductive Morbidity 

A. Percent of eligible women had their last pregnancy since 1-1-1999, having 

(i) Pregnancy complication 

(ii) Delivery complication 

(iii) Post-Delivery complication 

B. Percent of eligible women having side effects due to use of contraceptive method 

(i) Female sterilization 

(ii) IUD 

(iii) Pills 

C. Menstruation related problem 

D. Any symptom of RTI/STI (abnormal vaginal discharge) 

E. Percent of husband having any symptom of RTI/STI 

15. Home Visit by Health Worker 

A. Percent of women visited by ANM/ health worker during three months prior to survey date 

B. Percent of women who had said worker spent enough time with them 

16. Utilisation of Government Health Services 

Percentage of women who utilised government health facility for 

(i) Antenatal care 

(ii) Treatment of complications during pregnancy 

(iii) Treatment of post-delivery complications 

(iv) Treatment of complications due to contraceptive use 

(a) Female sterilization 

(b) IUD 

(c) Pills 

(v) Treatment for RTI/STI (vaginal discharge) 

36.6 

59.5 

59.8 

88.3 

26.6 

51.7 

14.8 

11.3 

6.9 

16.6 

12.7 

13.7 

4.7 

14.1 

77.9 

20.4 

11.4 

4.2 

5.0 

0.0 

0.0 

12.5 

12

CHAPTER – 1 

INTRODUCTION 

1.1 BACKGROUND AND OBJECTIVES OF THE SURVEY 

The Reproductive and Child Health (RCH) programme interventions that are being 

implemented by Government of India (GoI) are expected to provide quality services and 

achieve multiple objectives. There has been a positive paradigm shift from Method-Mix- 

Target based activity to client-centred-demand driven quality services. Attempts are being 

made by GoI to not only re-orient the programme and the attitude of service provider's 

attitude at grass-roots level, but also to strengthen the services at outreach levels. 

The new approach requires decentralisation of planning, monitoring and evaluation of 

the services. Under such objectives, the district being the basic nucleus of administration, GoI 

has been interested in generate district level data, other than service statistics, on the 

utilisation of services provided by government health facilities. It is also of interest to GoI 

assess people's perceptions of the quality of these services. Therefore, it was decided to 

undertake District Level Household Surveys (DLHS) under the RCH Project in the country. 

In the Phase I of the second round of DLHS-RCH about 50 percent of the districts were 

covered and the remaining districts are to be taken-up in the Phase II of the DLHS-RCH. 

Ahmedabad district is one of the selected districts covered in the Phase I of the project in 

Gujarat. 

The main focus of the District Level Household Survey is on the following aspects: 

1. Coverage of ANC & immunisation services 

2. Proportion of safe deliveries 

3. Contraceptive Prevalence Rates 

4. Unmet need for Family Planning 

5. Awareness about RTI/STI and HIV/AIDS 

6. Utilisation of health services and the users’ satisfaction. 

1.2 ABOUT THE DISTRICT 

Ahmedabad district is situated in the central part of Gujarat. The total land area of the district 

is 8086 sq.kms. 

As shown in Table 1.1, the population of Ahmedabad district is 58.1 lakh as per 2001 

census and constitutes about 11 percent of the population of the state. The district has a 

population density of 718 persons per sq. km., which is high compared to 258 persons per 

square kilometre in the state. The annual exponential growth rate of the district during 1991- 

2001 is 2.3 percent, which is higher than that of the state (2.03 percent). About 80 percent of 

the population of the district live in urban areas in contrast to 38 percent in the state. The sex 

ratio of the district is 892 females per 1000 males, which is lower than that of the state 

average of 921. 

13

The literacy rate (population age 7+ years) of the district is 80 percent, with 87 percent 

for males and 71 percent for females, which are higher than the respective rates of the state. 

Thus, both in terms of level of literacy rate as well as the extent of urbanisation Ahmedabad 

district is at an advantage position as compared to the state as a whole. 

Table 1.1: BASIC DEMOGRAPHIC INDICATORS 

Demographic indicators of Ahmedabad district of Gujarat 

Indicators Ahmedabad Gujarat 

Population (in thousands) 

5808 50597 

Average annual exponential growth rate (in percent) 

Population density (per sq km) 

Sex ratio (females per 1000 males) 

Percent urban 

Percent of literate population age 7+ years 

Person 

Male 

Female 

Source : Census, 2001 

2.359 

718 

892 

80.09 

79.89 

86.81 

71.12 

2.028 

258 

921 

37.67 

69.97 

80.50 

58.60 

1.3 SURVEY DESIGN AND SAMPLE SIZE OF THE DLHS-RCH SURVEY 

Like the First Round, in Round II again in the Phase I of the DLHS-RCH, nearly 50 percent 

of the 25 districts as existed in 2001 census were selected with random start from either the 

first or the second district and then every alternative district were selected. With this 

procedure, 13 districts were covered in Gujarat state in the Phase I in 2002 and the remaining 

12 districts will be taken-up for the second phase of the DLHS-RCH. In each of the selected 

districts, 40 Primary Sampling Units (PSUs - Villages/Wards/UFS) were selected with 

probability proportional to size (PPS) after stratification of the PSU. The village/ward level 

population as per 1991 census was used for this purpose. The list of PSUs covered for the 

survey in Ahmedabad district is given in Annexure II. 

The sample size for the DLHS-RCH was fixed at 1000 households, i.e. 25 households 

from each of the 40 selected PSUs. In order to take care of non-response due to various 

reasons, over sampling of 10 percent of the households was done. In addition to this, each 

selected PSU was visited twice to improve the coverage. Thus, in all, 28 households from 

each PSU were selected following circular systematic random sampling procedure. 

1.4 HOUSE LISTING 

A household listing operation carried out in each of the selected PSUs prior to the data 

collection provided the necessary frame for selecting the households for the DLHS-RCH. 

The household listing involved, preparation of location map of each selected PSU, layout 

sketch of the structures, and recording details of the households in these structures in the 

selected PSU (village/urban frame size). Twelve independent teams carried out this exercise, 

each comprising, one lister and one mapper under the overall supervision and monitoring of 

the research staff of CORT. 

A complete listing was carried out in the villages with households up to 300. In case of 

large villages with more than 300 household, the villages were divided into two or more 

segments of equal size depending on the estimated number of households and one segment in 

14

each village was selected at random. In each of the selected segments, a complete listing was 

carried out for the selection of the households. 

In the case of small villages with less than 50 households, the village was combined with 

the nearest village available. After combining it with the nearest village the same sampling 

procedure was adopted as mentioned above. 

1.5 QUESTIONNAIRES 

The International Institute for Population Sciences (IIPS), Mumbai, the Nodal Agency for 

DLHS-RCH Project has made necessary modifications in Household Questionnaire and 

Women's Questionnaire and added three more Questionnaires i.e., Husband's 

Questionnaire, Village Questionnaire and Health and Nutritional Questionnaire in 

consultation with MoHFW and World Bank. These questionnaires were discussed and 

finalized in training cum workshop organized at IIPS during the first week of November 

2001. 

These questionnaires had been canvassed in the Phase I of Round II of the DLHS- 

RCH survey, taking into consideration the viewpoints of all the regional agencies involved 

in the survey. The house listing teams and the interviewers and the supervisors for the 

main survey were given rigorous training, based on the manuals developed for the purpose 

by the Nodal Agency. 

The Household Questionnaire was used to list all the usual members in the selected 

households as well any visitors who stayed in the household, the night before the 

interview, and to collect information on marriages, births, infant and maternal deaths since 

1 st January, 1999 among the usual residents of the households. In addition, the 

questionnaire contained question for collecting information on socio-economic 

characteristics of the households, and the incidence/prevalence of malaria, tuberculosis 

and blindness. For all the marriages reported in the survey, the age at marriage of boys and 

girls that were performed in the household since 1 st January 1999 was recorded. 

The Women's Questionnaire was used to collect information from the eligible women 

listed in the household questionnaire, i.e., all currently married women age 15-44 years 

who were usual residents of the selected household or visitors who stayed in the selected 

household the night before the interview and whose marriage were consummated. 

The Women's Questionnaire consisted of the following broad sections: 

Woman's characteristics 

Antenatal, natal and postnatal care 

Immunization and childcare 

Contraception 

Quality of Government health services and client's satisfaction 

Awareness of RTI/STI and HIV/AIDS and reported symptoms of RTI/STI. 

The Husband Questionnaire was used to collect information, from the husband's of 

eligible women listed in the household questionnaire, on knowledge of RTI/STI and 

HIV/AIDS, and reported symptoms of RTI/STI and male participation in family planning. 

15

The Village Questionnaire collected information on availability on health and 

education facilities in the village and whether the health facilities accessible throughout 

the year. 

In addition, the health investigator in each survey team measured the weight of 

children below 72 months of age at the time of survey. The health investigator also 

collected the blood sample from children below 72 months of the age, pregnant women 

and adolescent's girls from selected households to assess hemoglobin level. This 

information is useful for assessing prevalence rates of anemia among pregnant women, 

adolescents'girls and children. 

The questionnaires were printed in both English and Gujarati languages. 

1.6 RECRUITMENT, TRAINING AND FIELDWORK 

A total of 72 field persons were recruited for conducting the survey in Gujarat state. The field 

investigators were both males and females with at least a Bachelor’s degree in social science 

subjects. Most of the field interviewers had some work experience after obtaining their 

Bachelor’s degree and had previous field experience. All health investigators were DMLT 

and had worked in some laboratory. All the supervisors were males and had obtained a 

Master’s degree. Most of the field interviewers had some working experience after 

Bachelor’s degree. The supervisors were those who had more field experience. 

A total of 12 teams were formed for data collection in the state. Each team consisted of 

one male supervisor, three female interviewers, one male investigator and one health 

investigator. 

The training of field staff for the main survey was organised for the teams at Jeevan 

Darshan, Baroda during July 2002 following the guidelines given by the Nodal Agency. The 

professional staff members of the CORT were involved in the training. After 8 days of 

classroom training, the teams were taken to the field to collect data from the rural/urban areas 

in the presence of trainers. Their filled in questionnaires were thoroughly scrutinised to see 

gaps in their understanding. Such classroom and field training exercise were repeated till the 

trainers were satisfied with the total understanding of the questionnaires by the field teams. 

Monitoring and supervision was carried out by the professional staff of the CORT. During 

the period of survey, the IIPS team headed by a Research Officer did the 10 percent quality 

check. Fieldwork was carried out in the Ahmedabad district of Gujarat state in January 2003. 

1.7 DATA PROCESSING AND TABULATION 

All the completed questionnaires were brought to headquarters of CORT, Baroda for data 

processing. The data were processed using Micro Computers. The process consisted of 

office editing of questionnaires, data entry, data cleaning and tabulation. Data cleaning 

included validation, range and consistency checks. IIPS developed the software package 

for both data entry and tabulation of the data 

In generating state level demographic indicator sample weight for household, women, 

husband and children’s, weight have been used and these for a particular district are based on 

three sections probabilities f i i 

1 , f 2 

i 

and f 3 pertaining to i th PSU of the district. These 

probabilities are defined as, 

i 

f 1 =Probability of selection of i th PSU of the district 

16

=( n 

r * H i )/ H, where n r is the number of rural PSU to be selected from the district, H i 

refers to the number of households in the i th PSU and H = Σ H i , total number of households 

in the district. 

f 2 

i 

= Probability of selecting segment (s) from segmented PSU (in case the i th selected 

PSU is segmented) 

= (number of segments selected after segmentation of PSU) / (number of segment a PSU 

is divided) 

The value of f 2 

i 

is to be equal to one for unsegmented PSU. 

f 3 

i 

=probability of selecting a household from the total listed households of a PSU or 

segment of a PSU 

=(28*HR i )/ HL i 

Where HR i is the household response rate of the i th sampled PSU and HL i is the number of 

households listed in i th PSU of the district. 

For urban PSU, f 1 

i 

is computed either as the ratio of number of urban PSUs to be included 

from the district to the total number of UFS blocks of the district or as the ratio of urban 

population of the selected PSU to the total urban population of the district. 

The probability of selecting a household from the district works out as 

f i = f 1 

i 

* f 2 

i 

* f 3 

i 

The non- normalized weight for the i th PSU of the district is, w i = 1/f i while the normalized 

weight used in the generation of district indicators separately for rural and urban PSUs of the 

i th district is 

∑ 

n 

i 

= i 

i 

* w 

i 

∑ n i * w 

i 

. 

Where n i is the number of households interviewed in the i th PSU. The weight for women, 

husbands and children respectively is computed in a similar manner considering the 

corresponding response rate. 

1.8 STANDARD OF LIVING INDEX (SLI) 

In Phase-I of First Round of the RHS, type of house alone was taken as the proxy for the 

economic status of the households. But in Phase-II, questions related to household amenities 

and possession of some selected household items were considered for developing economic 

status index. In order to develop SLI, the following scores related to response categories for 

each question were given: 

17

Table 1.2: STANDARD OF LIVING INDEX (SLI) 

Sr. No Variable Categories Scores 

1 Source of Drinking Water 1.Tap (own) 

2.Tap shared 

3.Hand pump + Well 

4.Others 

3 

2 

1 

0 

2 Type of House 1. Pucca 

2. Semi Pucca 

3.Kachcha 

3 Source of Lighting 1.Electricity 

2.Kerosene 

3.Other 

4 

2 

0 

2 

1 

0 

4 Fuel for Cooking 1.LPG 

2.Kerosene 

3.Others 

5 Toilet Facility 1.Own Flush Toilet 

2.Own Pit Toilet 

3.Shared Toilet 

4.No Toilet 

6 Ownership of items 1.Fan 

2.Radio/Transistor 

3. Sewing machine 

4.Television 

5.Telephone 

6.Bicycle 

7.Motor cycle/Scooter 

8.Car 

9.Tractor 

2 

1 

0 

4 

2 

2 

0 

2 

2 

2 

3 

3 

2 

3 

4 

4 

The total of the scores may vary from the lowest of 0 to a maximum of 40. On the basis of 

total score, households are divided into three categories as: 

(a) Low if total score is less than or equal to 9. 

(b) Medium if total score is greater than 9 but less than or equal to 19. 

(c) High if total score is greater than 19. 

Most of the indicators under DLHS-RCH, Phase I of the Second Round are also 

tabulated by these three categories of SLI, in addition to variables like residence 

(rural/urban), caste and education. 

18

CHAPTER – 2 

HOUSEHOLD CHARACTERISTICS 

This chapter presents the demographic and socio-economic characteristics of the households 

interviewed in the DLHS-RCH Ahmedabad district of Gujarat. The DLHS-RCH household 

population is tabulated by de facto population only. This may differ from the de jure 

population because of temporary population movements and would result in non-coverage of 

usual residents who are temporarily elsewhere at the time of the survey. 

2.1 HOUSEHOLD POPULATION 

Table 2.1 presents the percentage of household population by age, residence and sex. The sex 

ratio i.e., the number of males per 100 females is 105. There was not much variation in the 

sex ratio in urban and the rural areas of the district. The total sample population covered in 

district is 4,943 with 2530 males and 2413 females. Around 29 percent of them fall in age 

group 0-14 and 32 percent in the age group of 15-29 years. A significant difference was 

observed in the age distribution of population in rural and urban areas. About one-third of the 

total population in the rural areas (33 percent) were in the age cohort of 0-14 years whereas in 

urban areas the corresponding proportion of this age group was 28 percent. On the other 

hand, while 25 percent of the rural population was in the age group (15-29), slightly higher 

percentage (34 percent) of the urban population is in this age group. Higher proportion below 

age 15 in rural areas is an indication of the fact that rural fertility is slightly higher than that of 

the urban fertility in this district. About seven percent of the total population were reported to 

be in the older age group of 60 years and above. 

Table 2.1 HOUSEHOLD POPULATION 

Percentage distribution of the household population by age and by residence and sex, Ahmedabad district of Gujarat, RCH, 

2002 

Age group 

(in years) 

0-4 

5-9 

10-14 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

45-49 

50-59 

60+ 

Total 

10.1 

9.4 

9.7 

12.1 

11.2 

8.6 

6.0 

6.9 

6.2 

4.4 

8.4 

7.0 

Residence 

Sex 

Rural Urban Male Female 

Total Percentage 100.0 100.0 100.0 100.0 100.0 

Number of persons 4943 969 3974 2530 2413 

Sex Ratio (100*M/F) 105 103 105 NA NA 

Table is based on the 'de facto' population 

11.0 

12.2 

9.9 

8.9 

7.9 

7.8 

6.8 

7.3 

5.8 

4.1 

9.1 

9.0 

9.8 

8.8 

9.6 

12.8 

12.0 

8.7 

5.8 

6.8 

6.3 

4.5 

8.3 

6.5 

NA: Not applicable 

10.7 

8.7 

10.0 

10.7 

11.9 

8.9 

5.6 

7.0 

6.2 

4.2 

9.8 

6.2 

9.5 

10.2 

9.4 

13.5 

10.5 

8.2 

6.4 

6.8 

6.3 

4.6 

6.9 

7.8 

19

2.2 GENERAL CHARACTERISTICS 

Table 2.2 presents the percentage distribution of households by selected background 

characteristics. Male is the head in almost all of the households in Ahmedabad district. 

Almost 95 percent of the households are headed by male and only five percent households 

are headed by female. More or less same situation existed in rural and urban areas of the 

district. 

Table 2.2 HOUSEHOLD CHARACTERISTICS 

Percent distribution of households by selected characteristics of household head and household size, according to 

residence, Ahmedabad district of Gujarat, RCH, 2002 

Residence 

Characteristic 

Total 

Rural 

Sex of the household head 

Male 

Female 

Age of the household head 

Less than 30 

30-44 

45-59 

60+ 

95.1 

4.9 

14.4 

35.8 

34.2 

15.6 

95.5 

4.5 

8.8 

39.6 

29.6 

22.0 

Urban 

95.0 

5.0 

15.8 

34.8 

35.3 

14.0 

Median age of the household head 44.9 45.8 44.7 

Religion of household head 

Hindu 

Muslim 

Christian 

Jain 

Zoroastrian 

90.2 

3.2 

0.5 

5.6 

0.5 

93.5 

6.5 

0.0 

0.0 

0.0 

89.4 

2.4 

0.6 

7.0 

0.6 

Caste/tribe of household head 

Scheduled caste 

Scheduled tribe 

Other backward class 

Other# 

Don’t know 

Number of usual members* 

1 

2 

3 

4 

5 

6 

7 

8 

9+ 

3.5 

4.7 

16.8 

20.5 

18.3 

14.3 

9.8 

2.1 

10.1 

3.3 

9.6 

11.2 

12.4 

25.4 

17.1 

8.7 

3.1 

9.3 

3.6 

3.4 

18.2 

22.4 

16.5 

13.6 

10.1 

1.8 

10.3 

Mean household size 5.2 5.2 5.2 

Number of households 1007 198 809 

* Based on the de jure population 

# Higher caste (not belonging to scheduled caste, scheduled tribe or other backward class) 

10.1 

2.5 

43.2 

43.2 

0.9 

20.7 

0.0 

49.0 

30.3 

0.0 

7.6 

3.1 

41.8 

46.4 

1.1 

Around 14 percent of the head of the households are below 30 years of age. The 

corresponding percentage is nine in the rural area and 16 in the urban area. The heads of the 

households belonging to age group 30-44 are 40 percent in rural and 35 percent in the urban 

areas. The median age of the head of the households is 45 years. Majority of the sample 

population are Hindus (90 percent). Very small percent belonged to other religious group, six 

percent Jain, three percent Muslims and negligible proportion to other groups. Overall, there 

are about 10 percent of SC and three percent of ST households. Nearly 70 percent of the rural 

households and 53 percent of the urban households belong to Scheduled castes, Scheduled 

tribes and other backward castes. The average household size is 5.2 in rural and urban areas 

of the district. 

20

2.3 HOUSING CHARACTERISTICS 

Table 2.3 presents the percentage distribution of households by selected background 

characteristics. The main source of lighting is electricity in nearly 97 percent of the 

households being 98 percent in the urban areas and 94 percent in the rural areas. 

Table 2.3 HOUSING CHARACTERISTICS 

Percentage distribution of households by housing characteristics, according to residence, Ahmedabad district of Gujarat, 

RCH, 2002 

Housing characteristics 

Electricity 

No 

Yes 

Source of drinking water 

Tap 

Hand pump/bore well 

Well 

Other 

Sanitation facility 

Own flush toilet 

Shared toilet (any type) 

Public/community toilet (any type) 

No toilet facility 

Main type of fuel used for cooking 

Liquid petroleum gas/electricity 

Kerosene 

Wood 

Other 

Type of house 

Kachcha 

Semi-pucca 

Pucca 

Households assets 

Fan 

Radio/transistor 

Sewing machine 

Television 

Telephone 

Bicycle 

Motor cycle/scooter 

Car/ jeep 

Tractor 

Standard of living index 

Low 

Medium 

High 

21 

Total 

2.6 

97.4 

93.6 

1.8 

2.4 

2.2 

65.1 

8.5 

0.8 

25.6 

63.7 

8.6 

27.4 

0.3 

6.0 

21.3 

72.7 

94.9 

39.2 

15.5 

74.1 

27.5 

55.8 

34.6 

4.0 

1.5 

Residence 

Rural 

5.6 

94.4 

82.6 

4.9 

1.2 

11.3 

17.5 

1.3 

0.0 

81.2 

11.0 

2.9 

85.2 

0.9 

27.5 

48.7 

23.8 

85.4 

18.5 

4.2 

44.1 

11.6 

41.3 

14.3 

0.6 

7.5 

Urban 

10.2 

30.5 

59.3 

42.4 

41.8 

15.8 

2.3 

27.7 

70.0 

Number of households 1007 198 809 

Majority (94 percent) of the households have access to tap water for drinking, only two 

percent each received water through hand pump or from wells. About 96 percent of the 

households in urban and 83 percent in rural areas get piped water for drinking. However, 

about 11 percent of the households in rural areas depended on other sources for drinking 

water. 

Only 65 percent of the households have a flush toilet facility and above nine percent are 

utilize shared (public and own) toilet while about 26 percent of the households have no toilet 

facility at all. Household with flush toilet facility is high (77 percent) in the urban areas and 

18 percent of the rural areas had this facility. Majority of the households in the rural areas did 

not have toilet facility (81 percent). 

Liquid petroleum gas (LPG) is the most commonly used fuel for cooking as more than 

three-fifths of the households depend on it while 27 percent of the households use wood and 

nine percent rely on kerosene, as expected use of wood is high in rural areas (85 percent). 

1.9 

98.1 

96.3 

1.0 

2.7 

0.0 

76.7 

10.2 

1.0 

12.0 

76.6 

10.1 

13.2 

0.2 

0.7 

14.6 

84.7 

97.3 

44.3 

18.2 

81.5 

31.3 

59.3 

39.5 

4.9 

0.0

About six percent of the households live in kachcha and 21 percent in semi- pucca 

houses and 73 percent reside in pucca houses. As expected, a majority of the urban 

households (85 percent) are living in pucca houses compared to the rural households (24 

percent). 

In addition to the above amenities information on possession of some durable goods is 

also collected from surveyed households. Analysis of the same shows that about 95 percent 

of the households reported owning a fan, while 74 percent reported owning of Television. 

Another 56 percent reported owning bicycle. And 39 percent of them reported owning 

Radio/transistor, 35 percent motorcycle. About 28 percent reported that they own telephone. 

The other durable goods found are sewing machine (16 percent). Ownership of all these 

items is more among the urban households than among the rural households. 

Taking all these indicators into consideration, SLI was computed. As per the analysis 

around three-fifths of the households (59 percent) have high standard of living, 31 percent 

have a medium level of standard of living and only 10 percent of the households have low 

standard of living. The percent of households with medium or higher-level of standard of 

living is more in urban areas (98 percent) compared to the rural areas (58 percent). 

2.4 MARITAL STATUS OF HOUSEHOLD POPULATION 

The DLHS-RCH, collected information on marital status of all household members above 10 

years of age. Table 2.4 shows the percent distribution of household population by marital 

status classified by age and sex. Among females aged 10-14; about four percent are currently 

married. The proportion of never married reached lowest among men by the time they reach 

the age 30, while in the case of women the never married reached lowest by the time they 

reach the age 25. The proportions divorced, separated, or deserted are small, and widowhood 

is quite limited until the older ages. More women were widowed by the age 45 and above 

compared with males. 

Table 2.4 MARITAL STATUS OF THE HOUSEHOLD POPULATION 

Percentage distribution of the household population age 10 and above by marital status, according to age group and sex in 

Ahmedabad district of Gujarat, RCH,2002 

Age Group 

Marital Status 

Male 

Female 

Never Currently Widower/ Total Number Never Currently Widow/ Total Number 

married married Divorced/ percent of married married Divorced/ percent of 

Separated 

males 

Separated females 

10-14 99.6 0.4 0.0 100.0 252 96.2 3.8 0.0 100.0 227 

15-19 90.9 9.1 0.0 100.0 272 87.8 12.2 0.0 100.0 325 

20-24 68.3 31.6 0.2 100.0 301 16.1 79.3 4.6 100.0 254 

25-29 20.7 78.8 0.4 100.0 226 2.9 94.3 2.8 100.0 197 

30-44 

3.6 92.3 4.0 100.0 476 0.8 96.4 2.8 100.0 469 

45-59 

0.2 95.1 4.6 100.0 356 0.2 88.5 11.3 100.0 278 

60+ 

0.8 84.2 15.0 100.0 157 0.0 38.5 61.5 100.0 188 

Total 37.7 59.3 3.0 100.0 2041 28.6 62.2 9.2 100.0 1937 

Table is based on the 'de facto'population 

22

2.5 MARRIAGES AND MORBIDITY 

Table 2.5 presents data on marriages, and morbidity in the households surveyed. In total 149 

boys and 125 girls were married in the district Ahmedabad during the period 1 st January 1999 

till the date of the survey. The mean ages at marriage for boys in district Ahmedabad is found 

to be 21 years and for girls it is less than 18 years. The mean ages at marriage for boys and 

girls married since 1 st January 1999 in rural areas were 25 and 13 years respectively and the 

comparative figures for urban areas are 20 and 19 years. 

Practice of early marriage is more prominent in rural areas as higher percent of boys (56 

percent) and (41 percent) girls were married below the legal age at marriage. Compared to 

this such practice is less prominent in the urban areas. 

The prevalence rate of blindness, tuberculosis and malaria, as reported in the surveyed 

households are 255, 85 and 506 per 100,000 population respectively in the district. The 

prevalence rate of complete blindness per 100,000 population is 258 among males and 251 

among females. The extent of partial blindness, however, is reported to be much higher (3146 

per 100,000 population) as compared to complete blindness (255 per 100,000 population). 

Similarly prevalence rate of tuberculosis among males and females is 99 and 71 per 100,000 

population respectively. The prevalence rate of malaria is 296 among males and 726 among 

females per 100,000 population. This clearly illustrates that the prevalence of the two 

morbidities (blindness and malaria) is higher among females than males. The prevalence rate 

of each of the morbidity blindness, tuberculosis and malaria was reported to be much higher 

in the rural as compared to urban areas of this district. 

Table 2.5 MARRIAGE AND MORBIDITY RATES 

Number of marriages, mean age at marriage and prevalence of blindness, tuberculosis and malaria, according to 


Characteristic 

Total 

Residence 

Rural 

Number of marriages reported since 1 st January 1999 

Boys 

Girls 

Mean age at marriage 

Boys 

Girls 

Percentage of marriages below legal age at marriage 

Boys 

Girls 

Morbidity 

Prevalence** rate of blindness 

Male 

Complete 

Partial 

Female 

Complete 

Partial 

Person 

Complete 

Partial 

Prevalence** rate of tuberculosis (2002) 

Male 

Female 

Person 

Prevalence ** rate of malaria for last two week 

Male 

Female 

Person 

23 

149 

125 

20.9 

17.5 

28.8 

32.5 

258 

2048 

251 

4298 

255 

3146 

99 

71 

85 

22 

38 

24.7 

13.3 

55.6 

41.1 

450 

3791 

158 

6283 

306 

5015 

467 

229 

350 

Urban 

296 

726 

506 

1273 

539 

912 

57 

773 

405 

Total population 5068 1005 4063 

** Prevalence rate per 100,000 population 

Note: All the rates refer to 'de jure’ population 

2.6 MORTALITY 

127 

87 

20.3 

19.4 

24.1 

28.6 

211 

1621 

274 

3803 

242 

2684 

9 

32 

20

Table 2.6 presents data on various mortality measures per 1000 population of the de jure 

population three year prior to survey in the district of Ahmedabad in Gujarat. The crude death 

rate is found to be 5. The neo-natal mortality and post neo-natal mortality rates are 40 and 8 

per 1000 births respectively. The infant mortality rate was estimated to be 48, per 1000 live 

births and the under five-mortality rate is 53 in Ahmedabad district. 

Table 2.6 VITAL RATES 

Crude death rate, neonatal, postneonatal, infant, child and under-five mortality rates, Ahmedabad district of Gujarat, 

RCH, 2002 

Crude death rate 

Neonatal mortality rate 

Post neonatal mortality rate 

Infant mortality rate 

Child mortality rate 

Under-five mortality rate 

* Refers to per 1000 population Note: All the rates refer to ‘de jure’ population. 

4.94 

39.76 

7.87 

47.63 

5.19 

52.83 

24

CHAPTER – 3 

CHARACTERISTICS OF THE WOMEN AND FERTILITY 

In this chapter a brief background and fertility profile of the currently married women (age 

15-44 years) interviewed for the survey is presented. The cohort fertility of the district as 

measured by the number of children ever born to the women age 15-44 years and the 

completed fertility as measured by the number of children ever born to the women age 40-44 

years is presented. The children ever born and the children surviving by sex and age per 

woman are also presented by some selected characteristics of woman. The coverage of the 

chapter also includes distribution of total pregnancies of the currently married women by type 

of outcome, in addition to fertility indicators in terms of age specific fertility rates, crude birth 

rate and total fertility rate. 

3.1 CHARACTERISTICS OF THE CURRENTLY MARRIED WOMEN 

The basic characteristics of the currently married women age 15-44 years are presented in 

Table 3.1. The currently married women interviewed are young, as almost half (48 

percent) of them interviewed were in the age group 15-29 years and the remaining women 

were aged 30 years and above. For a majority (67 percent) of the currently married 

women, marriages were consummated after age 18 years i.e. above the legal age at 

marriage. This figure is 42 percent in rural areas and it is 73 percent in urban areas. The 

early consummation of marriage is high in the rural areas. 

About 92 percent of the currently married women are Hindus, five percent are Jain 

and four percent are Muslims. Three-fifths of the women belong to scheduled caste (SC), 

scheduled tribe (ST) or other backward classes. Educational status of the women shows 

that thirty-three percent are illiterate and slightly more than one-third (35 percent) have 

completed 10 or more years of schooling. Compared to the respondents the educational 

status of their spouse is better as only 11 percent of them are illiterate and 54 percent have 

completed 10 or more years of schooling. The educational status in urban areas is much 

better in terms of literacy. About 42 percent of the women respondents and 61 percent of 

their spouses in urban areas had completed 10 or more years of schooling; the corresponding 

figures in rural areas is only four and 25 percent respectively. With regard to the standard of 

living, about nine percent of the women belong to low level (42 percent in rural and one 

percent in urban areas), 34 percent have medium level and 57 percent have high standard of 

living. Those having medium or higher level of standard of living are more in urban areas 

compared to the rural areas. 

25

Table 3.1 BACKGROUND CHARACTERISTICS OF ELIGIBLE WOMEN 

Percentage distribution of currently married women age 15-44 by selected background characteristic, according to 


Background characteristic 

Total 

Residence 

Rural 

Age Group (Years) 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

Age at consummation of marriage 

Below 18 years 

18 years & above 

Religion 

Hindu 

Muslim 

Jain 

Caste 

Scheduled caste 

Scheduled tribe 

Other backward class 

Other# 

Don’t know 

Education (Years of schooling) 

Illiterate 

0-9@ years 


Husband’s education (Years of schooling) 

Illiterate 

0-9 @ years 

10 years and above 


Low 

Medium 

High 

Availability of health facility in the village 

No 

Yes 

4.8 

17.6 

25.7 

17.2 

16.5 

18.2 

32.9 

67.1 

91.5 

3.8 

4.7 

11.9 

3.0 

44.7 

40.3 

0.1 

32.9 

32.4 

34.6 

7.8 

19.1 

24.5 

19.7 

17.8 

11.1 

57.9 

42.1 

91.5 

8.5 

0.0 

20.2 

0.0 

50.0 

29.8 

0.0 

60.9 

34.9 

4.2 

Urban 

Number of women 769 149 620 

# Higher caste (not belonging to scheduled caste, scheduled tribe, or other backward class) 

@ Literate women with no years of schooling are also included NA: Not applicable 

10.7 

34.9 

54.3 

9.2 

33.7 

57.1 

NA 

NA 

25.9 

49.4 

24.7 

42.3 

41.7 

16.0 

55.0 

45.0 

4.1 

17.3 

26.0 

16.6 

16.2 

19.8 

26.9 

73.1 

91.5 

2.7 

5.7 

9.9 

3.7 

43.4 

42.8 

0.1 

26.2 

31.8 

41.9 

7.1 

31.4 

61.4 

1.2 

31.8 

67.0 

NA 

NA 

3.2 CURRENT FERTILITY 

In the present phase of the DLHS-RCH survey currently married women in the age group of 

15-44 years were asked about the live births they had during the three-year period preceding 

the survey, along with the corresponding age of women at the time of delivery. On the basis 

of this information, average annual births experienced by women in the conventional five 

year age groups during the aforesaid period, that is age specific fertility rates are computed 

taking into account the age distribution of all women in the reproductive age group of 15-44 

years and person-years lived during the period preceding the survey since 1 st January 1999. 

The age specific fertility rates are subsequently utilized for the estimation of total fertility rate 

(TFR) and crude birth rate (CBR). These indicators of current fertility rate are shown in the 

Table 3.2. It may be observed that average annual births per woman attain peak in the mid 

twenties thereafter it declines with increasing age of women. The average number of children 

that a woman had, on an average, in the reproductive life time as depicted by TFR stands at 

2.1 The average annual births per thousand population during the three years period 

preceding the survey in the form of CBR is 23 in Ahmedabad district. TFR of 2.1 in 

Ahmedabad district illustrates that this district probably has reached the replacement level of 

fertility. 

26

Table 3.2 CURRENT FERTILITY 

Age-specific fertility rates and total fertility rates, and crude birth rate, during the three years period preceding the survey, 

Ahmedabad district of Gujarat, RCH, 1999-2002. 

Age Group 

Age specific fertility rate 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

0.038 

0.160 

0.163 

0.036 

0.014 

0.004 

TFR (15-44) 2.08 

CBR 23.33 

Rates refer to period from 1.1.1999 to the date of survey 

3.3 CHILDREN EVER BORN AND LIVING 

Table 3.3 presents data on children ever born and surviving by selected characteristics of 

the currently married women. The mean number of children ever born is 2.7 per currently 

married woman and the mean number of children surviving is 2.5. The corresponding 

figures for children ever born in the rural and urban areas were 3.2 and 2.6 respectively. 

The mean number of children surviving in the rural and urban areas of this district were 

2.0 and 2.4 respectively. The completed fertility i.e. the mean number of children ever 

born to women of age 40-44 years is 3.3 in the district. 

Table 3.3 FERTILITY 

Mean number of children ever born (CEB) and children surviving (CS) by selected background characteristics of currently 

married women* age 15-44, Ahmedabad district of Gujarat, RCH, 2002 


Age group 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

Duration of marriage 

0-4 

5-9 

10-14 

15+ 

Residence 

Rural 

Urban 

Religion 

Hindu 

Muslim 

Jain 

Casteβ 

Scheduled castes 

Scheduled tribes 

Other backward communities 

Other 

Education 

Illiterate 

0-9 @ years 


Standard of living Index 

Low 

Medium 

High 

Mean children 

ever born 

Mean children surviving 

Male Female Total Male Female Total 

0.27 

0.85 

1.07 

1.36 

1.61 

1.79 

0.39 

1.12 

1.29 

1.85 

1.54 

1.28 

1.34 

1.46 

0.91 

1.37 

1.27 

1.49 

1.13 

1.71 

1.26 

0.98 

0.93 

1.00 

1.01 

1.48 

1.92 

1.49 

0.95 

0.83 

1.45 

1.79 

1.67 

1.29 

1.39 

1.48 

0.85 

2.08 

1.78 

1.40 

1.08 

1.89 

1.22 

0.95 

1.21 

1.85 

2.09 

2.85 

3.54 

3.29 

1.35 

1.96 

2.74 

3.65 

3.21 

2.58 

2.73 

2.94 

1.76 

3.46 

3.05 

2.90 

2.22 

3.61 

2.48 

1.94 

0.05 

0.83 

1.00 

1.17 

1.48 

1.56 

0.37 

1.10 

1.20 

1.59 

1.33 

1.16 

1.20 

1.34 

0.91 

1.30 

0.66 

1.30 

1.07 

1.49 

1.13 

0.94 

0.72 

0.88 

0.99 

1.39 

1.84 

1.34 

0.93 

0.74 

1.36 

1.66 

1.48 

1.23 

1.29 

1.39 

0.81 

2.05 

1.78 

1.28 

0.99 

1.74 

1.13 

0.91 

0.77 

1.71 

1.99 

2.56 

3.32 

2.91 

1.30 

1.84 

2.56 

3.26 

2.82 

2.39 

2.50 

2.73 

1.73 

3.35 

2.45 

2.59 

2.07 

3.23 

2.26 

1.86 

Number of 

women 

1.70 

1.48 

1.18 

1.84 

1.61 

1.15 

3.55 

3.09 

2.33 

1.44 

1.35 

1.06 

1.67 

1.49 

1.09 

3.11 

2.85 

2.16 

65 

217 

384 

All women 1.33 1.37 2.70 1.19 1.27 2.47 667 

β The total figure may not add to (N) and percentage may not add up to 100.0 due to don’t know and missing cases 

@ Literate women with no years of schooling are also included 

* Women who have/had given live birth 

Note: Percentage may not be reliable as based on less than 25 cases. 

(11) 

106 

160 

129 

125 

136 

111 

143 

145 

268 

132 

535 

612 

27 

28 

82 

(16) 

305 

263 

238 

206 

223 

27

The mean number of children ever born is 2.7 for Hindus, 1.8 for Jain and 2.9 for 

Muslims. The mean number of children ever born is 3.5 for SCs and 3.1 for STs and it is 2.9 

for other backward classes. It may be mentioned here that the mean values are not 

standardised and therefore, the comparisons made here have this limitation. The mean 

number of children ever born has declined with the increase in the level of education of the 

currently married women. An illiterate woman in the reproductive ages, on an average, bears 

3.6 children compared to 1.9 children borne by those with at least 10 years of schooling. The 

mean number of children ever born has also declined with the increase in the standard of 

living of the household. 

3.4 OUTCOME OF PREGNANCY 

Keeping in view the implication of socio-economic, health care and nutritional status of 

currently married women on pregnancy outcome. Table 3.4 presents the distribution of total 

pregnancies of the eligible women by type of outcome. The outcome of pregnancy are live 

births, stillbirths, spontaneous abortion and induced abortion. There were 2010 reported 

pregnancies. About 90 percent of these ended as live births. The percentages of pregnancies 

that ended in spontaneous and induced abortions were five each, while the rest resulted in 

stillbirths. The incidence of pregnancy wastage in the absence of external intervention is 

more among women in the age group of 20-29 and 35-39. But the external intervention is 

concentrated among women in 25-29 and 40-44 age group. 

Table 3.4 OUTCOME OF PREGNANCY 

Percentage distribution of total pregnancies of currently married women age 15-44, Ahmedabad district of Gujarat, 

RCH, 2002 

Age group 

Type of outcome 

Number of 

Live birth Still birth Spontaneous 

abortion 

Induced 

abortion 

Total Pregnancies 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

98.0 

85.3 

87.2 

91.6 

90.2 

91.6 

0.0 

0.2 

1.5 

1.6 

0.5 

0.2 

28 

2.0 

9.9 

5.3 

2.2 

6.7 

1.1 

0.0 

4.6 

6.0 

4.6 

2.6 

7.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

All women 89.7 0.8 4.5 5.0 100.0 2010 


3.5 BIRTH ORDER 

The study of distribution of births by birth order is necessary to understand the 

fertility. Table 3.5 shows the distribution of the births during the three years period 

before the survey by birth order and age group of women. 

Table 3.5 BIRTH ORDER 

Percentage distribution of births during three years preceding the survey by birth order, according to women 15-44 age, 

Ahmedabad district of Gujarat, RCH, 2002 

Age group 1 2 3 4+ Total Number 

of births 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

76.6 

44.6 

58.4 

48.8 

30.4 

43.5 

23.4 

39.3 

10.9 

6.7 

31.9 

12.6 

0.0 

14.6 

26.8 

24.3 

0.0 

3.8 

0.0 

1.5 

3.9 

20.2 

37.7 

40.0 

100.0 

100.0 

100.0 

100.0 

100.0 

100.0 

All women 51.9 18.4 21.0 8.7 100.0 624 


Table 3.5 reveals that 52 percent of all births are first order birth, 18 percent are 

second order births, 21 percent are third order births and nine percent are births of order 

four or higher. Further, age-specific birth order shows that, first order births are higher 

among women in the younger age group of 15-29 years of age. Higher order birth of four 

or more was high among older women above 40 years of age. 

(13) 

230 

384 

402 

491 

490 

(16) 

155 

286 

130 

30 

(7)

CHAPTER - 4 

UTILIZATION OF MATERNAL HEALTH SERVICES 

An important objective of the District Level Household Survey (DLHS) is to provide 

information on maternal and child health care practices. This chapter presents information 

on antenatal, natal and postnatal care received by CMW (from 1 st January 1999 till the 

date of the survey). ` 

4.1 ANTENATAL CHECK-UPS BY SERVICE PROVIDER 

Table 4.1(A), presents data 

on ANC coverage and 

service providers by 

selected background 

characteristics of the CMW. 

In the district of 

Ahmedabad, around 92 

percent of pregnant women 

had received any ANC 

service. Doctors are the 

main ANC service 

providers followed by 

ANM. About 68 percent of 

the women availed the 

services from doctor 

followed by ANM, 

Nurse/LHV (20 percent). It 

Sources 

ANM at home 

ANM/Nurse/LHV 

DLHS-RCH, 2002 

Any ANC 

may be mentioned that only six percent of the women received ANC services at home 

(Figure 4.1). 

Almost all the women in the three-age cohorts had availed the ANC services. This 

indicates that the services are reaching the target population in this district. Younger 

women below 20 years of age received the services from ANM (71 percent) while those 

above 20 years received ANC services from doctor. The proportion of women who 

reported having availed at least one antenatal care service decreased with the increase in 

the number of children. The proportion of women having received any ANC services was 

82 percent in the rural areas and 95 percent in the urban areas. Relatively higher 

proportion of women belonging to other caste (96 percent), as compared to scheduled 

caste (SC)/scheduled tribe (ST) women (74 percent) reported to have received any ANC 

services. 

The proportion of pregnant women who had received at least one antenatal care 

services steadily increased with the number of years of schooling. Among the illiterate 

women, 80 percent had received any ANC services, whereas cent percent of the women, 

with 10 or more years of schooling, reported to have received such services. 

29 

Figure: 4.1 

Sources of antenatal care 

Doctor 

6.3 

19.8 

67.5 

91.8 

0 20 40 60 80 100 

Percent

Similarly, less percent of women belonging to low standard of living (87 percent) had 

received ANC services, whereas this was 100 percent for women belonging to high 

standard of living. It is observed that utilization of ANC services is comparatively less in 

villages having health facility (78 percent) than in the villages without health facility (84 

percent). More specifically, health facilities where doctors are available are better utilized 

than those having ANM or nurse. 

>>>> 

Table 4.1 (A) ANTENATAL CHECK-UP 

Percentage of women* who received any antenatal check-ups (ANC) during pregnancy by health personnel, according to 

selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Background characteristics 

Any ANC Health personnel 

providing ANC 

Number of 

Women 

Age group 

Less than 20 years 

20-34 years 


Children ever born 

1 

2 

3 

4+ 

Residence 

Rural 

Urban 

Religion 

Hindu 

Muslim 

Other 

Caste# 

SC/ST 

Other 

Education 

Illiterate 

0-9@ years 



Low 

Medium 

High 

Availability of health facility in village 

No 

Yes 

30 

100.0 

91.4 

92.9 

100.0 

86.2 

90.2 

86.7 

82.1 

94.6 

91.9 

85.8 

100.0 

73.8 

95.3 

79.5 

95.7 

100.0 

86.6 

84.3 

99.9 

Only at 

home by 

ANM 

0.0 

6.4 

9.0 

1.2 

3.6 

14.2 

13.7 

24.5 

1.2 

6.4 

0.0 

11.8 

8.4 

5.9 

12.5 

5.2 

1.3 

30.1 

5.5 

0.0 

Doctor 

29.4 

68.8 

75.3 

80.5 

68.4 

46.7 

61.2 

40.1 

75.3 

66.5 

85.8 

88.2 

53.2 

70.3 

45.9 

67.1 

89.2 

25.5 

54.7 

91.1 

ANM 

Nurse/ 

LHV 

84.3 

78.2 

37.6 

1.8 

31.0 

55.8 

15.7 

26.6 

37 

(21) 

All Women 91.8 6.3 67.5 19.8 261 

# The total figure may not add to (N) and percentage may not add upto 100.0 due to multiple responses 


* Women who had their last live/still birth since 1-1-1999 


4.2 ANTENATAL CHECK-UPS AT HEALTH FACILITY 

Table 4.1(B) presents data on ANC coverage and ANC services by different categories of 

health facilities by selected background characteristics of the CMW. Concerning the 

source of ANC service, the data shows that women preferred private source to avail the 

ANC services to Government. About 66 percent of the women had approached private 

health facility, 30 percent went to government health facility including PHC and SC and 

only six percent of them had received the services at their doorstep provided by ANM. A 

very negligible percent of women approached ISM facilities (both government as well as 

private). 

Utilization of ANC services by place of residence shows that private health facilities 

were more preferred by women in urban (75 percent) than rural areas (35 percent). The 

proportion of women who had received ANC services through private health facility 

increased with the increase in education, from 42 percent of illiterate women to as high as 

70.6 

18.1 

8.7 

19.6 

17.1 

30.2 

13.2 

19.7 

19.8 

20.7 

5.2 

0.0 

13.9 

20.9 

23.3 

25.6 

10.3 

34.1 

25.5 

10.6 

(10) 

238 

(13) 

99 

70 

48 

43 

58 

203 

247 

(9) 

(5) 

42 

219 

85 

89 

87 

36 

105 

120

96 percent for those women who had 10 or more years of schooling. A relatively large 

proportion of the other caste group (71 percent) received ANC services from private 

sources as compared to the SC/ST (43 percent) women. The proportion of women who 

received ANC from private sources was directly related to their standard of living. The 

proportion of women who had received ANC services through government facility 

considerably increased with the availability of government health facilities of any type in 

the village. 

Table 4.1(B) ANTENATAL CHECK-UP 

Percentage of women* who received any antenatal check-ups (ANC) during pregnancy by source, according to selected 

background characteristics, Ahmedabad district of Gujarat, RCH, 2002 


Age group 

Less than 20 years 

20-34 years 



1 

2 

3 

4+ 

Residence 

Rural 

Urban 

Religion 

Hindu 

Muslim 

Other 

Caste# 

SC/ST 

Other 

Education 

Illiterate 

0-9@ years 



Low 

Medium 

High 

Availability of health facility in village 

No 

Yes 

Home 

0.0 

6.4 

9.0 

1.2 

3.6 

14.2 

13.7 

24.5 

1.2 

6.4 

0.0 

11.8 

8.4 

5.9 

12.5 

5.2 

1.3 

30.1 

5.5 

0.0 

Govt. 

health 

facility 

73.1 

19.1 

1.8 

24.4 

17.2 

30.6 

5.5 

13.4 

22.3 

21.3 

4.4 

0.0 

19.5 

20.5 

20.1 

39.2 

1.3 

19.4 

26.5 

15.3 

Place of ANC¢ 

Private 

health 

facility 

26.9 

67.8 

73.5 

84.3 

63.4 

43.3 

57.9 

34.6 

75.4 

65.6 

76.2 

88.2 

43.1 

71.0 

41.8 

60.8 

96.2 

20.2 

53.3 

91.5 

PHC$ 

70.6 

6.3 

0.0 

9.8 

0.8 

21.8 

4.0 

8.5 

8.6 

9.0 

0.0 

0.0 

7.0 

8.9 

14.3 

11.4 

0.0 

6.6 

16.3 

2.4 

SC^ 

3.0 

0.8 

0.0 

1.1 

1.1 

0.0 

0.9 

3.9 

0.0 

0.9 

0.0 

0.0 

0.7 

0.9 

2.2 

0.4 

0.0 

4.0 

0.8 

0.0 

ISM facility 

Govt. Private 

0.0 

0.1 

0.0 

0.0 

0.2 

0.0 

0.0 

0.0 

0.1 

0.1 

0.0 

0.0 

0.0 

0.1 

0.0 

0.2 

0.0 

0.4 

0.0 

0.0 

0.0 

0.6 

0.0 

0.5 

1.4 

0.0 

0.0 

0.0 

0.8 

0.6 

0.0 

0.0 

0.0 

0.7 

0.0 

0.3 

1.4 

0.0 

0.0 

1.3 

Number 

of 

Women 

37.6 

1.8 

6.1 

26.1 

24.9 

51.4 

6.1 

12.7 

0.0 

10.6 

0.0 

0.0 

0.0 

0.0 

37 

(21) 

All Women 6.3 20.4 66.4 8.6 0.9 0.1 0.6 261 

¢ Other health facility is not included in the analysis, 

# The total figure may not add to (N) and percentage may not add upto 100.0 due to multiple responses 

$ Primary health center ^ Sub-center 




4.3 ANTENATAL CARE 

Antenatal care refers to care provided to the mother during pregnancy by a doctor or 

health worker at a medical facility or at home. To assess whether the women had received 

all the cares and services during pregnancy, information was collected regarding the 

number of home visits by ANM, timing of the first visit and type of services received. 

Information collected has been presented in the Table 4.2(A), and Table 4.2(B), by 

selected background characteristics of the women. The number of antenatal visits and 

timing of first ANC is important for the health of the mother and outcome of pregnancy. 

For proper monitoring of the pregnancy, the first check-up is mandatory, immediately on 

(10) 

238 

(13) 

99 

70 

48 

43 

58 

203 

247 

(9) 

(5) 

42 

219 

85 

89 

87 

36 

105 

120 

31

confirmation or at least before twenty weeks of gestation. Minimum of three check-ups are 

essential. 

Table 4.2 (A) ANTENATAL CARE 

Percentage of women* by type of antenatal care and by some selected background characteristics, Ahmedabad district of 

Gujarat, RCH, 2002 

Type of antenatal care 

Total Residence Caste# Availability of health 

facility in the village 

Rural Urban SC/ST Other No Yes 

Number of ANC visits 

No visit 

1 

2 

3 

4+ 

Stage of pregnancy at the time of the 

first antenatal check-up 

No antenatal check-up 

First trimester 

Second trimester 

Third trimester 

Services received 

Weight measured 

Height measured 

Blood pressure checked 

Blood tested 

Urine tested 

Abdomen examined 

Internal examination done 

Breast examined 

X-ray 

Sonography/ultrasound 

Amniocentesis 

Advice received 

Diet 

Danger signs 

Delivery care 

Breastfeeding 

New born care 

Family planning 

8.2 

3.6 

10.5 

12.7 

64.9 

8.2 

62.6 

19.4 

9.9 

69.8 

19.9 

70.4 

76.8 

66.4 

78.3 

47.9 

23.0 

9.6 

48.2 

3.3 

88.3 

58.5 

48.9 

26.7 

40.8 

23.4 

76.1 

30.2 

18.8 

15.5 

14.2 

13.4 

91.8 

66.5 

57.4 

29.9 

48.3 

26.3 

64.9 

53.9 

9.1 

6.0 

5.2 

1.0 

92.9 

59.4 

56.6 

30.7 

47.7 

27.8 

84.4 

24.8 

9.4 

12.7 

15.7 

6.2 

61.6 

39.7 

35.1 

20.2 

11.8 

25.9 

Women who received IFA tablets 86.7 73.9 90.3 73.0 89.3 78.2 66.3 

Daily dose (consumed) 

One IFA tablet 

Two or more IFA tablets 

Women who consumed IFA tablets 

Less than 100 IFA tablets 

100+ IFA tablets 

Women who received TT 

No TT 

1 

2+ 

63.2 

20.4 

53.3 

29.1 

10.6 

5.7 

83.7 

Full ANC £ 28.3 11.8 33.0 16.6 30.6 9.3 16.1 

Number of women 261 58 203 42 219 37 (21) 

32 

17.9 

14.1 

27.4 

17.5 

23.2 

17.9 

37.2 

42.4 

2.5 

27.4 

3.2 

26.6 

42.4 

25.9 

51.1 

24.9 

6.3 

3.9 

17.7 

4.1 

44.0 

19.9 

46.2 

14.0 

27.8 

4.5 

67.7 

5.4 

0.9 

5.8 

11.4 

76.7 

5.4 

69.8 

12.9 

11.9 

81.8 

24.6 

82.8 

86.5 

77.9 

86.0 

54.5 

27.8 

11.2 

56.9 

3.1 

68.7 

20.5 

55.3 

33.3 

5.7 

6.1 

88.2 

26.2 

0.0 

7.7 

35.0 

31.1 

26.2 

27.2 

31.9 

14.7 

50.2 

3.4 

52.7 

58.0 

48.5 

63.3 

17.8 

8.6 

0.5 

8.2 

0.0 

56.0 

11.7 

51.1 

16.6 

29.2 

0.8 

70.1 

4.7 

4.3 

11.1 

8.4 

71.5 

4.7 

69.4 

17.0 

8.9 

73.6 

23.1 

73.8 

80.4 

69.9 

81.2 

53.8 

25.8 

11.3 

56.0 

3.9 

64.7 

22.0 

53.7 

31.5 

7.0 

6.7 

86.3 

# The total figure may not add to (N) and percentage may not add upto 100.0 due to don’t know and missing cases 

£ 

At least 3 ANC visits and 100+ IFA tablets and at least one TT injection 

* Women who had their last live/still birth since 1.1.1999 


About 78 percent of the women had undergone all the three check-ups in Ahmedabad 

district of Gujarat during their pregnancy period. This was high among urban women (88 

percent) than their rural counterparts (41 percent). Further, education and standard of 

living had positive impact on number of women having received or having undergone all 

the three check-ups. Timing of the first check-up shows that, 63 percent of the women, 

had their first check-up done during their first trimester. Relatively higher proportion of 

women in the urban areas (70 percent) as compared to the rural areas (37 percent) reported 

first trimester check-up. Further, relatively higher proportion of other caste (higher caste) 

groups compared to SC/ST groups had their first check-up done during their first trimester 

of pregnancy. Again higher percent of women educated with high standard of living 

respected timely check-up during the first trimester. Interestingly, this practice is more 

common in villages with health facility as compared to those villages, which did not have 

any health facility. 

15.7 

15.5 

38.0 

18.3 

12.5 

15.7 

25.0 

56.2 

3.1 

15.9 

3.2 

22.0 

40.8 

21.8 

43.2 

12.2 

3.2 

6.1 

9.3 

3.2 

53.2 

9.3 

50.0 

9.3 

31.1 

6.2 

62.7 

21.8 

11.6 

9.0 

16.0 

41.7 

21.8 

58.3 

18.5 

1.5 

47.4 

3.2 

34.7 

45.3 

33.0 

64.9 

47.0 

11.8 

0.0 

32.2 

5.8 

28.1 

38.3 

39.8 

22.2 

22.1 

1.5 

76.4

About the routine check-up during pregnancy, around 70 percent of the women had 

their weight monitored and about 70 percent of the women also had their blood pressure 

measured. About 78 percent women had abdominal check-ups and 77 percent had their 

blood tested. Women with better education and living standard were more conscious about 

such routine check-up. 

A pregnant women needs six times more iron than a non-pregnant women and about 

87 percent of the pregnant women were given iron and folic acid tablets and among them 

84 percent had consumed it daily. Tetanus toxoid injection protects the mother and her 

baby against tetanus. About 84 percent women had received two doses of TT in this 

district. 

Overall only 28 percent of the pregnant women had received full ANC care that is one 

dose of TT, 100 IFA tablet and at least 3 ANC visit during their pregnancy period. This 

indicates that for better coverage, health workers have to educate women on the 

importance of ANC and provide them with the service. 

Table 4.2 (B) ANTENATAL CARE 

Percentage of women* by type of antenatal care and by some selected background characteristics, Ahmedabad district of 


Type of antenatal care 

Education Standard of living index Children Ever Born 

Number of ANC visits 

No visit 

1 

2 

3 

4+ 

Stage of pregnancy at the time of the 

first antenatal check-up 

No antenatal check-up 

First trimester 

Second trimester 

Third trimester 

Services received 

Weight measured 

Height measured 

Blood pressure checked 

Blood tested 

Urine tested 

Abdomen examined 

Internal examination done 

Breast examined 

X-ray 

Sonography/ultrasound 

Amniocentesis 

Advice received 

Diet 

Danger sign 

Delivery care 

Breastfeeding 

New born care 


Illiterate 

20.5 

8.1 

16.7 

14.9 

39.8 

20.5 

35.4 

21.8 

22.3 

43.4 

4.4 

43.3 

59.2 

39.1 

55.0 

15.5 

6.8 

7.7 

10.8 

3.6 

0-9@ 

years 

4.3 

2.6 

8.5 

16.3 

68.2 

4.3 

65.9 

24.0 

5.8 

68.3 

21.4 

70.4 

74.9 

66.6 

80.8 

51.6 

19.4 

11.6 

54.3 

0.7 

10 & 

above 

0.0 

0.3 

6.6 

7.0 

86.1 

0.0 

85.8 

12.4 

1.8 

97.2 

33.5 

96.9 

96.0 

93.1 

98.7 

76.0 

42.7 

9.3 

78.7 

5.7 

Low Medium High 1 2 3+ 

76.7 

52.1 

16.5 

12.8 

12.2 

10.1 

89.7 

57.2 

58.9 

20.3 

45.2 

32.1 

98.4 

66.1 

70.2 

46.8 

64.2 

27.6 

79.5 

35.2 

25.0 

19.2 

20.5 

11.7 

83.9 

64.0 

30.9 

10.0 

29.3 

20.1 

94.8 

60.6 

71.5 

43.4 

56.8 

29.8 

98.7 

56.5 

73.1 

39.1 

68.2 

25.6 

86.0 

61.0 

35.8 

19.1 

30.5 

23.5 

78.9 

59.6 

33.3 

19.4 

19.7 

21.3 

Women who received IFA tablets 76.7 85.6 97.6 82.2 75.3 97.9 91.8 81.8 86.0 

Daily dose (consumed) 

One IFA tablet 

Two IFA tablets or more 

Women who consumed IFA tablets 

Less than 100 IFA tablets 

100+ IFA tablets 

Women who received TT 

No TT 

58.0 

13.1 

49.8 

18.9 

23.4 

16.7 

59.9 

55.5 

27.0 

57.5 

25.0 

8.4 

0.6 

91.0 

1 

2+ 

Full ANC £ 16.9 25.0 43.0 21.7 16.7 40.4 38.9 28.0 17.5 

Number of women 85 89 87 36 105 120 99 70 91 

76.3 

20.7 

52.5 

43.2 

0.3 

0.3 

99.5 

13.4 

13.0 

34.3 

11.4 

27.8 

13.4 

35.5 

46.6 

4.5 

28.5 

2.7 

26.9 

46.4 

21.4 

42.5 

14.5 

5.9 

0.0 

7.8 

0.0 

49.0 

23.3 

44.4 

25.3 

19.6 

7.9 

72.5 

15.7 

4.4 

6.6 

13.9 

59.5 

15.7 

50.8 

16.9 

16.7 

55.6 

10.5 

58.2 

74.7 

63.1 

69.4 

34.7 

7.8 

14.7 

31.3 

2.9 

59.5 

14.4 

56.1 

16.7 

16.8 

10.4 

72.8 

0.1 

0.2 

7.0 

12.1 

80.6 

0.1 

80.9 

13.6 

5.5 

94.4 

33.1 

93.9 

87.6 

82.7 

96.7 

69.4 

41.4 

8.0 

75.0 

4.7 

70.7 

24.6 

53.5 

40.9 

2.5 

1.1 

96.4 

0.0 

1.5 

1.4 

5.2 

92.0 

0.0 

88.6 

11.0 

0.4 

80.3 

28.4 

83.2 

91.2 

89.7 

98.7 

82.2 

38.2 

8.1 

79.8 

4.1 

65.5 

21.7 

46.7 

40.2 

5.0 

0.2 

94.8 

13.8 

3.2 

12.1 

9.2 

61.7 

13.8 

51.0 

22.2 

13.0 

76.9 

16.6 

78.7 

78.1 

70.4 

62.5 

33.6 

11.7 

22.3 

33.3 

3.9 

60.5 

18.9 

48.5 

28.4 

17.3 

1.5 

81.2 

11.5 

6.4 

19.4 

23.8 

38.9 

11.5 

44.1 

26.7 

17.7 

54.0 

13.4 

51.1 

61.1 

39.2 

69.5 

22.5 

15.6 

1.6 

26.3 

2.0 

63.8 

20.3 

64.9 

18.0 

10.3 

15.0 

74.6 

33


£ 

At least 3 ANC visits and 100+ IFA tablets and at least one TT injection 


The proportion of women who received advice for diet, danger sign, delivery care, 

breastfeeding, new born care and family planning were found increasing with the increase 

in education level and standard of living. 

4.4 PREGNANCY COMPLICATIONS AND TREATMENT 

Complications during pregnancy may adversely affect both women’s health and the 

outcome of pregnancy. Early detection of pregnancy complications and their management 

are important components of the Safe Motherhood Programme. In the survey, the women 

were asked if they had faced such problems, and their treatment seeking behavior. The 

data analyzed is presented in Table 4.3. 

Table 4.3 PREGNANCY COMPLICATIONS 

Percentage of women* by pregnancy complication and type of treatment sought by selected background characteristics, 


Pregnancy complication and type of 

treatment 

Total 

Residence Availability of health 


ANC 

Rural Urban No Yes No Yes 

Women who reported at least one symptom 

of pregnancy complication 26.6 20.8 28.3 15.6 29.8 8.1 28.3 

Symptoms 

Swelling of hands and feet 

Paleness 

Visual disturbances 

Excessive bleeding 

Convulsion 

Abnormal position of foetus 

Other 

18.0 

6.4 

6.4 

0.3 

0.5 

1.1 

7.9 

8.4 

10.0 

14.4 

0.0 

2.1 

1.6 

10.2 

Women who sought treatment for pregnancy 

complication 57.8 40.5 61.4 0.0 77.2 70.5 57.5 

Source of treatment** 

Government health facility 

PHC 

SC 

Private health facility 

ISM facility 

11.4 

1.6 

0.4 

87.7 

1.3 

31.5 

6.4 

0.0 

68.5 

0.0 

Number of women 261 58 203 37 (21) (21) 240 


** Total percent may add to more than 100.0 due to multiple responses 


The table reveals that, 27 percent of the women had suffered from at least one 

complication during pregnancy. Relatively higher percent of women in the urban area (28 

percent) reported at least one symptom of pregnancy complication as compared to the 

women in the rural area (21 percent). Further, a higher proportion of women in the rural 

area reported any symptom of pregnancy complication especially in those villages with 

health facilities (30 percent) compared to those villages, which had no health facility (16 

percent). It was observed that among women who availed ANC services the proportion of 

women having any symptoms of pregnancy complications was higher (28 percent) as 

compared to those who did not utilize the ANC services (8 percent). This implies that 

women who seek ANC are probably more aware about pregnancy complications and as a 

result could recognize and report the complication they had experienced. 

20.7 

5.4 

4.2 

0.4 

0.0 

1.0 

7.3 

8.6 

1.0 

0.5 

90.3 

1.5 

0.0 

3.1 

12.4 

0.0 

0.0 

0.0 

6.3 

0.0 

0.0 

0.0 

0.0 

0.0 

23.0 

22.1 

17.7 

0.0 

5.8 

4.4 

16.9 

31.5 

6.4 

0.0 

68.5 

0.0 

6.7 

8.1 

7.2 

0.0 

5.7 

0.0 

0.0 

100.0 

0.0 

0.0 

0.0 

0.0 

19.0 

6.2 

6.4 

0.4 

0.0 

1.2 

8.6 

8.6 

1.7 

0.4 

90.4 

1.4 

34

The availability of health 

services also has a positive impact 

on the utilization of ANC service, 

which in turn may have resulted 

in increased level of awareness 

about such complications. The 

most frequently reported 

complications were swelling on 

hands and feet (18 percent), 

followed by visual disturbances (6 

percent) and paleness (6 percent). 

Very few reported other problems 

like abnormal position, 

convulsion, bleeding etc. (Figure 

4.2). Among those who had any 

complications, 58 percent of them 

had sought treatment mainly from 

the private health facility (88 percent). Relatively higher proportion of urban women 

sought treatment (61 percent) for pregnancy complications than the rural counterpart (41 

percent). 

4.5 PLACE OF DELIVERY 

Complications 

Figure: 4.2 

Percentage of women with pregnancy 

complications 

Swelling of hands and feet 

Abnormal position of foetus 


Paleness 

Visual disturbances 


Convulsion 

Tables 4.4(A) and 4.4(B) present the delivery characteristics by selected background 

characteristics of women. One of the thrust areas of the maternal and child health services 

is the encouragement for the safe delivery under proper hygienic conditions and under the 

supervision of trained health personnel to ensure better health of the mother and child. 

Other 

Figure: 4.3 

Place of delivery and assistance during delivery 

0.3 

0.5 

1.1 

6.4 

6.4 

7.9 

18.0 

0 10 20 30 40 50 

Percent 

Percent disribution of women by place of 

delivery 

Percent disribution of home deliveries 

by type of assistance during delivery 

Private 

health 

institutions 

59.4% 

Home 

28.3% 

Relative/ 

friends 

6.4% 

None 

1.1% Doctor 

10.9% 

ANM/ 

Nurse 

18.8% 

Government 

health 

institutions 

12.3% 

Untrained 

dai 

46.9% 

Trained dai 

15.8% 


Most of the deliveries in the district were normal deliveries (79 percent). The 

proportion of caesarian deliveries is substantially high in urban areas (22 percent) than 

rural areas (5 percent). Of the total deliveries conducted, 28 percent of deliveries were 

reported to be home deliveries while majority of deliveries (72 percent) took place in the 

institutions (Figure 4.3). 

35

Majority (85 percent) of the total deliveries were safe delivery. Safe deliveries were 

more prominent in urban areas than rural areas. Education, standard of living and children 

ever born had positive impact on the percentage of women who had safe deliveries that is 

higher percentage of women having 10 and above years of schooling belonging to higher 

standard of living and having one child had safe delivery. Most of the institutional 

deliveries (59 percent) had taken place in the private institutions. About seven percent of 

deliveries in the rural areas and 14 percent in the urban areas took place in government 

health facility. Home deliveries were reported to be high in rural areas of Ahmedabad 

district (62 percent) than in urban areas (19 percent). As usual home deliveries were 

observed more amongst women with low standard of living (70 percent) than those 

belonging to high standard of living (10 percent). 

Table 4.4 (A) DELIVERY CHARACTERISTICS 

Percentage of women* by place of delivery, assistance during delivery and delivery complications by selected background 

characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Place of delivery, assistance received and 

complications 

Percentage distribution of women who had 

Normal delivery 

Caesarean delivery 

Assisted delivery 

Total 

78.5 

18.4 

3.1 

Residence Caste# Availability of 

health facility in 

the village 


94.7 

5.3 

0.0 

73.9 

22.2 

4.0 

79.0 

21.0 

0.0 

78.4 

17.9 

3.7 

93.9 

6.1 

0.0 

96.2 

3.8 

0.0 

Percentage distribution of women by place of 

delivery 

Health institution 

Government 

Private 

Home 

71.7 

12.3 

59.4 

28.3 

37.8 

6.5 

31.2 

62.2 

81.4 

14.0 

67.4 

18.6 

69.5 

9.5 

60.0 

30.5 

72.2 

12.9 

59.3 

27.8 

37.5 

6.1 

31.4 

62.5 

38.2 

7.3 

30.9 

61.8 

Percentage of home deliveries by type of 

assistance during delivery $ 

Doctor 

ANM/nurse 

Trained dai 

Untrained dai 

Relatives/friends 

None 

10.9 

18.8 

15.8 

46.9 

6.4 

1.1 

14.5 

0.0 

8.4 

66.5 

8.3 

2.3 

7.6 

36.6 

22.8 

28.5 

4.6 

0.0 

40.8 

1.4 

7.2 

50.6 

0.0 

0.0 

4.6 

22.5 

17.6 

46.2 

7.8 

1.3 

19.5 

0.0 

5.1 

65.3 

10.1 

0.0 

5.7 

0.0 

14.3 

68.6 

5.2 

6.2 

Percentage of women who had safe delivery £ 84.6 52.0 93.8 84.6 84.6 52.9 50.5 

Percentage of women who had delivery 

complications 

Premature labour 


Prolonged labour (12+ hours) 

Obstructed labour 

Breech presentation 

Other 

51.7 

17.3 

3.2 

12.9 

29.1 

10.5 

8.6 

59.8 

22.9 

9.9 

9.7 

39.5 

7.6 

4.6 

49.3 

15.7 

1.3 

13.8 

26.1 

11.3 

9.7 

46.2 

12.7 

1.6 

7.4 

18.4 

8.7 

15.0 

52.7 

18.2 

3.5 

14.0 

31.2 

10.8 

7.3 

49.7 

9.4 

6.4 

6.1 

34.3 

6.1 

3.2 

77.4 

46.4 

16.0 

15.9 

48.6 

10.1 

7.1 

Number of women 261 58 203 42 219 37 (21) 

# The total figure may not add to (N) due to don’t know and missing cases $ Based on home delivery 

£ Either institution delivery or home delivery assisted by Doctor/ Nurse/ANM/Trained dai 



Further, 53 percent of home deliveries were attended by untrained person. This 

practice remained the same in all the caste groups. The trained dai and trained personnel 

(doctor, ANM, nurse, LHV etc.) conducted only 16 percent and 30 percent home 

deliveries respectively (Figure 4.3). There is a need to increase the awareness, especially 

among the rural women to seek assistance from trained personnel for conducting the 

deliveries. 

36

The proportion of 

institutional deliveries are 

markedly higher (81 percent) in 

the urban areas as compared to the 

rural areas (38 percent). The 

proportion of institutional 

deliveries increased with the 

increase in standard of living. 

About 65 percent of the illiterate 

women, as against 92 percent of 

those with at least 10 years of 

education had institutional 

deliveries (Figure 4.4). 

Nearly 52 percent of the 

women had suffered from delivery 

10 + years 

STANDARD OF LIVING INDEX 

92.3 

complications and such 

Low 29.7 

proportions of women were more 

Medium 

65.0 

in rural areas (60 percent) 

High 

90.1 

compared to the urban areas (49 

percent). Of those who had 

0 20 40 60 80 100 


Percent 

delivery complications, 29 percent 

had suffered from obstructed labour and around 17 percent from premature labour, 13 

percent from prolonged labour and 11 percent from breech presentation. 

Table 4.4 (B) DELIVERY CHARACTERISTICS 

Percentage of women* by place of delivery, assistance during delivery and delivery complications by selected background 


Place of delivery, assistance 

received and complications 

Education 

Standard of living 

index 


Percentage distribution of women 

who had 

Normal delivery 

Caesarean delivery 

Assisted delivery 

Percentage distribution of women by 

place of delivery 

Health institution 

Government 

Illiterate 

89.7 

10.3 

0.0 

64.7 

6.0 

58.7 

35.3 

0-9@ 

years 

97.5 

1.8 

0.7 

58.4 

23.5 

34.9 

41.6 

Figure: 4.4 

Institutional deliveries by some selected 

background characteristics of women 

RESIDENCE 

10 & 

above 

48.0 

43.4 

8.6 

92.3 

7.1 

85.2 

7.7 

CASTE 

EDUCATION 

Low Medium High 1 2 3+ 

Private 

Home 

Percentage distribution of home 

deliveries by type of assistance 

during delivery $ 

Doctor 

3.9 18.7 0.0 12.2 7.6 18.7 19.2 13.2 3.1 

ANM/nurse 

0.6 26.2 59.5 0.6 20.1 52.8 27.7 24.5 8.8 

Trained dai 

9.2 22.3 9.3 6.6 25.2 6.2 35.9 13.8 0.4 

Untrained dai 

72.9 29.4 27.5 65.4 43.4 19.3 17.3 42.4 76.6 


10.7 3.4 3.8 11.9 3.8 3.1 0.0 6.1 8.4 

None 

2.7 0.0 0.0 3.2 0.0 0.0 0.0 0.0 2.7 

Percentage of women who had safe 

delivery £ 69.5 86.4 97.6 43.4 83.5 97.8 95.5 88.3 71.1 

Percentage of women who had 

delivery complications** 

Premature labour 


Prolonged labour (12+ hours) 

Obstructed labour 

Breech presentation 

Other 

39.9 

16.2 

4.4 

5.1 

24.0 

5.1 

9.2 

43.9 

7.4 

3.2 

9.0 

35.2 

1.0 

1.5 

71.1 

28.6 

2.0 

24.6 

27.8 

25.4 

15.3 

54.2 

21.6 

16.0 

7.3 

45.3 

6.0 

4.3 

27.2 

7.6 

0.4 

5.5 

12.8 

2.7 

6.3 

72.2 

24.5 

1.8 

21.0 

38.5 

18.5 

11.9 

65.6 

21.7 

3.4 

22.2 

39.4 

13.5 

13.0 

39.8 

13.8 

1.3 

9.4 

20.6 

1.2 

11.1 

46.4 

15.5 

4.4 

5.8 

24.8 

14.3 

2.0 

Number of women 85 89 87 36 105 120 99 70 91 

100.0 

0.0 

0.0 

29.7 

6.3 

23.5 

70.3 

Rural 

Urban 

SC/ST 

Others 

Illiterate 

0-9 years 

91.3 

8.2 

0.6 

65.0 

10.7 

54.3 

35.0 

61.0 

32.8 

6.2 

90.1 

15.5 

74.6 

9.9 

37.8 

58.4 

66.1 

25.7 

8.2 

74.0 

16.5 

57.5 

26.0 

69.5 

64.7 

72.5 

81.4 

85.5 

14.5 

0.0 

75.9 

15.8 

60.1 

24.1 

86.1 

13.9 

0.0 

67.1 

5.3 

61.8 

32.9 

37

* Women who had their last live/still birth since 1.1.1999 ** Multiple responses 

£ Either institution delivery or home delivery assisted by Doctor/ Nurse/ANM/Trained dai 

$ Based on home deliveries @ Literate women with no years of schooling are also included 

4.6 POSTNATAL CARE 

Table 4.5 presents women by post-delivery complications and type of treatment of these 

complications by background characteristics. About 10 percent women in both the rural 

and the urban areas had post-delivery follow up visit within two weeks. The percentage of 

women who had at least one symptom of post-delivery complication was reported to be 

15. Women reporting post-delivery complication were high in rural areas (31 percent), 

belonging to low standard of living (27 percent) and villages where there was health 

facility (43 percent). 

Lower abdominal pain, severe headache, and high fever were the major complications 

reported by women who had post-delivery complications. It is observed that 56 percent of 

the women who had post delivery complications had sought treatment for their problems 

mainly from private facility (94 percent). Treatment seeking behaviour was better among 

women living in urban areas, belonging to other caste community with 10 year and above 

education, belonging to higher standard of living and villages with health facilities. 

Table 4.5 POSTNATAL CARE 

Percentage of women* by post-delivery complication and sought treatment by type of treatment by background 


Complication and type of 

treatment 

Women who had postdelivery 

follow up visit 

(within two weeks) 

Women who reported at 

least one symptom of postdelivery 

complication 

Women who had postdelivery 

complication by 

type of complication 

High fever 

Lower abdominal pain 

Foul smelling vaginal 

discharge 


Convulsion 

Severe headache 

Other 

Women who sought 

treatment for post- delivery 

complication 

Women who sought 

treatment by source of 

treatment ** 

Government health 

facility 

PHC 

SC 


ISM facility 

Total 

Residence Caste# Education Standard of living 

index 

Rural Urban SC/ST Other Illiterate 0-9@ 

years 

38 

10 Low Medium High 

years 

& 

above 

Availability 

of health 

facility in 

the village 

No Yes 

9.6 9.8 9.5 2.3 11.0 8.6 17.9 2.0 10.8 17.8 2.1 3.1 21.4 

14.8 31.4 10.1 12.8 15.2 12.3 24.3 7.5 26.7 8.3 17.0 24.8 42.9 

5.9 

5.2 

2.1 

1.4 

0.6 

6.3 

4.5 

15.8 

15.3 

6.8 

3.7 

2.1 

20.7 

1.4 

3.0 

2.3 

0.7 

0.7 

0.2 

2.2 

5.3 

6.2 

3.3 

3.5 

0.4 

0.0 

10.5 

0.0 

5.8 

5.5 

1.8 

1.5 

0.8 

5.4 

5.3 

7.2 

7.8 

1.8 

1.3 

1.4 

9.2 

0.0 

7.3 

3.9 

3.2 

1.4 

0.0 

6.4 

11.5 

3.1 

3.9 

1.1 

14.4 

0.5 

3.3 

1.6 

10.0 

11.0 

7.6 

6.0 

0.0 

16.7 

0.0 

7.3 

6.4 

1.2 

0.2 

1.2 

4.2 

0.8 

3.4 

2.3 

1.2 

1.0 

0.3 

4.9 

9.0 

9.2 

9.3 

3.2 

0.0 

0.0 

12.3 

0.0 

27.4 

25.6 

13.1 

10.1 

5.8 

35.3 

3.8 

56.3 24.5 84.2 26.0 61.2 39.2 55.6 85.7 19.3 44.3 78.6 0.0 49.1 

4.2 

1.4 

0.0 

93.7 

2.1 

7.0 

7.0 

0.0 

93.0 

0.0 

3.5 

0.0 

0.0 

93.9 

2.6 

29.8 

0.0 

0.0 

70.2 

0.0 

2.4 

1.5 

0.0 

95.4 

2.2 

11.4 

7.5 

0.0 

77.7 

10.9 

3.7 

0.0 

0.0 

96.3 

0.0 

0.0 

0.0 

0.0 

100.0 

0.0 

Number of women 261 58 203 42 219 85 89 87 36 105 120 37 (21) 

@ Literate women with no year of schooling are also included 

* Women who had their last live/ still birth since 1-1-1999 ** Total percent may 

add more than 100.0 due to multiple responses 

# Total figure may not add to (N) due to don’t know and missing cases 


16.8 

16.8 

0.0 

83.2 

0.0 

4.1 

0.0 

0.0 

95.9 

0.0 

2.7 

0.0 

0.0 

94.5 

2.8 

0.0 

0.0 

0.0 

0.0 

0.0 

7.0 

7.0 

0.0 

93.0 

0.0

CHAPTER - 5 

CHILD CARE AND IMMUNIZATION 

The vaccination of children against six major diseases has been an important part of the 

child health care programme in India. The National Immunization Porgramme has been 

implemented as per the National Health Policy. The Expanded Programme on 

Immunization (EPI) was started by the Government of India in 1978. The main objective 

of this programme was to reduce the morbidity, mortality and disabilities. The Universal 

Immunization Programme (UIP) was also introduced in 1985-86. The standard 

immunization schedule developed for the child immunization programme specifics the age 

at which vaccine is to be administered, the number of doses to be given. In this chapter the 

information on immunization status of the children, breastfeeding practices, the awareness 

and practice of women during diarrhoea and pneumonia among children have been 

discussed and presented below. 

5.1 BREASTFEEDING AND WEANING PRACTICES 

As recommended by WHO, 

breastfeeding should be initiated 

immediately after birth and should be 

continued exclusively up to four 

months. The WHO also suggests that 

the mother’s first milk (yellowish 

milk, known as colostrum) should be 

given to the baby because it provides 

protection against certain infections. 

In the later months, breast milk it has 

to be supplemented with other semisolid 

and solid foods. Table 5.1 

presents the breastfeeding practices 

among the CMW of Ahmedabad 

district. 

Same day 

after two 

hours of 

birth 

27.5% 


Figure: 5.1 

Initiation of breastfeeding 

1-3 days 

39.1% 

After 3 days 

10.3% 

Never 

0.2% 

Immediately 

/ within two 

hours of 

birth 

22.9% 

As Table 5.1 shows, about 23 percent of the mothers breastfed their children 

immediately/within two hours of birth. About five percent of the children were breastfed 

exclusively for stipulated period of 4 months. Here it needs to be mentioned that, 

exclusive breastfeeding includes breastfeeding the child without giving any thing 

including water. Practice of colostrum feeding shows that around three-fifths of the 

women squeezed out the first milk. This practice was found to be relatively high among 

the women residing in the rural area (72 percent), belonging to scheduled caste 

(SC)/scheduled tribe (ST) community (68 percent) and belonging to low standard of living 

2

(68 percent). This indicates urgent need to educate women about the importance of 

colostrums milk for the health of the child. 

3

Table 5.1 BREASTFEEDING 

Percentage of women* by timing of first breastfeeding to child by selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Breastfeeding 

Total Residence Caste# Education Standard of Living Index 


years 

10 years & 

above 

Low Medium High 

Percent distribution of women who breastfed the child by 

timing of first breastfeeding 

Immediately/Within two hours of birth 

Same day after two hours of birth 

1-3 days 

After 3 days 

Never 

22.9 

27.5 

39.1 

10.3 

0.2 

19.2 

12.7 

55.8 

11.6 

0.7 

23.8 

31.0 

35.0 

10.0 

0.1 

Percentage of women who squeezed out the first breast milk 58.9 71.5 55.8 67.7 57.2 50.3 73.3 53.5 67.5 62.8 53.4 

16.9 

35.7 

38.4 

9.0 

0.0 

24.1 

25.8 

39.3 

10.6 

0.3 

29.1 

21.4 

41.4 

7.6 

0.4 

29.9 

32.4 

36.9 

0.6 

0.3 

10.7 

28.4 

39.1 

21.8 

0.0 

12.2 

13.7 

68.8 

4.2 

1.2 

23.8 

34.4 

36.3 

5.2 

0.2 

25.0 

25.2 

33.8 

16.1 

0.0 

Percentage of women whose children were on exclusive breast 

milk 

For four month ** 

For six months *** 

5.0 

0.5 

3.0 

0.7 

5.5 

0.4 

1.3 

1.3 

5.8 

0.3 

14.1 

1.2 

0.0 

0.0 

1.3 

0.3 

4.8 

1.2 

9.7 

0.2 

1.2 

0.5 

Number of women 257 51 206 41 216 84 83 90 32 102 123 

* With youngest child born after 1-1-1999 

** With youngest child born after 1.1.1999 and 4 months or older at the time of survey and breastfed for more than 4 months 

*** With youngest child born after 1.1.1999 and 6 months or older at the time of survey and breastfed for more than 6 months 

# The total figure may not add to (N) due to don’t know and missing cases 


4

5.2 IMMUNIZATION OF THE CHILDREN 

Immunization of the children is a very important component of the Expanded Programme 

on Immunization (EPI) started by the Govt. of India in 1978. To understand the coverage 

of immunization, data of all those children who were born since 1 st January 1999 and were 

age 12 months at the time of survey was collected. The immunization status of the 

children is presented in Tables 5.2(A) and 5.2(B). 

Table 5.2 (A) VACCINATION OF CHILDREN 

Percentage of children* who received vaccination, Hepatitis B, Vitamin A, IFA tablets/liquid by some selected background 


Type of vaccination 

Total Residence Caste# Availability of health 



Polio zero 61.0 38.9 65.7 63.1 60.6 31.5 49.6 

BCG 93.3 87.2 94.6 97.0 92.6 91.8 80.7 

DPT injection 

No DPT 

1 

2 

3 

Don’t remember 

Polio doses 

No Polio 

1 

2 

3 

5.5 

94.3 

85.8 

74.4 

0.3 

3.5 

92.6 

87.3 

72.4 

13.0 

87.0 

80.8 

73.0 

0.0 

6.5 

92.8 

89.1 

78.3 

3.9 

95.8 

86.9 

74.7 

0.4 

2.9 

92.6 

87.0 

71.2 

5.7 

94.3 

90.8 

72.3 

0.0 

16.2 

82.4 

81.6 

76.2 

5.4 

94.2 

84.9 

74.8 

0.3 

1.1 

98.9 

82.8 

76.1 

8.2 

91.8 

87.7 

75.4 

0.0 

8.2 

91.8 

87.7 

71.5 

Measles 76.7 66.2 76.2 48.9 82.0 83.6 72.5 

Full vaccination £ 64.2 66.2 63.7 45.1 67.8 71.5 58.7 

No vaccination at all 1.3 6.5 0.2 2.6 1.0 8.2 4.0 

Hepatitis B 19.3 8.6 21.5 0.0 23.1 11.9 4.0 

Vitamin A 

None 

1 

2 

3 


45.2 

33.2 

8.3 

0.3 

1.3 

41.4 

45.4 

15.5 

0.0 

4.7 

Iron Folic Acid Tablets/ Liquid 20.1 17.8 20.6 1.8 23.7 11.9 26.1 

Number of children 281 49 232 45 234 29 (20) 

* Includes only last and last but one living child born since 1.1.1999 and 12 months or older at the time of survey 


£ BCG, three doses of DPT, three doses of Polio (excluding Polio zero) and Measles 

46.0 

30.6 

6.8 

0.4 

0.5 


Immediately after birth, 

the baby is given one drop 

of oral polio, which is called 

zero polio. Out of 281 

children, around 61 percent 

had received Polio – zero. 

This proportion was quite 

high in the urban areas (66 

percent) compared to rural 

areas (39 percent). 

Percentage of children 

protected against all the six 

killer diseases shows that 93 

percent were given BCG, 74 

Percent 

100 

80 

60 

40 

20 

0 

Boy 

57.0 

Girl 

64.6 

Full 

vaccination 


Boy 

81.7 

18.1 

21.8 

3.8 

0.0 

0.0 

50.6 

35.0 

8.7 

0.4 

1.5 

Figure: 5.2 

Vaccination of children 

Girl 

71.5 

Measles 

Girl 

Boy 79.2 

65.9 

3 Doses of 

Polio 

Girl 

Boy 

77.7 

71.2 

3 Doses of 

DPT 

28.7 

51.4 

11.8 

0.0 

8.1 

Boy 

90.2 

BCG 

Girl 

96.5 

19.9 

80.1 

71.0 

69.4 

0.0 

4.0 

94.1 

91.1 

88.0 

59.5 

36.8 

20.8 

0.0 

0.0 

5

percent were given all the three doses of DPT, 72 percent received all the three drops of 

polio and 77 percent were protected by measles vaccine (see Figure 5.2). 

Overall, 64 percent of the children were fully immunized. Full immunization status 

was below 50 percent among SC/ ST group (45 percent) and illiterate mothers (49 percent) 

but the economic status of the family did not influence much. Slightly more than threefifths 

(64 percent) of the children belonging to the economically poor family were fully 

immunized. Availability of health facilities in villages did not have any significant impact 

on the immunization status of the children in the district as 72 percent of the children were 

fully immunized in the villages without health facility compared to those belonging to 

health facility (59 percent). To reduce the risk of night blindness, babies are supposed to 

get required doses of Vitamin A supplement, more than half (55 percent) of the children, 

slightly higher percent of children in rural than urban areas, received at least one does of 

Vitamin A. Higher percentage of children with mothers having 10 and above years of 

schooling belonging to high standard of living had received at least one dose of Vitamin 

A. Again more male than female had received Vitamin A solution. Further, children are 

also given IFA tablets for iron supplements under the national programme. The table 

reveals that 20 percent of the children had received IFA tablets. 

Table 5.2 (B) VACCINATION OF CHILDREN 

Percentage of children* who received vaccinations, Hepatitis B, Vitamin A, IFA tablets/liquid by some selected background 



Mother’s Education Standard of living index Sex of the child 

Illiterate 0-9@ 

years 

10 years 

& above 

Low Medium High Male Female 

Polio zero 38.2 64.4 81.4 21.2 56.0 76.5 45.0 77.7 

BCG 82.4 97.9 99.9 88.8 89.3 98.5 90.2 96.5 

DPT injection 

No DPT 

1 

2 

3 


Polio doses 

No Polio 

1 

2 

3 

7.0 

92.4 

77.8 

67.0 

0.6 

8.7 

90.0 

76.7 

70.5 

9.0 

90.7 

80.9 

70.4 

0.2 

1.6 

98.4 

96.4 

71.1 

0.1 

99.9 

99.3 

86.2 

0.0 

0.1 

89.2 

89.0 

75.9 

6 

12.5 

87.5 

84.6 

75.6 

0.0 

2.5 

94.4 

93.4 

79.9 

8.3 

91.2 

80.8 

67.4 

0.5 

7.2 

92.6 

83.3 

69.0 

0.7 

99.1 

91.2 

81.1 

0.2 

0.0 

92.2 

89.9 

74.0 

2.2 

97.6 

82.3 

71.2 

0.2 

0.8 

92.0 

82.9 

65.9 

Measles 56.4 79.2 95.3 77.0 60.4 93.2 81.7 71.5 

Full vaccination £ 48.9 62.2 71.5 64.3 51.4 69.3 57.0 64.6 

No vaccination at all 2.1 1.6 0.1 2.5 2.2 0.0 0.7 1.9 

Hepatitis B 0.5 6.1 52.7 3.7 3.8 39.0 24.0 14.3 

Vitamin A 

None 

1 

2 

3 


40.7 

22.5 

8.3 

0.9 

3.1 

58.7 

28.3 

6.7 

0.0 

0.6 

35.8 

49.5 

10.0 

0.0 

0.0 

Iron Folic Acid Tablets/ Liquid 5.8 25.5 29.5 14.8 11.5 30.2 10.5 30.1 

Number of children 95 95 91 32 126 123 143 138 


£ 

BCG, three doses of DPT, three doses of Polio (excluding Polio zero) and Measles 


Table 5.2(C) shows the percentage of children age 12-23 months and 24-35 months 

who received specific vaccination by age according to residence in Ahmedabad district of 

Gujarat state. It can be seen from the Table 5.2(C) that two percent of children in age 

group 24-35 months did not receive any vaccination at all, while 66 percent of the children 

in the age group 24-35 months were fully immunized in the district, children fully 

immunized in 12-23 months of age is 44 percent. In Ahmedabad district eight percent 

43.0 

47.5 

10.5 

1.9 

7.2 

54.3 

14.2 

6.5 

0.0 

1.0 

36.6 

48.7 

9.5 

0.2 

0.0 

46.9 

36.1 

11.0 

0.2 

2.5 

8.8 

90.8 

89.5 

77.7 

0.4 

6.3 

93.2 

91.9 

79.2 

43.4 

30.1 

5.5 

0.4 

0.0

children in age group 12-23 months, and four percent in age group 24-35 months did not 

receive DPT injection. The percentage of children (in both the age group) who received all 

the three DPT injection (61 and 80 percent respectively in 12-23 and 24-35 months) is less 

as compared to those who received the at least one DPT injection (92 and 95 percent 

respectively in 12-23 and 24-35 months). Similar type of situation did exist in case of 

children receiving the polio doses in the district. It was observed that the percentage of 

children specially in the age group of 12-23 months who received full vaccination was 

higher in rural areas (66 percent) than urban areas (41 percent) of the district. Otherwise 

the immunization status was found to be more or less the same among children aged 24-35 

years in rural and urban areas. 

Table 5.2 (C) CHILDHOOD VACCINATIONS RECEIVED BY 12 MONTHS OF AGE 

Percentage of children age 12-23 months and 24-35 months who received specific vaccinations by age according to 



Total Rural Urban 

12-23 

months 

24-35 

months 

12-23 

months 

24-35 

months 

12-23 

months 

24-35 

months 

Polio zero 60.2 63.7 56.5 31.9 60.7 68.9 

BCG 89.4 95.4 89.3 80.1 89.4 97.9 

DPT Injection 

No DPT 

1 

2 

3 


Polio doses 

No Polio 

1 

2 

3 

7.8 

92.2 

75.1 

61.0 

0.0 

5.7 

94.1 

83.6 

62.4 

4.3 

94.9 

91.9 

80.0 

0.8 

2.0 

83.8 

81.3 

69.1 

8.5 

91.5 

87.2 

79.0 

0.0 

0.0 

100.0 

95.7 

87.5 

23.4 

76.6 

65.4 

65.4 

0.0 

11.1 

85.3 

74.2 

74.2 

7.7 

92.3 

73.4 

58.4 

0.0 

6.5 

93.3 

81.8 

58.8 

Measles 58.0 92.0 72.6 76.6 55.9 94.5 

Full vaccination £ 44.0 65.9 66.2 65.4 40.7 66.0 

No vaccination at all 0.1 2.0 0.0 11.1 0.1 0.5 

Number of children 113 75 (14) (11) 98 64 

£ BCG, three doses of DPT, three doses of polio (excluding polio zero) and measles 

Note: Table includes only surviving children from among the two most recent births in the three years preceding the survey 


5.3 SOURCE OF IMMUNIZATION 

Table 5.3 shows the sources of immunization by residence and availability of health 

facilities. Most of the children (43 percent) were immunized at a government health 

facility and 23 percent of them at a private health facility. Further, among the children 

immunized at a government health facility, 35 percent of them were immunized at 

PHC/CHC, seven percent at government hospital and two percent at sub-centre. 

Table 5.3 SOURCE OF VACCINATIONS 

Percentage distribution of children* who had received any vaccination by source of last vaccination and by residence and 

availability of health facility in the village, Ahmedabad district of Gujarat, RCH, 2002 

Source of vaccination 

Total Residence 

Availability of health 


Rural Urban No Yes 

1.2 

97.9 

96.3 

82.4 

0.9 

0.5 

83.5 

82.4 

68.3 

7

Government 

Government hospital 

PHC/CHC 

Sub-centre 

ANM (Village session) 

Other 

Private 

Private hospital 

Private doctor 

6.8 

34.9 

1.7 

0.1 

32.7 

19.4 

3.4 

ISM facility 1.1 0.0 1.3 0.0 0.0 

Total percent 100.0 100.0 100.0 100.0 100.0 

No. of children who received a vaccination 277 46 232 26 (19) 



As can be observed from the table that in the district Ahmedabad, government sources 

are more preferred to private hospital for immunization of children. This clearly indicates 

that government health facilities in majority of cases have been providing immunization 

services in this district. 

0.0 

8.0 

5.0 

0.0 

83.4 

3.6 

0.0 

8.2 

40.1 

1.0 

0.1 

22.7 

22.5 

4.0 

0.0 

4.5 

0.0 

0.0 

95.5 

0.0 

0.0 

0.0 

12.8 

11.9 

0.0 

66.9 

8.4 

0.0 

5.4 AWARENESS AND TREATMENT OF DIARRHOEA 

Diarrhoea is a major killer disease among children under five years of age. Deaths from 

acute diarrhoea are mostly due to dehydration resulting from loss of water and electrolyte. 

Here an attempt was made to collect the data on awareness among women about the 

causes and treatment of diarrhoea, which has been presented in Table 5.4. 

, 

Table 5.4 AWARENESS OF DIARRHOEA 

Percentage of women* with last child born after 1-1-1999, who are aware of diarrhoea management and practices followed 

during diarrhoea by selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Diarrhoea 

Total 


index 

Rural Urban SC/ST Other Illiterate 0-9@ 10 yrs & Low Medium High 

years above 

8 

Availability 

of health 

facility in 

the village 

No Yes 

Women aware of what to do if child 

gets diarrhoea 98.8 99.3 98.7 98.9 98.8 98.2 98.5 99.8 98.1 98.3 99.5 100.0 98.0 

Type of practices to be followed if 

child gets diarrhoea** 

Give ORS 

Salt and sugar solution 

Continue normal food 

Continue breastfeeding 

Give plenty of fluids 

Other 

35.5 

25.8 

7.4 

3.9 

6.1 

85.5 

24.2 

24.0 

8.7 

0.0 

2.2 

87.2 

38.3 

26.2 

7.1 

4.9 

7.0 

85.1 

16.2 

11.7 

4.6 

0.6 

14.8 

73.9 

39.2 

28.5 

8.0 

4.5 

4.4 

87.7 

15.1 

21.0 

7.6 

0.7 

7.6 

75.1 

52.6 

21.1 

6.8 

6.2 

1.5 

86.9 

38.8 22.1 

34.5 24.2 

7.9 10.9 

4.8 0.7 

8.8 1.0 

93.8 84.9 

38.6 36.6 

19.5 31.3 

4.4 9.1 

2.7 5.7 

6.1 7.4 

77.4 92.3 

Women whose child suffered from 

diarrhoea during two weeks prior to 

survey 4.8 11.2 3.2 7.1 4.3 7.4 4.6 2.5 10.9 4.0 3.8 3.5 24.4 

Women who continued breastfeeding 

same as before diarrhoea 3.6 11.2 1.7 7.1 2.9 7.4 2.1 1.4 10.9 3.7 1.6 3.5 24.4 

Women $ who gave child to drink 

amount of fluid 

Less than usual quantity 

Same as usual quantity 

More than usual quantity 

Women $ who gave child the 

amount of the food 

Less than usual quantity 

Same as usual quantity 

More than usual quantity 

0.3 

3.8 

0.1 

0.3 

2.9 

0.2 

0.6 

9.3 

0.6 

0.6 

7.0 

0.6 

0.2 

2.5 

0.0 

0.2 

1.9 

0.1 

0.0 

6.5 

0.0 

0.0 

3.4 

0.6 

0.4 

3.3 

0.1 

0.4 

2.8 

0.1 

0.4 

6.3 

0.0 

0.4 

4.2 

0.4 

0.3 

3.0 

0.4 

0.3 

3.1 

0.3 

0.3 

2.2 

0.0 

0.3 

1.5 

0.0 

1.0 

8.3 

0.0 

1.0 

3.8 

1.0 

0.0 

2.8 

0.3 

0.0 

2.8 

0.0 

0.4 

3.5 

0.0 

0.4 

2.7 

0.2 

21.3 

28.4 

7.1 

0.0 

0.0 

85.7 

29.1 

16.5 

11.5 

0.0 

6.0 

89.8 

0.0 1.7 

3.5 19.1 

0.0 1.7 

Women who gave ORS during 

diarrhoea 7.5 5.5 9.3 0.0 9.8 8.7 0.0 17.2 8.9 5.7 8.0 0.0 6.8 

Women who consulted any body or 

sought treatment 50.1 58.6 42.8 21.6 59.0 58.6 30.0 61.1 28.3 94.3 28.5 0.0 73.2 

0.0 

0.0 

0.0 

1.7 

19.1 

1.7


* With youngest child born after 1.1.1999 


** Percentage may exceed 100.0 due to multiple responses 

$ Percentages may not add upto 100 due to cases where child is on exclusive breast milk 



Almost all the women (99 percent) are aware of what to do when child gets diarrhoea. 

Among those who are aware, 36 percent of them reported giving ORS, and 26 percent of 

them reported giving salt sugar solution as one of the important remedial measure against 

diarrhoea. This was reported more by women in the urban areas than those in the rural 

areas as the remedial measure against diarrhoea. Women who are literate, belonging to 

high standard of living, mentioned these remedial measures more. Some of the women 

also reported that the child should be kept on continued breastfeeding (4 percent) and 

given normal food (7 percent) and plenty of fluids (6 percent) if the child gets diarrhoea. 

During two weeks prior to the survey, only five percent of women reported that their 

child had suffered from diarrhoea and four percent of mothers continued breastfeeding in 

the same way as before diarrhoea. Among those who suffered from diarrhoea, eight 

percent of the mothers mentioned that they gave ORS to their child. Practice of giving 

more liquids was absolutely absent as very negligible percent of the mothers mentioned 

about it. The practice remained more or less same irrespective of the caste or education or 

economic status of the family or even availability of having health facility in the village. 

5.5 AWARENESS AND TREATMENT OF PNEUMONIA 

Another major killer disease among infants and children is ARI (Acute Respiratory 

Infection), also called pneumonia. An attempt was made to understand the proportion of 

children who suffered from it in the last two weeks before the survey and their health 

seeking behaviour. About 25 percent of the women are aware of danger signs of 

pneumonia. Slightly higher percent of women in the rural areas (29 percent) are aware of 

danger signs of pneumonia, whereas this figure is 24 percent in the urban areas. 

Furthermore, Table 5.5 shows that the level of knowledge of the danger signs of 

pneumonia is associated with education, standard of living, and availability of health 

facility in the village. 

The danger sign of pneumonia more commonly reported by women are: difficulty in 

breathing (18 percent), pain in chest and productive cough (14 percent), rapid breathing 

(12 percent), excessively drowsy and difficulty in keeping awake (8 percent), chest in 

drawing (6 percent), and wheezing/whistling (5 percent). Unable to drink or take a feeding 

were also reported as the danger signs of pneumonia. 

The data shows that 13 percent of the children had suffered from pneumonia. More 

proportion of women in the rural (16 percent) as compared to the urban (12 percent) 

reported about the child’s ill health due to pneumonia. About 51 percent of the children 

were given treatment mainly at private hospitals (69 percent). 

9

Table 5.5 AWARENESS OF PNEUMONIA 

Percentage of women* who are aware of danger signs of pneumonia and practices followed during pneumonia episodes by 

selected backgrounds characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Pneumonia 

Total 


index 


years 

10 

yrs. & 

above 

Availability 

of health 

facility in 

the village 

Low Medium High No Yes 

Women aware of danger 25.1 28.6 24.2 7.0 28.5 10.5 31.4 32.8 21.8 23.6 27.2 24.7 35.3 

signs of pneumonia 

Danger signs** 

Difficulty in breathing 17.7 8.0 20.1 3.6 20.4 5.7 20.0 26.9 10.8 17.2 20.0 3.5 15.6 

Chest in-drawing 

Not able to drink or take a 

feeding 

Excessively drowsy and 

difficulty in keeping awake 

Pain in chest and 

5.8 

1.0 

8.2 

13.9 

1.3 

4.7 

2.8 

2.4 

0.0 

13.1 

0.0 

1.6 

6.5 

0.7 

10.3 

14.2 

1.6 

5.5 

0.5 

0.5 

0.0 

5.1 

1.1 

1.1 

6.8 

1.1 

9.8 

15.6 

1.3 

5.4 

2.6 

1.7 

0.0 

4.4 

0.8 

0.0 

12.1 

0.0 

17.0 

8.6 

2.8 

0.0 

2.9 

1.4 

7.8 

27.8 

0.3 

13.6 

5.4 

0.0 

0.0 

9.3 

0.0 

0.0 

7.6 

1.4 

14.1 

4.7 

0.5 

0.9 

4.3 

1.0 

5.6 

22.8 

2.3 

9.1 

3.5 

0.0 

0.0 

10.5 

0.0 

0.0 

1.7 

6.5 

0.0 

17.5 

0.0 

4.3 

productive cough 

11.9 21.0 9.7 5.0 13.3 4.7 12.1 18.5 10.0 7.5 16.1 21.1 20.8 

Conditions get worse 

than before 

Wheezing/ whistling 

Rapid breathing 

Women whose child 

suffered from cough, cold 13.1 16.2 12.3 5.5 14.5 12.0 6.1 20.5 19.4 5.8 17.5 7.2 31.6 

and difficulty in breathing 

during two weeks prior to 

survey 

Women who sought 51.2 38.2 55.4 84.1 48.8 46.2 81.1 45.6 40.6 60.3 51.8 0.0 53.1 

treatment for child’s cough 

and cold 

Source of treatment** 

Home remedy 

Government health 

facility 

12.1 

6.4 

69.4 

9.9 

0.0 

51.1 

12.6 

7.8 

73.4 

23.7 

13.7 

30.0 

10.6 

5.5 

74.3 

6.7 

18.7 

48.4 

10.8 

5.5 

83.6 

15.7 12.3 

0.0 24.2 

74.0 63.5 

12.7 

7.4 

45.3 

11.8 

2.1 

78.3 

0.0 

0.0 

0.0 

9.9 

0.0 

51.1 


ISM facility 

1.5 

10.7 

0.0 

39.0 

1.8 

4.4 

0.0 

32.6 

1.6 

8.0 

0.0 

26.2 

0.0 

0.0 

3.0 

7.4 

0.0 

0.0 

0.0 

34.6 

2.2 

5.6 

0.0 

0.0 

0.0 

39.0 

Other 


* With youngest child born after 1.1.1999 ** Percentage may exceed 

100.0 due to multiple responses 

# The total figure may not add to (N) and percentage may not add upto 100.0 due to don’t know and missing cases 


Note: Percentage may not be reliable as based on less than 25 cases.

CHAPTER - 6 

FAMILY PLANNING 

Information about the knowledge of family planning and the use of contraceptive methods 

is of practical use to policy makers and programme administrators for formulating policies 

and strategies. This chapter begins with an assessment of women’s knowledge of family 

planning methods and special attention is focussed on non-use, reasons for 

discontinuation, health problems and satisfaction with the current use and their sources of 

motivation to use family planning. It also deals with the past users, future intention to use, 

unmet need of family planning and future fertility intention of the respondents. In addition, 

the chapter presents males’ attitude towards and perception of family planning methods. 

6.1 KNOWLEDGE OF CONTRACEPTIVE METHODS 

The awareness of 

contraceptives by selected 

background characteristics 

of CMW is shown in 

Table 6.1 All women are 

aware of at least one 

modern method of 

contraception and 82 

percent of them are aware 

of all modern methods (73 

percent in rural and 84 

percent in urban areas). 

Further, 99 percent of 

them are aware of any 

modern spacing method 

(97 percent in rural areas, 

and 100 percent in urban 

areas) (Figure 6.1). 

Awareness of all modern 

methods and any spacing 

methods is relatively more 

among the other caste 

groups, literate and those 

who were economically 

well off. 

Methods 

Any modern 

method 

Any modern 

spacing method 

All modern 

methods 

Female 

sterilization 

Male sterilization 

Contraceptive 

herbs 


IUD/Loop 

Pills 

Condom 

Traditional 

methods 

Figure: 6.1 

Knowledge of family planning methods 

9 

58.8 

81.9 

85.9 

93.8 

100 

99.1 

100 

97.7 

97.5 

0 20 40 60 80 100 

Percent 

2

Method-wise awareness shows that all the women knew about female sterilization. 

The proportion of those women who are aware of male sterilization, IUD/loop, and pills 

ranged between 94-98 percent. About 86 percent of the women know about condom. 

About 26 percent of the women knew about injectables and 19 percent about sponge 

method of family planning. 

3

Table 6.1 KNOWLEDGE OF CONTRACEPTIVE METHODS 

Percentage of currently married women age 15-44 who know any contraceptive method by method and by selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Contraceptive Method 

Total Residence Caste# Education Standard of living index Availability of health 


Rural Urban SC/ST Other Illiterate 0-9@ 10 years & Low Medium High No Yes 

years above 


Any modern spacing* method 

All modern** methods 

100.0 

99.1 

81.9 

100.0 

96.7 

72.7 

100.0 

99.7 

84.1 

100.0 

98.3 

66.2 

100.0 

99.3 

84.6 

100.0 

97.7 

69.7 

100.0 

99.7 

83.2 

100.0 

99.9 

92.2 

100.0 

94.2 

62.8 

100.0 

99.4 

79.9 

100.0 

99.7 

86.1 

100.0 

98.6 

68.0 

100.0 

94.5 

78.4 

Female sterilization 

Tubectomy 

Laparoscopic 

100.0 

96.8 

95.7 

100.0 

100.0 

99.8 

100.0 

96.1 

94.7 

100.0 

99.8 

99.8 

100.0 

96.3 

95.0 

100.0 

95.8 

95.6 

100.0 

97.6 

91.2 

100.0 

97.2 

100.0 

100.0 

100.0 

99.5 

100.0 

96.1 

92.3 

100.0 

96.8 

97.1 

100.0 

100.0 

100.0 

100.0 

100.0 

99.4 


Vasectomy 

No-scalpel vasectomy 

93.8 

62.6 

30.1 

87.5 

45.1 

6.5 

95.3 

66.8 

35.8 

93.2 

56.4 

32.4 

94.0 

63.7 

29.8 

89.5 

50.9 

22.1 

97.2 

55.4 

20.3 

94.8 

80.5 

46.9 

83.5 

49.5 

1.1 

92.2 

49.1 

22.4 

96.5 

72.7 

39.3 

86.2 

18.0 

5.5 

89.2 

78.4 

7.9 

IUD/Loop 97.7 95.6 98.3 98.0 97.7 97.0 99.0 97.2 92.7 98.9 97.9 98.6 92.0 

Pills 

Daily 

Weekly 

Condom/Nirodh 

Sponge (today) 

Injectables 

Norplant 

Contraceptive herbs 


Any other Indian system of medicinal 

97.5 

84.6 

38.6 

85.9 

19.2 

26.1 

2.8 

9.0 

58.8 

3.2 

92.3 

70.5 

10.7 

81.7 

1.1 

12.2 

0.0 

2.2 

33.0 

0.2 

98.7 

88.0 

45.2 

86.9 

23.6 

29.5 

3.5 

10.6 

64.9 

3.9 

93.0 

59.5 

35.4 

76.1 

6.8 

14.4 

0.1 

7.3 

27.0 

0.6 

98.2 

89.0 

39.2 

87.6 

21.4 

28.2 

3.3 

9.3 

64.3 

3.7 

92.6 

67.4 

23.6 

77.3 

4.5 

13.8 

0.1 

4.1 

33.0 

0.3 

99.7 

87.0 

28.3 

85.0 

9.9 

20.1 

0.1 

5.2 

55.6 

4.9 

99.9 

98.7 

62.4 

94.7 

42.0 

43.5 

7.9 

17.2 

86.2 

4.4 

91.2 

76.4 

5.4 

72.7 

1.3 

13.7 

0.2 

1.1 

32.3 

0.0 

95.3 

77.1 

31.5 

86.0 

10.2 

18.3 

0.1 

4.6 

40.1 

2.9 

99.7 

90.4 

48.0 

87.9 

27.5 

32.8 

4.8 

12.9 

74.0 

3.9 

91.7 

54.0 

6.8 

79.0 

0.0 

5.6 

0.0 

0.0 

26.5 

0.0 

93.1 

90.6 

15.3 

84.9 

2.4 

20.2 

0.0 

4.8 

40.9 

0.6 

Number of women 769 149 620 115 654 254 249 266 71 259 439 82 67 

4

# The total figure may not add to (N) 100.0 due to don’t know and missing cases 

* Include IUD, pills and condom 

** Include Female sterilization, Male sterilization, IUD, pills and condom 


5

Around two-fifths (59 percent) of women were aware of any traditional methods. 

Only three percent of woman reported knowing of any other contraceptive of the Indian 

System of medicine. 

6.2 KNOWLEDGE OF NO-SCALPEL VASECTOMY (NSV) 

The Table 6.2 presents percent of husbands of eligible women by knowledge of NSV. The 

table shows that slightly more than half (53 percent) of husbands are aware about the NSV 

as a contraceptive method. The knowledge of NSV is higher in urban area (56 percent) 

than rural area (45 percent) but the percentage remained more or less the same among 

those belonging to villages having or not having health facilities in the village. Among 

those who reported that they have heard of NSV, 52 percent of them say it is simpler than 

conventional method. Further, analysis of this data shows that 41 percent of the husbands 

feel that NSV does not lead to any complication, and 36 percent of them feel that NSV 

does not affect the man’s sexual performance. 

Table 6.2 NO-SCALPEL VASECTOMY (NSV) 

Percentage of husbands of eligible women by knowledge of NSV by residence and availability of health facility in the 

village, Ahmedabad district of Gujarat, RCH, 2002 

Knowledge of NSV 

Total Residence Availability of 


the village 


Percentage of husbands who have knowledge about NSV 

Who know that NSV is simpler than conventional vasectomy 

Who feel that NSV does not lead to any complication 

Who feel that NSV does not affect man’s sexual performance 

52.9 

52.4 

40.7 

35.9 

44.7 

45.6 

61.3 

42.9 

55.5 

54.1 

35.6 

34.2 

45.7 

31.7 

61.8 

37.9 

43.4 

64.6 

60.5 

49.6 

Number of husbands 404 95 308 54 42 

6.3 CONTRACEPTIVE PREVALENCE RATE 

Table 6.3 shows the contraceptive prevalence rate by selected background characteristics 

in Ahmedabad district, 56 percent of the couples use any methods of contraception of 

whom 50 percent had acceptors of modern method. Among the acceptors of modern 

methods 28 percent had accepted permanent method of sterilization. The use of modern 

method is same in the urban and rural areas of the district. The use of traditional method is 

six percent in this district. 

About 27 percent of the women had 

undergone sterilization. Percentage of 

sterilization acceptors is higher in the 

rural areas (40 percent) than those in the 

urban areas (25 percent). Acceptance of 

male sterilization is almost negligible in 

the district. Further, six percent are IUD 

users, eight percent pills users and nine 

percent condom users (Figure 6.2). 

Usership of spacing methods is relatively 

high among urban, educated and couples 

having high standard of living. The use 

of modern methods of contraception is 

high among the literate couples, having 

high standard of living and with availability of government health facilities. 

6 

Figure: 6.2 

Practice of family planning methods 

Female 

sterilization 

26.8% 

IUD/Loop 

5.6% 

Pills 

8.1% 


Condom 

8.7% 

Any 

traditional 

method 

6.1% 

Male 

sterilization 

1.0% 

Not using 

any method 

43.7%

Table 6.3 CONTRACEPTIVE PREVALENCE RATE 

Percentage of currently married women aged 15-44 by current use of contraceptive method and by selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Method 

Percentage of women/husbands using 

Any method 


Any sterilization 


Percentage distribution of 

women/husband using Modern method 



IUD/Loop 

Pills 

Condom/Nirodh 

Traditional method 

Rhythm/periodic abstinence 

Withdrawal 

Total 

56.3 

50.2 

27.8 

6.1 

1.0 

26.8 

5.6 

8.1 

8.7 

5.3 

0.8 

Residence Caste# Education Standard of living index Availability of 


the village 

Rural Urban SC/ST Other Illiterate 0-9@ years 10 years Low Medium High No Yes 

& above 

52.6 

50.4 

40.1 

2.2 

0.0 

40.1 

5.1 

1.0 

4.3 

1.1 

1.1 

57.3 

50.3 

24.9 

7.0 

1.3 

23.6 

5.7 

9.8 

9.8 

6.3 

0.7 

43.4 

36.8 

25.7 

6.7 

0.6 

25.1 

1.1 

0.9 

9.1 

6.5 

0.2 

58.7 

52.7 

28.2 

6.0 

1.1 

27.1 

6.4 

9.4 

8.7 

5.1 

0.9 

Any other modern method 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0 


# The total figure may not add to (N) 100.0 due to don’t know and missing cases. 

@ 

Literate women with no years of schooling are also included. 

56.3 

48.7 

44.4 

7.6 

0.5 

44.0 

1.5 

0.4 

2.4 

7.2 

0.4 

48.3 

44.3 

27.0 

4.0 

2.7 

24.3 

4.3 

8.3 

4.7 

3.6 

0.4 

64.1 

57.5 

12.8 

6.6 

0.1 

12.7 

10.7 

15.4 

18.4 

5.1 

1.4 

41.4 

39.6 

36.5 

1.7 

0.3 

36.2 

0.0 

0.0 

3.2 

1.7 

0.0 

47.5 

43.2 

34.4 

4.4 

2.9 

31.5 

2.8 

2.8 

3.2 

4.0 

0.3 

64.0 

56.2 

22.6 

7.8 

0.1 

22.5 

8.2 

12.6 

12.9 

6.6 

1.1 

47.1 

47.1 

32.0 

0.0 

0.0 

32.0 

8.2 

1.4 

5.5 

0.0 

0.0 

59.4 

54.5 

50.0 

4.8 

0.0 

50.0 

1.2 

0.5 

2.8 

2.4 

2.4 

7

6.4 USE OF CONTRACEPTIVES 

Table 6.4 shows the current use of contraceptive by selected background characteristics of 

CMW. Contraceptive prevalence rate in this district is 56 percent. The use of 

contraceptives increased from four percent among the currently married adolescent aged 

15-19, to as high as 69 percent among women aged 30-34 and 82 percent among women 

aged 40-44 years. The use of contraceptives increases with the increase in number of 

surviving children. However, the proportion of women accepting a method with no living 

daughters is 44 percent against 19 percent of the women accepting a method with no living 

son. The data clearly indicates that preference for sons is existing in this district. 

Table 6.4 USE OF CONTRACEPTIVES 

Percentage of currently married women aged 15-44 by current use and by ever use of contraceptives, according to 

selected demographic characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Demographic 

Characteristics 

Age-group 

15-19 

20-24 

25-29 

30-34 

35-39 

40-44 

Surviving children 

0 

1 

2 

3 or more 

Surviving sons 

0 

1 

2 or more 

Surviving daughters 

0 

1 

2 or more 

Modern 

method 

4.2 

32.7 

39.7 

53.5 

61.6 

81.2 

2.7 

36.7 

59.4 

68.9 

17.7 

55.2 

80.7 

42.3 

53.1 

55.3 

Percentage of women/ 

their husbands using 

Traditional 

method 

0.0 

8.5 

2.4 

15.1 

7.1 

1.2 

0.0 

2.1 

9.8 

7.4 

0.9 

14.4 

1.2 

1.2 

8.3 

8.5 

Any 

method 

4.2 

41.2 

42.1 

68.6 

68.7 

82.3 

2.7 

38.8 

69.2 

76.3 

18.6 

69.6 

81.9 

Not using 

any method 

95.8 

58.8 

57.9 

31.4 

31.3 

17.7 

97.3 

61.2 

30.8 

23.7 

81.4 

30.4 

18.1 

Percentage distribution 

of women/their 

husbands by use of 

contraceptives 

Ever Never 

6.4 

46.7 

64.7 

75.2 

77.1 

83.4 

4.0 

66.7 

76.0 

80.9 

36.0 

78.0 

84.1 

93.6 

53.3 

35.3 

24.8 

22.9 

16.6 

96.0 

33.3 

24.0 

19.1 

64.0 

22.0 

15.9 

Number of 

women 

All women 50.3 6.1 56.3 43.6 66.0 34.0 769 

The total percent may not add up to 100.0 due to missing cases. 

43.5 

61.4 

63.8 

56.5 

38.6 

36.2 

49.0 

74.6 

73.1 

51.0 

25.4 

26.9 

37 

136 

198 

132 

127 

140 

105 

157 

244 

263 

253 

290 

225 

245 

303 

221 

6.5 SOURCE OF MODERN METHODS OF CONTRACEPTION 

During the survey, information was also collected regarding the sources of supply of 

contraceptives. Table 6.5 shows that government health facility was the main source of 

supply for the permanent family planning methods. Almost all acceptors of male and 69 

percent of the female sterilization used the government health facility. However, about 23 

percent of the acceptors of female sterilization used private health facility. But in the case 

of IUD/Loop the method was mainly accepted from private facility (66 percent) than the 

government (16 percent) facility. However, 94 percent each of pill and condom users 

obtained these contraceptives from chemist or medical store. 

8

Table 6.5 SOURCE OF MODERN CONTRACEPTIVE METHODS 

Percentage distribution of current users of modern contraceptive methods by source, according to specific method, 


Source 

Percentage distribution of current 

users by source of supply 

Government/municipal hospital 

CHC/PHC 

Family planning/ RCH camp 


Government doctor 

Private doctor 

Government nurse/ ANM 

Private nurse 

Medical shop/chemist 

Other 

Female 

sterilization 

23.6 

30.7 

14.6 

22.6 

0.0 

0.5 

0.0 

0.0 

0.0 

8.0 

Male 

sterilization 

92.4 

4.7 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

2.9 

IUD/ 

Loop 

8.1 

8.1 

0.0 

65.8 

1.4 

10.5 

0.0 

5.2 

0.0 

0.8 

Pill 

0.3 

4.3 

0.0 

0.4 

0.0 

0.0 

0.7 

0.0 

93.9 

0.4 

Condom/ 

Nirodh 

Number of users of modern method 205 (8) 43 62 66 


0.0 

0.5 

0.0 

0.0 

0.3 

0.0 

0.0 

0.0 

94.9 

4.2 

6.6 SIDE-EFFECTS OF CONTRACEPTION AND SATISFACTION WITH 

CURRENT USE 

Table 6.6 summarizes the data on side-effects of the contraceptive methods being used, 

prior knowledge of possible side-effects and related aspects. 

Table 6.6 HEALTH PROBLEMS AND SATISFACTION WITH CURRENT USE OF CONTRACEPTIVES 

Percentage of women informed about side-effects, had side-effects, sought treatment, follow-up and satisfaction with 

the method by use of method, Ahmedabad district of Gujarat, RCH, 2002 

Health problem/type of treatment 

Type of method 

Female IUD/loop 

Pill 

Sterilization 

Women who were informed about all the available methods 13.5 - - 

Women who were informed about the side-effects before adoption of method 36.0 51.8 31.8 

Women who had side-effect/health problem due to use of method 11.3 6.9 16.6 

Type of health problems/side-effects* 

Weakness/ inability to work 

Body ache/ backache 

Cramps 

Weight gain 

Dizziness 

Nausea/vomiting 

Breast tenderness 

Irregular periods 


Spotting 

White discharge 

Women who sought treatment for the health problem 52.3 22.1 0.0 

Source of treatment 



Other 

9 

1.4 

8.5 

0.1 

0.5 

0.2 

0.4 

0.0 

0.3 

06 

0.6 

2.8 

5.0 

95.0 

0.1 

0.0 

5.4 

0.0 

0.0 

0.0 

0.0 

0.6 

0.0 

1.0 

0.0 

1.0 

0.0 

100.0 

0.0 

Women who had follow-up visit by health worker after adoption of method 38.2 1.7 1.7 

Women who are satisfied with method of current use 98.9 100.0 83.8 

Number of current users 206 43 63 

The data reveal that 37 percent of current users were informed about side-effects 

before adopting the respective method. About half (52 percent) of the IUD users, 32 

percent pill user and 36 percent acceptors of female sterilization reported being informed 

15.4 

0.0 

0.0 

0.0 

0.0 

0.7 

0.0 

0.0 

0.4 

0.0 

0.7 

0.0 

0.0 

0.0

about side-effects before adopting the method. About 11 percent of the women sterilized 

reported that they had suffered from some health problems after adopting the method. 

These percentages in the case of IUD/Loop users is seven and 17 among pill users. Those 

who adopted sterilization as a method of family planning mainly experienced problems 

like bodyache, weakness, white discharge etc. after its acceptance. Out of those who had 

health problems, slightly more than half (52 percent) of them sought treatment mainly 

from private health facility (95 percent) followed by government health facility (5 

percent). None of the women, using pills sought the treatment for their problem while 22 

percent of the IUD/loop users sought the treatments. About 38 percent of the sterilization 

users reported being visited by health worker after adoption of contraception while only 

two percent each of IUD and pill users reported follow-up visit by health worker. Further, 

majority of the current users were satisfied with the current use of contraceptives 

irrespective of method adopted. 

6.7 ADVICE ON CONTRACEPTION AND INTENTION TO USE FAMILY 

PLANNING IN THE FUTURE 

During the survey, all CMW who were not using contraceptives at the time of survey were 

asked about their future intention regarding the use of family planning method. This type 

of information would help family planning programme administrators in identifying 

potential groups of users and in providing the types of contraception that are likely to be in 

demand. 

Table 6.7 gives the extent of coverage of family planning counselling and intention to 

use family planning methods in the future. Around 18 percent of the current non-users 

were advised by ANM/health worker to use contraceptives. This proportion was 22 

percent in rural areas as compared to 16 percent in urban areas. About 43 percent of the 

women reported that they were advised to accept IUD/loop followed by female 

sterilization (34 percent) and pills (21 percent). It is evident from the table that the health 

workers are promoting IUD/loop than other spacing methods. Nearly 36 percent of the 

current non-users intended to use contraceptives in future. This percentage is found more 

in rural areas (43 percent) than urban areas (34 percent). 

Almost 80 percent of the women intend to accept female sterilization in the future. 

Slightly more than one-tenth (13 percent) of women intend to use IUD in future. A higher 

percent of the women in rural areas (19 percent) than those in urban areas (11 percent) 

intend to accept IUD in future. 

10

Table 6.7 ADVISE ON CONTRACEPTIVE USE AND FUTURE INTENTION TO USE 

Percentage of current non-users* who were advised by the ANM/health worker to use contraceptives by suggested method, and who intend to use contraceptives in future by preferred method by selected 

background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Advice Future intention of method 

Total Residence Caste# Education Standard of living index Availability of 


the village 


years 

10 years & 

above 


Percentage of current non-users advised by ANM/health worker 

to use of contraceptive method 17.5 22.4 16.0 13.4 18.5 15.2 28.8 4.6 37.7 17.9 11.3 24.4 18.2 

Percentage distribution of women who were advised 



IUD/loop 

Pill 

34.4 

1.1 

43.1 

21.4 

83.1 

0.0 

16.9 

0.0 

14.5 

1.6 

53.8 

30.2 

Percentage of current non-users intended to use contraceptive in 

future 36.1 43.2 34.0 20.6 39.9 23.5 37.9 50.2 44.8 39.2 30.7 42.2 45.3 

Percentage distribution of women who Intend to use 

contraceptive in future by preferred method 


IUD/loop 

Pill 

Condom/Nirodh 

Other method 

80.3 

13.1 

1.6 

0.7 

4.4 

80.8 

19.2 

0.0 

0.0 

0.0 

80.1 

10.8 

2.2 

0.9 

6.0 

Number of non-users 244 55 189 48 196 87 91 66 32 101 111 37 (18) 

* Exclude women in menopause or those who have undergone hysterectomy 




71.7 

7.3 

17.9 

3.1 

100.0 

0.0 

0.0 

0.0 

0.0 

27.7 

0.0 

47.6 

24.7 

77.7 

14.7 

1.8 

0.8 

4.9 

90.3 

3.6 

0.0 

6.2 

91.2 

5.8 

3.0 

0.0 

0.0 

7.6 

0.0 

63.2 

29.2 

71.3 

27.3 

0.7 

0.7 

0.0 

25.4 

0.0 

54.2 

20.4 

82.9 

2.6 

1.8 

1.1 

11.7 

85.2 

0.0 

9.7 

5.1 

79.4 

16.3 

4.3 

0.0 

0.0 

17.3 

0.0 

42.3 

40.4 

79.0 

21.0 

0.0 

0.0 

0.0 

10.0 

3.8 

76.4 

9.8 

82.1 

2.5 

2.4 

1.8 

11.3 

87.2 

0.0 

12.8 

0.0 

71.2 

28.8 

0.0 

0.0 

0.0 

71.2 

0.0 

28.8 

0.0 

100.0 

0.0 

0.0 

0.0 

0.0 

11

6.8 FUTURE FERTILITY INTENTION 

About 31 percent of 

CMW say that they do 

not want any more 

children. Similarly 24 

percent of the husbands 

do not want additional 

children. In total 21 

percent of couples said 

that they do not want any 

more children. The 

couples wanting no more 

children is higher in rural 

areas than in urban areas. 

The percentage of 

women who desire the 

next child to be a boy is 

24 percent, which is high 

in rural areas than urban 

areas. Slightly higher 

percent of husband 

Percentage 

50 

40 

30 

20 

10 

0 

Figure 6.3: 

Fertility preferences among men and women 

Women 

31.2 


Men 

24.2 

Not desiring 

additional child 

Women 

23.7 

desire next child to be a boy. This suggests that there is a prevalence of son preference 

among the people. 

Men 

33.6 

Desiring 


to be a Boy 

Women 

3.4 

Men 

1.0 

Desiring 


to be a Girl 

Women 

5.5 

Men 

8.4 

Desiring next 

child after 2 

years 

Table 6.8 FUTURE FERTILITY INTENTION 

Percentage of eligible women* and men** desiring additional child by preference of sex and waiting time, according to 

selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Characteristics 

Total Residence Caste# Education of husband Standard of living 

index 

Rural Urban SC/ST Other Illiterate 0-9@ 10 years Low Medium High 

years & above 

Women reported 

Not desiring additional children 

Desiring the next child to be 

Boy 

Girl 

Desiring next child after two years 

Men reported 



Boy 

Girl 


31.2 

23.7 

3.4 

5.5 

24.2 

33.6 

1.0 

8.4 

41.2 

26.4 

2.1 

4.2 

45.0 

36.7 

3.0 

6.3 

28.3 

22.9 

3.8 

5.9 

15.8 

32.4 

0.2 

9.3 

45.7 

28.9 

4.4 

0.0 

24.0 

9.3 

6.4 

0.0 

27.6 

22.4 

3.2 

6.9 

23.8 

37.6 

0.2 

9.8 

44.2 

24.0 

1.5 

2.4 

NA 

NA 

NA 

NA 

23.2 

21.1 

1.6 

1.3 

NA 

NA 

NA 

NA 

25.2 

27.1 

8.4 

15.7 

NA 

NA 

NA 

NA 

47.1 

25.0 

3.5 

7.3 

48.6 

33.2 

5.2 

5.5 

32.5 

17.0 

0.8 

10.8 

15.4 

37.4 

0.2 

2.7 

25.5 

29.5 

5.8 

0.2 

22.5 

30.6 

0.1 

14.2 

Couples reported 



Boy 

Girl 


21.2 

20.5 

1.3 

1.4 

34.4 

16.6 

4.5 

4.6 

15.5 

22.2 

0.0 

0.0 

* Refers to women who are non-users and who are either menstruating or in amenorrhoea 

** Refers to men who are non-users 


@ Literate women with no years of schooling are also included NA: Not applicable 

22.4 

0.7 

7.0 

0.0 

20.9 

25.2 

0.0 

1.7 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

45.8 

24.4 

8.2 

8.4 

16.6 

23.3 

0.0 

0.0 

16.1 

16.1 

0.0 

0.0 

12

It is interesting to note that 22 percent of the couples reported desire for additional 

children, and the percentage reporting the same varies by caste and standard of living. 

About 21 percent couples who want another child say that they want the next child to be a 

son, only one percent say that they want a daughter, suggesting a strong son preference 

existing in the district, and this is not much affected by the background characteristics of 

the couples. A negligible percent of the couples in Ahmedabad reported their desire for 

spacing the next child. The desire for spacing the next child is reported by the couple in 

rural areas and those with low standard of living only. 

6.9 REASONS FOR DISCONTINUATION OF USE AND NON-USE OF 

CONTRACEPTIVES 

All CMW who had discontinued using contraceptive and those who had never used any 

method of contraceptive at the time of survey and were not pregnant were asked about the 

reasons for the same. Their response analyzed is summarized in Table 6.9. Seventy-four 

respondents discontinued the method in the surveyed households because most of them 

(37 percent) wanted to have a child, and the remaining were apprehensive of health 

problems like weakness/inability to work, body ache, etc. 

There were 129 current non-users in the surveyed households, of these 30 respondents 

were from rural areas and the remaining 99 were from urban areas. About 18 percent of 

them had fear of side-effects with the use of contraceptives or afraid of sterilization. 

Hence, they did not accept the method. These cases were more in the urban areas (22 

percent) than in rural (8 percent). Health does not permit, against religion were reported 

as other reasons for non-use of contraceptives by around two to four percent of the 

respondents. 

13

Table 6.9 REASONS FOR DISCONTINUATION OF USE AND NON-USE OF CONTRACEPTIVE METHODS 

Percent distribution of past users (current non-users) by reason for discontinuation of the current method and current non-users by reasons for non-use by selected background characteristics, 


Reason 

Total Residence Caste# Education Standard of living index 

Rural Urban SC/ST Other Illiterate 0-9@ 10 years & Low Medium High 

years above 

Number of past users (current non-users) 74 (15) 59 (5) 68 (11) 41 (22) (7) (22) 45 

Reason for discontinuation 

Wanted child 

Method failed/became pregnant 

Supply not available 

Difficult to get method 

Weakness/inability to work 

Bodyache/backache 

Dizziness 

Irregular period 


Spotting 

White discharge 

Lack of pleasure 

Method was inconvenient 

Other 

37.0 

1.0 

0.3 

1.5 

9.9 

5.8 

1.7 

0.9 

10.2 

13.1 

5.4 

1.1 

1.3 

10.7 

49.3 

0.0 

0.0 

7.6 

0.0 

0.0 

8.2 

0.0 

0.0 

0.0 

22.7 

0.0 

0.0 

12.3 

33.8 

1.3 

0.4 

0.0 

12.5 

7.3 

0.0 

1.1 

12.8 

16.4 

1.1 

1.4 

1.6 

10.3 

50.3 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

3.0 

0.0 

0.0 

41.7 

0.0 

5.0 

0.0 

35.9 

1.1 

0.3 

1.7 

10.7 

6.3 

1.8 

0.7 

11.0 

14.1 

2.6 

1.2 

1.0 

11.5 

36.0 

0.0 

0.0 

10.0 

0.0 

0.0 

10.8 

0.0 

0.0 

0.0 

19.7 

0.0 

4.0 

19.6 

31.6 

1.9 

0.6 

0.0 

18.0 

0.0 

0.0 

1.0 

18.1 

23.8 

4.4 

0.0 

0.0 

0.7 

47.4 

0.0 

0.0 

0.0 

0.0 

19.7 

0.0 

1.1 

1.0 

0.0 

0.0 

3.8 

2.4 

24.6 

17.7 

0.0 

0.0 

17.1 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

51.4 

0.0 

0.0 

13.9 

20.5 

0.0 

0.0 

0.0 

32.5 

0.0 

5.6 

1.8 

32.5 

0.0 

0.0 

0.0 

0.0 

7.0 

47.7 

1.7 

0.5 

0.0 

0.5 

9.5 

0.0 

0.6 

1.0 

21.3 

1.4 

1.9 

2.1 

12.0 

Number of current Non-users 129 30 99 (24) 105 58 32 39 (22) 65 42 

Reason for non-use 

Against the religion 

Opposed to family planning 

Husband opposed 

Other family members opposed 

Does not like existing methods 

Afraid of sterilization 

Cannot work after sterilization 

Worry about side-effects 

Cost too much 

Health does not permit 

Inconvenient to use method 

Difficult to become pregnant 

Other 

2.3 

0.9 

1.3 

0.3 

5.1 

8.4 

2.1 

10.4 

0.2 

4.4 

0.6 

3.1 

60.8 

7.6 

3.8 

0.0 

1.2 

0.0 

7.6 

3.9 

0.0 

0.0 

11.8 

0.0 

4.1 

59.9 

0.8 

0.0 

1.7 

0.0 

6.6 

8.7 

1.6 

13.5 

0.3 

2.2 

0.8 

2.8 

61.1 

0.0 

4.7 

2.4 

0.0 

0.0 

30.2 

2.6 

2.7 

0.0 

1.1 

0.0 

0.5 

55.8 

2.9 

0.0 

1.1 

0.4 

6.2 

3.5 

2.0 

12.2 

0.3 

5.1 

0.7 

3.7 

62.0 

3.9 

2.0 

1.5 

0.6 

3.6 

14.4 

2.0 

0.4 

0.3 

6.3 

0.4 

0.0 

64.5 

0.0 

0.0 

0.0 

0.0 

0.0 

8.0 

1.4 

10.6 

0.0 

0.7 

0.8 

5.4 

73.0 

1.9 

0.0 

2.2 

0.0 

11.3 

0.0 

2.9 

25.0 

0.3 

4.6 

0.6 

5.7 

45.6 

10.3 

0.0 

0.0 

1.7 

2.8 

10.3 

5.3 

0.0 

0.0 

10.5 

0.0 

0.0 

59.1 

0.0 

1.7 

0.9 

0.0 

3.2 

11.3 

0.0 

16.4 

0.5 

2.1 

0.0 

0.0 

63.9 

1.8 

0.0 

2.6 

0.0 

9.1 

3.1 

3.8 

6.6 

0.0 

4.8 

14.8 

9.4 

57.0 




14

6.10 UNMET NEED 

Table 6.10 subdivides unmet need for family planning into unmet need for spacing and 

limiting. The total unmet need of family planning among women in this district is12 

percent. In other words, 12 percent of women did not want any more children or wanted 

more children, but after two or more years and were still not practicing any method of 

contraception. The proportion of unmet need was higher 19 percent in rural areas 

compared to urban areas (11 percent). Unmet need is high for limiting than for spacing. 

An almost equal percentage of husbands (13 percent) reported unmet need for family 

planning, though a higher proportion of husbands in the rural (24 percent) than those in the 

urban areas (9 percent) reported the same. 

About five percent of the couples reported unmet need for family planning. The 

unmet need for limiting is three percent and very negligible proportion is for spacing. 

Table 6.10 UNMET NEED 

Percentage of currently married women aged 15-44 years, their husbands and both the partners with unmet need for family 

planning by selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 

Percentage with 

unmet need 

Total 

Limiting 

Spacing 

Total 

12.3 

9.9 

2.4 

Residence 

Rural Urban Illiterate 

18.6 

15.3 

3.4 

10.8 

8.6 

2.2 

17.0 

15.1 

1.9 

Education of 

husband 

0-9@ 

Years 

9.4 

8.5 

0.9 

10 years 

& above 

10.5 

6.2 

4.3 

Standard of living 

index 

Availability of 


the village 



Total 

Limiting 

Spacing 

12.6 

9.3 

3.3 

24.0 

21.0 

3.0 

9.1 

5.7 

3.4 

NA 

NA 

NA 

Number of men 404 95 308 NA NA NA 47 115 242 54 42 

Total 

Limiting 

Spacing 

5.0 

4.7 

0.3 

12.7 

11.2 

1.5 

3.1 

3.1 

0.0 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

NA 

19.2 

16.2 

3.0 

5.5 

5.5 

0.0 

2.4 

2.4 

0.0 

19.7 

16.9 

2.9 

5.0 

5.0 

0.0 

Number of couples 380 78 303 NA NA NA 39 108 233 41 37 

@ Literate women with no years of schooling are included. 

NA: Not applicable 

Note: 

Unmet need for limiting: 

The proportion of currently married women who are neither in menopause nor had hysterectomy nor are currently pregnant 

and do not want any more children but are currently not using any family planning method. 

Unmet need for spacing: 

The proportion of currently married women who are neither in menopause nor had hysterectomy nor are currently pregnant 

and who want more children but after two years or later and are currently not using any family planning method. The 

women who are not sure about whether and when to have next child are also included in unmet need for spacing 

Total unmet need: Unmet need for limiting and spacing 

NA 

NA 

NA 

NA 

NA 

NA 

28.4 

21.3 

7.14 

29.9 

26.9 

3.0 

17.2 

12.7 

4.5 

9.2 

7.9 

1.4 

6.8 

6.4 

0.4 

10.9 

6.7 

4.2 

25.2 

19.4 

5.7 

36.6 

31.4 

5.2 

10.7 

10.2 

0.5 

7.7 

7.7 

0.0

CHAPTER - 7 

ACCESSIBILITY AND PERCEPTION ABOUT 

GOVERNMENT HEALTH SERVICES 

This chapter deals with the accessibility and the opinion of the currently married women 

about the services provided by government health workers. The quality of care offered by 

the government health programme as perceived by currently married women is also 

presented in this chapter. 

7.1 HOME VISIT BY HEALTH WORKERS 

In the rural areas, the health workers are deputed to visit each household in their work area 

to provide health care services to the community. In view of this, all the eligible women 

were asked whether any health worker had visited them at their home during the three 

months prior to the survey, the analysis of their responses is presented in Table 7.1. 

As can be seen from the Table 

7.1, 14 percent of the respondents 

reported that a health worker had 

visited them during the reference 

period. Same was reported by 

women belonging to different 

socioeconomic characteristics. 

Mainly ANM/LHV (97 percent) 

had visited them, followed by male 

health worker (10 percent) (Figure 

7.1). Most of them (78 percent) 

expressed satisfaction over the 

amount of time spent by the ANM. 

Similarly, 89 percent of them 

reported satisfaction with service/ 

advice given by health workers. 

The level of satisfaction does not 

vary much by the socio-economic 

background of the CMW. 

TOTAL 

Figure: 7.1 

Home visits of health workers by 

residence 

ANM/LHV 

Health worker- male 

RURAL 

ANM/LHV 


URBAN 

ANM/LHV 



4.7 

10.1 

30.1 

96.5 

98.7 

95.9 

0 20 40 60 80 100 

Percent 

2

Table 7.1 HOME VISITS BY HEALTH WORKERS 

Percentage of currently married women aged 15-44 years who were visited by selected health worker and the background characteristics of the Respondents, Ahmedabad district of Gujarat, 

RCH, 2002 

Visit/satisfaction 

Total Residence Caste# Education Standard of living index Availability of health 


Rural Urban SC/ST Other Illiterate 0-9@ years 10 years Low Medium High No Yes 

& above 

Women who were visited by health 

worker at home during 3 months prior to 

survey 14.1 15.7 13.8 17.4 13.4 11.8 21.2 9.7 16.8 13.8 13.9 20.6 9.7 

Category of health worker 

ANM/LHV 


96.5 

10.1 

98.7 

30.1 

95.9 

4.7 

96.3 

27.2 

96.7 

6.1 

94.5 

13.7 

97.5 

11.4 

96.6 

3.4 

97.4 

21.4 

95.1 

5.5 

97.1 

10.6 

100.0 

39.8 

95.2 

4.8 

Women who said worker spent enough 

time with them 77.9 82.2 76.7 91.2 74.6 65.4 88.6 70.6 69.8 77.6 79.7 86.3 71.6 

Percentage of women who satisfied with 

service/advice given by health worker 

88.5 82.2 90.2 91.2 87.8 85.8 95.9 76.7 69.8 94.7 88.5 86.3 71.6 




3

7.2 MATTER DISCUSSED WITH HEALTH WORKERS 

The Table 7.2 shows percentage of women who were visited by health workers and those 

who visited government health facility and discussed the health and family planning or 

any matter with the health worker. About 63 pregnant women or women with children 

born after 1 st January 1999, 29 current users of contraceptives and 16 non-users women 

were visited by health workers at home. During home visits the health worker generally 

discussed with pregnant women or women with children born after 1st January 1999 on 

issues related to immunization, disease prevention, antenatal care and on other topics as 

can be seen from the table. On the other hand women currently using family planning 

reported that during the visit the health workers mainly discussed about disease prevention 

and immunization of children and to some extent on treatment of health problem. Nonusers 

of family planning methods were informed about immunization, disease prevention 

and antenatal care practice. More or less a similar kind of discussion took place when 

respondents themselves visited the government health facilities. 

Table 7.2: MATTERS DISCUSSED DURING CONTACT WITH HEALTH OR FAMILY PLANNING WORKER 

Percentage of women who were visited by health worker and those who visited government health facility in three months 

preceding the survey by the specific topics discussed with the health worker, Ahmedabad district of Gujarat, RCH, 2002 

Topic discussed 

During home visit 


Breastfeeding 

Supplementary feeding 

Immunization 

Nutrition 

Disease prevention 

Treatment of health problem 

Antenatal care 

Delivery care 

Child care 

Sanitation/cleanliness 

Oral rehydration 

Other 

Pregnant women or 

women with 

children born after 

1-1-1999 

Other women 

Current 

contraceptive 

users 

Current non 

users 

Number of women 63 29 (16) 109 

1.6 

0.6 

1.7 

57.8 

0.6 

17.1 

4.7 

16.6 

0.7 

4.4 

0.5 

0.0 

3.7 

1.8 

0.0 

0.0 

48.4 

0.0 

58.8 

10.8 

0.0 

0.0 

2.6 

1.1 

1.1 

5.5 

0.0 

0.0 

0.0 

82.6 

1.1 

5.3 

5.8 

38.7 

0.0 

0.0 

0.0 

0.0 

5.1 

Total 

1.4 

0.3 

1.0 

58.9 

0.5 

26.6 

6.5 

15.3 

0.4 

3.3 

0.6 

0.3 

4.4 

During visit to health facility 


Supplementary feeding 

Immunization 

Disease prevention 

Treatment of health problem 

Antenatal care 

Postpartum care 

Child care 

Sanitation/cleanliness 

Other 

4.1 

2.0 

14.9 

5.2 

58.7 

17.6 

7.0 

7.5 

0.0 

0.0 

0.0 

0.0 

0.0 

1.4 

34.1 

60.0 

0.0 

1.3 

1.6 

1.6 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

0.0 

1.8 

0.8 

6.4 

3.0 

43.8 

39.1 

3.0 

7.8 

0.8 

0.8 

Number of women (13) (16) 0 31 

Note: Percentages add to more than 100.0 due to multiple responses 

Note: Percentage may not be reliable as based on less than 25 cases.

7.3 VISIT TO GOVERNMENT HEALTH FACILITY 

The Table 7.3 

represents 

percentage of CMW 

who visited health 

facility by their 

residence and 

availability of health 

facility in the village. 

It is clear from the 

table that majority 

(76 percent) of 

women who required 

treatment for their 

health problems had 

sought treatment 

from health facility. 

Only 10 percent of 

CMW had visited 

government health DLHS-RCH, 2002 

Percent 

facilities during the 

last three months before the survey and majority (86 percent) visited private facility. 

Among those who visited government health facility visited hospital and dispensary or 

PHC/SC (Figure 7.2). 

Table 7.3 VISIT TO HEALTH FACILITY 

Percentage of currently married women age 15-44 who visited health facility according to residence and availability of 

health facility in the village, Ahmedabad district of Gujarat, RCH, 2002 

Health facility 

Total 

2 

Residence 

Availability of health 



Women who needed to visit health facility and visited 75.5 55.6 79.4 46.8 69.4 


Government hospital/CHC/FRU/RH 

Government dispensary 

PHC 

Sub centre 

4.4 

3.5 

2.2 

0.3 

0.0 

0.0 

17.7 

2.1 

5.1 

4.0 

0.1 

0.1 

0.0 

0.0 

18.8 

0.0 

0.0 

0.0 

16.6 

4.3 



Private dispensary 

Private ISM hospital/dispensary 

Figure: 7.2 

Visits to government health facility by residence 

TOTAL 

Government hospital/ CHC/FRU/RH 


RURAL 

URBAN 

72.0 

13.8 

0.5 

Other 3.3 0.0 3.7 00 0.0 

Number of women 386 63 322 39 25 

7.4 CLIENT’S PERCEPTION OF QUALITY OF GOVERNMENT HEALTH 

SERVICES 

Utilization of services is an essential indicator reflecting the quality of services. Better 

quality of services would have a higher utilization rate and this is very important from the 

policy point because, unless clients are satisfied with the services provided by the 

government, efforts made by the government will be wasted. In order to assess the 

utilization of government health facilities, the CMW were asked whether they had visited 

any government health facility during the three months before the date of survey. It is 

PHC 

Sub centre 



PHC 

Sub centre 



PHC 

Sub centre 

0.3 

0.0 

0.0 

0.1 

0.1 

2.2 

2.1 

3.5 

4.0 

60.3 

19.8 

0.0 

4.4 

5.1 

73.6 

12.9 

0.5 

17.7 

0 10 20 30 

55.9 

25.3 

0.0 

65.0 

14.1 

0.0

interesting to note that majority of the women had positive opinion about the quality of 

services provided at the government health facility. However, about 32 percent 

of the women found the location to be inconvenient and 24 percent felt the waiting time 

very long and about 10 percent of them also opined that the staff is technically 

incompetent. 

Table 7.4 QUALITY OF GOVERNMENT HEALTH FACILITY 

Percentage of women who visited Government health facility and rated quality and availability of services, Ahmedabad 

district of Gujarat, RCH, 2002 

Quality of services 

1. The convenience of the health facility location 

2. Length of time spend towards waiting* 

3. Personal manner (courtesy, respect, sensitivity, friendliness) of the physician 

4. The technical skills and quality (thoroughness, carefulness, competence) of the 

physician 

5. Personal manner (courtesy, respect, sensitivity, friendliness) of nurse 

6. The technical skills and quality (thoroughness, carefulness, competence) of nurse 

7. Personal manner (courtesy, respect, sensitivity, friendliness) of other staff 

8. The technical skills and quality (thoroughness, carefulness, competence) of other staff 

9. The explanation of what was done to her 

10. Medical, surgical and diagnostic equipment 

11. General comfort 

3 

Poor 

32.0 

23.8 

4.6 

6.0 

5.9 

9.8 

5.4 

11.1 

3.8 

9.2 

3.5 

1 2 3 

Good Excellent 

* Poor indicate waiting long time. Good indicate average waiting time. Excellent indicate short waiting time 

7.5 REASONS FOR NOT VISITING THE GOVERNMENT HEALTH CENTRE 

Table 7.5 presents the reasons for not visiting government health center during the last 

three months before the survey. Eight percent women who needed to visit health facility 

visited government health facility. The percentage of women visiting government health 

facility is higher (11 percent) in rural areas as compared to eight percent in urban areas. 

Table 7.5 REASONS FOR NOT PREFERRING GOVERNMENT HEALTH FACILITY 

Percentage of currently married women age 15-44 who visited private health facility by reason for not preferring 

government health facility according to residence and availability of health facility in the village, Ahmedabad district of 


Reasons for not visiting government 


Women who needed to visit health facility and visited government health 

facility 

Total 

Residence 

15.8 

48.4 

28.5 

34.0 

23.9 

41.4 

64.8 

64.8 

69.9 

63.5 

45.3 

Availability of 

34.0 

8.7 

44.2 

37.4 

33.8 

11.7 

7.7 

1.4 

6.0 

5.5 

6.0 


the village 


8.0 11.0 7.3 8.8 14.5 

Women who needed to visit health facility and visited private health facility 65.1 44.6 69.1 38.0 54.9 

Percentage distribution of women who visited 

private health facility by reason for not preferring government health 

facility 

Not conveniently located 

Time is not suited 

Poor quality of services 

Heavy rush 

Non-availability of doctors/health workers 

Rare availability of doctors/health workers 

Doctors/health workers do not examine properly 

Medicine are not/rarely given 

Medicine are of bad quality 

Referred by Government Doctor 

Other 

Number of women 386 63 322 39 25 

About 65 percent of women who needed to visit health facility had visited private 

health facility. Among those who visited private health facility, did so due to inconvenient 

timing of the government health center (24 percent), inconvenient location of the facility 

(23 percent) and poor quality of government services (17 percent). These reasons were 

23.0 

24.1 

17.4 

7.6 

0.8 

0.2 

3.3 

0.6 

5.3 

2.8 

14.8 

26.7 

13.7 

30.6 

4.0 

0.0 

0.0 

1.1 

5.7 

18.1 

0.0 

0.0 

22.5 

25.5 

15.8 

8.1 

0.9 

0.2 

3.6 

0.0 

3.7 

3.2 

16.7 

23.2 

15.4 

46.0 

7.7 

0.0 

0.0 

0.0 

0.0 

7.7 

0.0 

0.0 

30.6 

11.9 

14.0 

0.0 

0.0 

0.0 

2.3 

11.9 

29.3 

0.0 

0.0

considered to be some of the major reason for not preferring government services. Women 

also reported, poor quality of medicines, heavy rush etc. as some of the other reason for 

not visiting government health facility. In light of the expressed grievances, matter need to 

be seriously looked into and accordingly redressed. 

CHAPTER – 8 

REPRODUCTIVE HEALTH 

The RCH programme gives a lot of emphasis on promoting and encouraging healthy 

sexual behaviour among couples by various IEC activities. The DLHS-RCH made an 

attempt to collect information on awareness of reproductive tract infection (RTI)/sexually 

transmitted infection (STI) and prevalence of these problems along with certain specific 

socio-economic and demographic background that can pre-dispose individuals toward 

various dimensions of risk through self reported symptoms among married male and 

female respondents in the sampled households. Information was also collected on the 

awareness of HIV/AIDS. 

8.1 AWARENESS ABOUT REPRODUCTIVE TRACT INFECTION (RTI)/ 

SEXUALLY TRANSMITTED INFECTION (STI) 

In an attempt to assess whether couples had the right knowledge about RTI/STI and 

HIV/AIDS, both males and females in each of the sampled households were asked if they 

were aware about it, its mode of transmission and curability. Their responses analyzed are 

presented in Table 8.1. 

Table illustrates that a 

higher proportion of males 

and females in urban areas 

(66 percent males and 40 

percent females) have heard 

about RTI/STI as compared 

to their rural counterparts 

(39 percent males and 23 

percent females) (Figure 

8.1). Males got to know 

about it through print media 

or through slogans or 

pamphlets or seen it on the 

wall hording (55 and 45 

percent respectively). In 

case of women, 

friends/relatives have been 

the major source of 

information (74 percent). A 

significant proportion of 

TOTAL 

RURAL 

URBAN 

Figure: 8.1 

Awareness of RTI/STI by sex and residence 

Female 

Male 

Female 

Male 

Female 

Male 


4 

23.1 

36.6 

38.9 

39.8 

59.5 

65.9 

0 20 40 60 80 100 

Percent

males came to know about it from TV (29 percent), while 13 percent of females came to 

know about RTI/STI through the same source. A negligible proportion of males (5 

percent) and females (1 percent) acquired knowledge about it from health workers. 

5

Regarding mode of transmission, about 70 percent of males in urban areas reported 

correctly that RTI/STI is transmitted through sexual intercourse while males in rural areas 

had less knowledge about it (56 percent). In case of females about 58 percent in urban 

areas reported sexual intercourse as the mode of transmission and in rural areas, this 

percentage is only 41. More females than males reported lack of personal hygiene as a 

cause of RTI/STI (39 and 28 percent respectively). A sizeable proportion of males (19 

percent) and females (25 percent) did not have the knowledge about mode of RTI/STI 

transmission. However, it is encouraging to note that majority of males (82 percent) and 

females (78 percent) stated that RTI/STI is curable, about 18 percent females and 13 

percent males had no knowledge about curability of the infection. It is important to note 

that four percent each of male and female were of the notion that RTI/STI is not curable. 

Table 8.1 KNOWLEDGE OF REPRODUCTIVE TRACT INFECTION (RTI)/ SEXUALLY TRANSMITTED INFECTION (STI) 

Percentage of currently married women aged 15-44 years and their husbands aware of RTI/STI by source of information, 

knowledge about mode of transmission and curability by sex and residence, Ahmedabad district of Gujarat, RCH, 2002 

Knowledge 

Male 

Female 

Total Rural Urban Total Rural Urban 

Percentage of respondents who are aware of RTI/STI £ 59.5 38.9 65.9 36.6 23.1 39.8 

Percentage of respondents* who are aware of RTI/STI by source 

Radio 

TV 

Newspaper/book/Magazine 

Slogan/ pamphlet/poster/ wall hoarding 

Doctor 

Health worker 

School teacher 

Community meeting 

Friends/relatives 

Other 

Percentage of respondents aware of mode of transmission 

Sexual intercourse 

Lack of personal hygiene 

Other 

Do not know 

Percent distribution of respondents who are aware of RTI/STI by 

knowledge about curability ¢ 

Curable 

Not curable 

Do not know 

4.2 

28.8 

55.1 

45.1 

7.4 

5.0 

0.4 

2.0 

35.5 

2.0 

67.6 

28.4 

12.1 

18.5 

81.7 

4.3 

12.9 

3.8 

41.0 

10.8 

15.4 

2.6 

7.6 

0.0 

11.4 

29.4 

6.8 

56.1 

10.5 

3.6 

37.0 

82.7 

0.0 

17.3 

4.3 

26.6 

63.2 

50.5 

8.3 

4.5 

0.5 

0.3 

36.6 

1.2 

69.7 

31.7 

13.7 

15.1 

81.5 

5.0 

12.1 

0.1 

13.1 

13.1 

14.4 

3.9 

1.2 

0.2 

0.6 

73.7 

0.8 

55.9 

39.2 

21.2 

25.2 

77.8 

4.0 

18.1 

0.0 

3.6 

3.6 

8.8 

2.7 

7.0 

0.0 

3.4 

96.4 

0.0 

41.2 

45.9 

46.3 

3.4 

88.4 

4.2 

7.4 

0.1 

14.5 

14.5 

15.1 

4.1 

0.4 

0.2 

0.2 

70.6 

0.9 

58.0 

38.2 

17.8 

28.2 

76.4 

4.0 

19.6 

Number of respondents (aware of STI/RTI) 240 37 203 281 34 247 

* Total percent may add more than 100.0 due to multiple responses 

£ Based on all respondents. ¢ Total percentage may not add 100.0 due to missing cases 

8.2 PREVALENCE OF RTI/STI AMONG MALES AND FEMALES 

In order to assess the incidence of RTI/STI respondents were asked about the various 

symptoms of this infection, which they had experienced in the past. The male respondents 

were asked to report whether they ever experienced problems like discharge from penis, 

sore in genital area etc. The question addressed to female respondents are whether they 

experienced unusual vaginal discharge, pain during sexual intercourse, pain in lower 

abdomen etc. during the past three months preceding the survey. Attempts have also been 

made to unearth whether those suffering from any of the symptoms of RTI/STI sought 

treatment and the place from where treatment was sought. The results are presented in 

Table 8.2. From this it can be noticed that five percent of males had suffered from at least 

one symptom of RTI/STI whereas 14 percent of females suffered from abnormal vaginal 

discharge. The treatment seeking behaviour shows that 12 percent of females and 18 

percent of males sought treatment for their problem mainly from the private facility. 

6

Table 8.2 PREVALENCE OF SYMPTOMS OF RTI/STI AMONG WOMEN/ MEN 

Percentage of eligible women aged 15-44 having menstruation related problems and abnormal vaginal discharge, and their 

husbands having symptoms of RTI/STI by residence, Ahmedabad district of Gujarat, RCH, 2002 

Prevalence of RTI/STI symptoms and treatment 

Total 

Residence 

Rural 

Urban 

*1. Number of women 78 (15) 63 

Women who reported having at least one menstruation related problem 12.7 13.3 12.6 

Women had at least one menstruation related problem 21.1 24.8 20.3 



Government 

Private 

ISM 

Other 

Health personnel 

Doctor 

ANM/Nurse/LHV/Trained Dai 

Other 

*2. Number of women 105 42 63 

27.5 

66.3 

1.2 

10.6 

95.6 

2.5 

1.9 

33.4 

50.0 

0.0 

41.6 

91.6 

0.0 

8.4 

25.8 

71.0 

1.6 

1.6 

96.7 

3.3 

0.0 

Women who reported having any abnormal vaginal discharge 

Women sought treatment for vaginal discharge 

13.7 

11.9 

28.1 

11.9 

10.2 

11.9 



Government 

Private 

ISM 

Other 

12.5 

62.3 

7.8 

17.5 

16.3 

44.6 

16.3 

22.8 

10.0 

73.9 

2.1 

14.0 


Doctor 

ANM/Nurse/LHV/ Trained dai 

Other 

*3. Number of men (19) (8) (11) 

Men who reported having at least one symptom of RTI/STI 

Men had at least one symptom of RTI/STI and sought treatment 



Private 

Other 


Doctor 

Other 

*1 Number of women who reported having at least one menstrual related problems 

*2 Number of women who reported having any vaginal discharge 

*3 Number of men who reported having at least one symptoms of RTI/STI problems 


8.3 SYMPTOMS OF RTI/STI 

Table 8.3 shows that around 50 percent of the eligible women have at least one symptom 

of RTI/STI. The major problems reported are low backache (42 percent), followed by pain 

in lower abdomen (12 percent) and around eight percent reported itching over vulva. The 

percentage of women having most of the symptoms of the RTI/STI is higher in rural areas 

than in urban areas. The percentage of women having symptoms of RTI/STI is slightly 

higher for scheduled caste and scheduled tribes women and women belonging to medium 

or low standard of living in the district. The prevalence of symptoms of RTI/STI is more 

among illiterate women (53 percent) than literate women who have completed at least 10 

years of schooling (46 percent). 

7 

79.7 

9.2 

11.1 

4.7 

18.3 

54.9 

45.1 

54.9 

45.1 

60.9 

16.3 

22.8 

8.3 

36.9 

51.5 

48.5 

51.5 

48.5 

92.2 

4.5 

3.3 

3.5 

4.8 

73.6 

26.4 

73.6 

26.4

Table 8.3: SYMPTOMS OF RTI/STI 

Percentage of eligible women aged 15-44 having symptoms of RTI/STI by selected background characteristics Ahmedabad district of Gujarat, RCH, 2002. 

Symptoms 

Total Residence Caste# Education Standard of living index 

Rural Urban SC/ST Other Illiterate 0-9@ 10 years Low Medium High 

years & above 

Women who reported at least one symptom of RTI/STI 50.5 61.2 47.9 73.0 46.6 53.3 52.1 46.3 56.2 55.7 46.5 

Symptoms 

Itching over vulva 

Boils/ulcers/warts around vulva 

Pain in lower abdomen 

Low backache 

Pain during sexual intercourse 

Bleeding after sexual intercourse 

Swelling in the groin 

Frequent/painful passage of urine 

Fever 

Some mass coming out of vagina 

Any involuntary escape of urine while 

coughing or sneezing 

8.0 

2.5 

12.4 

42.3 

3.5 

0.2 

0.8 

5.4 

3.9 

1.1 

1.6 

13.9 

4.8 

17.1 

51.3 

8.5 

0.5 

2.4 

10.5 

6.9 

3.3 

5.8 

6.6 

2.0 

11.3 

40.1 

2.3 

0.1 

0.5 

4.2 

3.2 

0.6 

0.6 

16.2 

3.5 

7.8 

69.6 

4.1 

0.0 

0.2 

5.9 

2.7 

2.1 

3.4 

6.6 

2.4 

13.3 

37.5 

3.4 

0.2 

0.9 

5.3 

4.1 

0.9 

1.3 

12.5 

2.0 

15.5 

45.3 

6.4 

0.0 

1.5 

7.0 

3.2 

1.4 

2.5 

7.0 

2.4 

9.7 

46.1 

2.6 

0.5 

0.2 

4.6 

3.8 

0.8 

2.0 

4.7 

3.2 

12.1 

35.8 

1.5 

0.0 

0.8 

4.6 

4.7 

1.0 

0.3 

13.8 

4.9 

17.7 

42.5 

7.8 

0.0 

1.8 

10.6 

6.4 

2.3 

6.7 

5.3 

1.9 

9.6 

51.6 

5.9 

0.3 

1.1 

3.1 

4.1 

1.4 

1.7 

8.7 

2.6 

13.3 

36.7 

1.4 

0.1 

0.5 

5.9 

3.3 

0.7 

0.7 




8

8.4 KNOWLEDGE OF HIV/AIDS 

The awareness of HIV/AIDS by 

certain selected background 

characteristics of respondents is 

presented in Table 8.4 More 

male (88 percent) than female 

respondents (60 percent) are 

aware of HIV/AIDS. Higher 

percent of male and female in 

the urban areas knew about 

HIV/AIDS as compared to their 

rural counterparts (Figure 8.2). 

Around 80 percent of the 

respondents reported TV as 

source of information (both 

males and females). The other 

source of information as 

reported by males were slogan 

(64 percent), print media (55 

TOTAL 

RURAL 

URBAN 

Female 

Male 

Female 

Male 

Female 

Male 


Figure: 8.2 

Knowledge of HIV/AIDS by sex and 

residence 

percent) and friends/relatives (25 percent) whereas in case of females, friends (51 percent) 

had been the other major source in the campaign for communicating awareness about the 

dreaded disease. A small proportion (6 percent) of males reported doctors as the source of 

knowledge, the same was reported by only three percent of females. Health workers are 

yet to take initiative for spreading awareness about HIV/AIDS. 

With regard to the knowledge about the mode of transmission of the virus, the table 

reflects that most of the males (97 percent) and females (73 percent) knew that sexual 

intercourse with infected person is one of the major mode of transmission. The other 

modes reported were use of un-sterilized or infected needles (41 percent males and 29 

percent females). About 42 percent of males and 28 percent of females were also aware 

that it could be transmitted through infected blood. Few reported homosexual intercourse 

and mother to child as mode of transmission. This indicates that only sexual intercourse 

was considered as the major mode of acquiring the virus. With regard to curability, males 

had relatively better knowledge as compared to females. Half of the males knew correctly 

that the disease is not curable. The corresponding percentage for females is only 33 

percent. A matter of concern for everyone that emerges from the table is that nearly 37 

percent of females did not know anything about curability of HIV/AIDS as against the 

corresponding percentage of 19 for males. 

Though HIV/AIDS is not curable, there are preventive measures, which can avoid 

acquiring the virus. When the respondents were asked about their knowledge regarding 

preventive measures, majority of males (89 percent) and females (73 percent) reported that 

sex with only one partner as one of the preventive measures. Other preventive measure 

reported were checking blood prior to transfusion (37 percent male and 33 percent 

female), use of sterilized needles and syringes for injection (34 percent male and 27 

percent female) and using condom correctly during each sexual intercourse (32 percent 

male and 16 percent female). A very small percent of them had no knowledge about any 

such preventive measures. Further, the survey data reveals that 37 percent of males and 38 

percent of females had misconceptions that HIV/AIDS is transmitted by shaking hands, 

hugging, kissing, sharing clothes, sharing kitchen utensils, mosquito bites, etc. This is an 

indication of the fact that in spite of having awareness, the respondents lack complete 

knowledge about the route and preventive care to avoid acquiring HIV/AIDS. 

Table 8.4 KNOWLEDGE OF HIV/ AIDS 

Percentage of currently married women age 15-44 years and their husbands aware of HIV/ AIDS by source of knowledge, 

knowledge of mode of transmission and knowledge about curability by sex and residence, Ahmedabad district of Gujarat, 

RCH, 2002 

HIV/AIDS Male Female 

28.3 

59.8 

62.0 

67.3 

88.3 

96.5 

0 20 40 60 80 100 

Percent

Total Rural Urban Total Rural Urban 

Respondents are aware of HIV/AIDS 88.3 62.0 96.5 59.8 28.3 67.3 

Respondents* aware of HIV/AIDS by source 

Radio 

TV 

Newspaper/book/magazines 

Slogan/ pamphlet/posters/ wall hoarding 

Doctor 

Health worker 

School teacher 

Community meeting 


Other 

14.2 

79.2 

55.1 

63.6 

6.2 

0.9 

0.6 

1.4 

24.9 

0.9 

4.1 

67.1 

37.7 

27.7 

5.7 

0.9 

2.4 

0.0 

21.9 

1.3 

16.2 

81.6 

58.5 

70.8 

6.3 

1.0 

0.3 

1.7 

25.5 

0.8 

3.0 

81.7 

33.1 

31.6 

3.2 

0.7 

2.5 

0.3 

50.5 

2.9 

5.3 

67.6 

9.7 

15.9 

5.9 

0.7 

0.0 

0.0 

52.9 

2.8 

2.8 

83.2 

35.4 

33.2 

2.9 

0.7 

2.8 

0.3 

50.2 

2.9 

Respondents* aware of HIV/AIDS by knowledge of 

mode of transmission 

Homosexual intercourse 

Heterosexual intercourse 

Needles/blades/skin puncture 

Mother to child 

Transfusion of infected blood 

Other 

Do not know 

7.6 

96.8 

41.2 

2.2 

41.9 

2.8 

3.1 

3.7 

92.1 

14.6 

0.4 

11.8 

2.7 

7.9 

8.4 

97.7 

46.5 

2.5 

47.9 

2.8 

2.1 

1.7 

73.3 

28.7 

8.8 

28.4 

2.4 

24.5 

0.0 

80.8 

13.8 

5.6 

27.2 

0.0 

19.2 

1.9 

72.5 

30.2 

9.1 

28.5 

2.7 

25.0 

Respondents* aware of preventive measures by type 

of measure 

Sex with only one partner 

Using condom correctly during each sexual 

intercourse 

Checking blood prior to transfusion 

Sterilize needles & syringes for injection 

Avoid pregnancy when having HIV/AIDS 

Other 

Do not know 

89.2 

31.6 

36.5 

34.4 

2.1 

12.9 

3.4 

81.5 

25.3 

12.8 

10.9 

0.4 

22.0 

7.0 

90.7 

32.8 

41.3 

39.1 

2.4 

11.1 

2.5 

73.0 

16.1 

33.0 

27.2 

8.4 

8.9 

23.1 

67.6 

2.2 

27.2 

13.8 

2.7 

10.1 

24.5 

73.6 

17.6 

33.6 

28.5 

8.9 

8.8 

22.9 

Respondents having misconception about HIV/AIDS 36.5 36.9 36.5 38.1 56.0 36.3 

Respondents* having misconceptions about mode of 

transmission by type of misconception 

Shaking hands 

Hugging 

Kissing 

Sharing clothes 

Sharing kitchen utensil 

Stepping on urine/stool 

Mosquito, flea or bedbug bites 

8.1 

8.0 

16.5 

12.2 

18.1 

15.3 

30.9 

26.2 

26.7 

28.0 

27.4 

27.4 

32.0 

32.6 

4.5 

4.3 

14.3 

9.2 

16.3 

12.0 

30.5 

10.7 

11.8 

23.1 

11.9 

17.4 

11.5 

22.2 

12.5 

23.8 

44.1 

14.6 

32.2 

30.2 

34.8 

10.5 

10.5 

20.9 

11.7 

15.9 

9.6 

20.9 

Percentage distribution of respondents by knowledge 

about curability 

Curable 

Not curable 

Don’t know 

31.5 

49.9 

18.6 

30.5 

39.8 

29.7 

31.6 

51.9 

16.4 

29.8 

32.9 

37.4 

28.0 

23.8 

48.2 

29.9 

33.8 

36.3 

Number of respondents (aware of HIV/AIDS) 357 60 297 460 42 418 

* Total percent may add more than 100.0 due to multiple responses

CHAPTER - 9 

NUTRITIONAL STATUS AND ANAEMIA 

In the second round of DLHS-RCH information on weight of children under 6 years of 

age, and prevalence of iron deficiency, anaemia among children under 6 years (0-71 

months), adolescent girls age 10-19 years and pregnant women age 15-44 years, are 

collected. To facilitate assessment of prevalence of malnutrition among children, the 

weight of children under 6 years was measured using Uni-Scale, and haemoglobin level of 

children, adolescent girls and pregnant women were measured from the blood samples 

collected using the test-kit. This information’s were not collected during earlier (First 

round) RHS-RCH. The following paragraphs give details of methodology followed in 

blood sample collection 

9.1 METHODOLOGY 

Haemoglobin level provides an assessment of nutritional status. It is best measured by directly adding 20 µl of blood into 

Drabkin's solution. 

Equipment required 

1. Haemoglobin pipette 

2. Whatman No. 1 fitter paper 1.5 X 1.5 cm 

3. Disposable lancet 

4. Drabkin's solution 

5. Vortex mixer 

A measured amount of 20 µl of blood is accurately pipettes on to 1.5 X 1.5 cm 

whatman No. 1 filter paper. This is allowed to dry. The filter papers is marked with a 

lead pencil and kept in a polythene bag. The filter papers are dispatched or carried to the 

laboratory (Institute for Research in Reproduction (IRR), Mumbai) at a convenient time 

during the next six days. The blood is then eluted from the filter paper in 5 ml of 

Drabkin's solution for 2 hours. The tube is shaken well or preferably vortexed for about 

one minute and optical density measured by appropriate equipment. 

9.2 PROCEDURES 

A. Selection of skin puncture site: In adults skin puncture is conveniently made on the 

centre of the palmer surface of the terminal segment of any of the first three fingers. 

Puncturing the tip too close to the nail or the side of the finger is avoided. In children 

less than 4 months of age, heel puncture is preferred. The selected site must be warm 

and free of oedema and infections.

B. Preparation of site and method of puncture 

i. Reassure the patient. If it is extremely cold, warm the skin by vigorously rubbing 

site; this will increase the blood flow and facilitated sampling. 

ii. Clean the selected site with a sprit with a sprit swab and allow it to dry completely 

(alcohol causes haemolysis in the sample) 

iii. Hold the finger firmly in a dependent position and apply gentle pressure just 

proximal to the puncture site. 

iv. Use the lancet to puncture the skim at right angles to the direction of skin creases. 

This allows the blood to form a drop and prevents it from running into the skin 

creases. 

v. Wipe the first drop away. 

C. Collection of blood sample 

i. Quickly place the tip of the haemoglobin pipette over the puncture and fill upto 20 

µl level or slightly more. 

ii. Once collection is over, elevate the finger and apply sufficient pressure to stop 

further bleeding 

iii. Wipe the outside of the pipette with wet gauze. If the level of the blood is higher 

than the 20 µl mark, bring it to the exact 20 µl mark by absorbing the extra 

blood on a wet snab. 

iv. Deliver the blood from the haemoglobin pipette on to the whatman No. 1 filter 

paper. 

v. Allow to dry admark the filter paper with the identification number using a lead 

pencil. Air-dry and keep in a polythene bag which also bears the 

identifications number. 

D. Hb estimation 

i. Drop the filter paper into 5 ml drabkin's solution and allow it to stand for an hour. 

ii. Vortex it for one minute and measure the optical density at 540 nm using 

Drabkins solutions blank and a commercial standard. 

iii. Calculate the Hb in g/dl by using the following formula: 

OD of sample × Concentration of Hb standard 

Hb in g/dl = 

× dilution factor (251) 

OD of standard × 1000 

where Concentration of Hb standard = 60 mg/dl 

9.3 HAEMOGLOBIN RESPONSE RATE 

The superstitious belief of people towards giving blood sample and non-availability 

particularly, of children and adolescent girls at the time of survey have affected the 

response rate used in the estimation of haemoglobin level. Any interpretation and 

conclusion drawn from the results shown in this chapter should take into consideration the 

response rate. To facilitate interpretation of results, haemoglobin response rate for 

Ahmedabad district for children (age 0-71 months), adolescent girls (age 10-19 years) and 

pregnant women (age 15-44 years) are shown in Table 9.1

Table 9.1 HAEMOGLOBIN RESPONSE RATE 

Percentage of children (age 0–71 months), adolescent girls (age 10-19 years) and pregnant women (age 15-44 years), 


Respondent Response Rate Percent Invalid Number 

Children 52.7 2.4 624 

Adolescents girls 59.8 2.2 526 

Pregnant women* 75.9 2.3 58 

Total 57.0 2.3 1208 

*Non-pregnant women age 15–19 years considered as adolescent girls. 

9.4 WEIGHT FOR AGE OF CHILDREN 

In the RCH program, emphasis is given to the monitoring of the health and well being of 

children on the basis of their nutritional status. To assess the nutritional status of children, 

the weight of all children under 6 years of age living in the selected households was 

obtained. The weights of children are subsequently adopted for construction of 

anthropometrics index, weight-for-age, for comparison with the international reference 

population recommended by the World Health Organization. The weight-for-age index is 

expressed in standard deviation (SD) units (Z-scores) from the median of international 

reference population, as empirical evidence has shown that well-nourished children in all 

population groups for which data exist follow similar growth pattern. On the basis of this 

comparison, children who are below –2SD reference median are considered to be 

moderately undernourished and those below –3SD are considered severely 

undernourished. The analysis has to exclude children whose weight could not be 

measured either due to their non-availability at home or refusal by their parents/guardians. 

While making inference about the nutritional status of children on the basis of weight-forage 

index using the above said criteria, we have to keep in mind that the index value is 

sensitive to age misreporting of children which results in age heaping at preferred digits. 

Nutritional status of children under 6 years of age, classified by weight-for-age index according to the selected 

characteristics is depicted in Table 9.2. Out of all the children, who had been investigated in the Ahmedabad district of 

Gujarat, in 2002, in the second round of the DLHS-RCH survey, 33 percent of them are found to be underweight, while 

10 percent are severely underweight. This gives an unimpressive nutritional status of children. The condition worsens 

with the age of children, which is evident from the data that children in the age group of 6-71 months are largely 

underweight. 

The sex of the children and place of residence influence under-nourishment. More male (36 percent) than female (30 

percent) children are found under-nourished, similarly higher percent of the children in the rural areas are undernourished 

(41 percent) as compared to their urban counterparts (31 percent). Similarly, substantial differentiation is noticed in caste 

in the district. More number of SC/ST children are underweight (39 percent) as compared to other caste children (32 

percent). The proportion of undernourished children in terms of weight-for-age index shows inverse relationship with 

standard of living index, as it decreased from 44 to 25 percent of underweight children as the index passes from low to 

high category.

Table 9.2 WEIGHT FOR AGE OF CHILDREN 

Percentage of children (aged 0–71 months) classified as undernourished by weight for age anthropometric index of 

nutritional status, according to selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002 


Age of child (in months) 

0–5 

6–11 

12–23 

24–47 

48–71 

Birth order 

1 

2–3 

4–5 

6+ 

Sex of Child 

Male 

Female 

Residence 

Rural 

Urban 

Religion 

Hindu 

Muslim 

Other 

Caste 

SC/ST 

Other 

Mother’s education 

Percentage below 

–3 SD 

Weight-for-age 

- 

5.7 

10.0 

14.4 

11.1 

11.0 

8.7 

12.5 

20.0 

11.4 

9.1 

14.9 

9.3 

10.3 

3.8 

21.1 

10.9 

10.2 

16.3 

Illiterate 

0–9 years 2 

12.7 

1.7 

10 and above 

Other 3 11.5 


Low 

Medium 

High 

19.0 

14.4 

5.7 

Number of 

Percentage below 

children 

–2 SD 1 

2.9 

20.0 

35.7 

35.1 

41.5 

31.5 

34.4 

27.5 

60.0 

36.0 

29.7 

40.5 

31.4 

33.4 

26.9 

36.8 

39.1 

32.0 

41.1 

35.5 

23.1 

30.8 

44.4 

42.3 

25.0 

35 

35 

70 

111 

135 

127 

183 

40 

(10) 

211 

175 

74 

312 

341 

26 

(19) 

64 

322 

129 

110 

121 

26 

63 

111 

212 

Total 10.4 33.2 386 

Note: The index is expressed in standard deviation units (SD) from the median of the International Reference 

Population. 

1 

Includes children who are below –3 SD from the International Reference Population median 

2 

Literate women with no year of schooling are also included 

3 

Women who were not present at the time of survey 

SC/ST: Scheduled Caste/Scheduled Tribe 

Table is based on unweighted cases 


A similar pattern of inverse relationship also emerges with educational level of mothers. The proportion of underweight 

children decreased from 41 percent for illiterate mothers to 23 percent for mothers with at least ten years of completed 

education.

9.5 ANAEMIA AMONG CHILDREN, ADOLESCENT GIRLS AND PREGNANT 

WOMEN 

A minimum level of haemoglobin in the blood is necessary for transfer of oxygen from the 

lungs to different tissues and other organs of the body. Low level of haemoglobin in the 

blood characterizes anaemia and it has detrimental effects on the health of children, 

adolescent girls and pregnant women, in particular. Children aged 6-24 months are most 

vulnerable to anaemia and it can result in impaired cognitive performance, behavioural 

and motor development, coordination, language development and scholastic achievement, 

besides increasing morbidity from infectious diseases. Associated with physiological and 

biological changes with age, adolescent girls do need an optimum level of haemoglobin to 

prepare themselves for children bearing in course of time. As a matter of fact the emerging 

medical sciences and the Government’s RCH Programme are recommending antenatal 

care right from the adolescent stage itself, instead of the conventional practice of 

beginning from conception. Anaemia among pregnant women results in increased risk of 

premature delivery and low birth weight. 

As anaemia is a serious health problem affecting nearly half of the population, DLHS- 

RCH undertook direct measurement of haemoglobin levels among children under 6 years 

of age, adolescent girls aged 10-19 years and pregnant women aged 15-44 years by 

collecting blood sample in the field using filter paper technique and these samples were 

sent to the Institute for Research in Reproduction (IRR), Mumbai, for ascertaining the 

level of haemoglobin using proper pathological procedures. 

On the basis of the measurement of haemoglobin level, children, adolescent girls and 

pregnant women were classified as anaemic or not anaemic. Those identified in the 

anaemic group were further classified as suffering from mild, moderate and severe 

anaemia. The recommended level of haemoglobin for classifying pregnant women and 

children (6-71 months) into not anaemic, mild, moderate and severe anaemic categories 

are a minimum of 11.0 g/dl, 8.0–10.9 g/dl, 5.0–7.9 g/dl and less than 5.0 g/dl respectively. 

Whereas for adolescent girls the recommended haemoglobin levels for the same categories 

are a minimum of 12.0 g/dl, 10.0-11.9 g/dl, 8.0-9.9 g/dl and less than 8.0 g/dl. Percentage 

distribution of children below 6 years and adolescent girls aged 10-19 years according to 

anaemia levels by selected characteristics, and for pregnant women aged 15-44 years by 

place of residence are presented in Table 9.3 through Table 9.5. 

Anaemia is a common problem amongst children in this district. It can be noted from 

Table 9.3 that 96 percent of the children under 6 years of age suffer from some level of 

anaemia. Of these, 60 percent are mildly anaemic and rest 36 percent are moderately 

anaemic. Moderate anaemia is very high amongst children below six months of age (44 

percent), followed by 24-71 months (43 percent), and about 28 percent of the children in 

the age group of 12-23 months are suffering from moderate anaemia. There was no 

systematic pattern of relationship between prevalence of anaemia and other background 

characteristics, such as, sex, religion, and caste/tribe.

Table 9.3 ANAEMIA AMONG CHILDREN 

Percentage of children (aged 0-71 months) classified as having iron-deficiency anaemia by selected background 

characteristics, Ahmedabad district of Gujarat, RCH, 2002. 


Age of child (in months) 

0–5 

6–11 

12–23 

24–47 

48–71 

Sex of child 

Male 

Female 

Birth order 

1 

2–3 

4–5 

6+ 

Weight for age of child 

Normal 

Below –2 SD 1 

Below –3 SD 

Place of residence 

Rural 

Urban 

Religion 

Hindu 

Muslim 

Other 

Caste/tribe 

SC/ST 

Other 

Percentage of 

children with 

any anaemia 

94.4 

100.0 

98.1 

96.1 

94.9 

96.6 

95.8 

95.0 

96.1 

100.0 

100.0 

95.7 

97.3 

97.1 

98.4 

95.8 

96.5 

100.0 

84.6 

100.0 

95.5 

Mother’s education 

Illiterate 

95.3 

0-9 2 

99.0 

10 + 

Other 3 94.6 

95.7 


Low 

Medium 

High 

98.1 

96.8 

95.3 

Percentage of children with 

anaemia 

Mild 

anaemia 

50.0 

72.4 

55.6 

53.4 

66.7 

61.6 

58.3 

63.0 

54.5 

70.3 

42.9 

60.7 

59.1 

55.9 

72.1 

57.3 

60.9 

73.7 

23.1 

69.1 

58.3 

Moderate 

Anaemia 

44.4 

27.6 

42.6 

42.7 

28.2 

35.0 

37.5 

32.0 

41.6 

29.7 

57.1 

35.1 

38.2 

41.2 

26.2 

38.5 

35.6 

26.3 

61.5 

30.9 

37.2 

Number of 

children 

Total 96.3 60.1 36.1 321 

Note: Haemoglobin level between 8.0-10.9 g/dl is mild anaemia, 5.0-7.9 g/dl is moderate anaemia and below 5.0 g/dl is 

severe anaemia. 

1 

Includes children who are below –3SD from the International Reference Population median 

2 


3 

Women who were not present at the time of survey 



Different in prevalence of anaemia among the children of rural and urban is notices. 

Slightly more percent of the children in the urban areas were moderately anaemic (39 

percent) as compared to their counterpart in rural areas (26 percent). None of the children 

were severely anaemic. 

Prevalence of anaemia among adolescent girls of age 10-19 years by selected socioeconomic 

and demographic characteristics are shown in Table 9.4. It is real matter of 

concern that in the district, 303 out of a sample of 308 adolescent girls were having 

anaemia of different degrees, mild (28 percent), moderate (54 percent) and 18 percent of 

them were severely anaemic. Almost equal percent of the adolescents belonging to 

different religious group are anaemic. No systematic and major differences in the 

59.8 

57.1 

60.2 

73.9 

64.8 

66.3 

55.2 

35.5 

41.8 

34.4 

21.7 

33.3 

30.5 

40.1 

(18) 

29 

54 

103 

117 

177 

144 

100 

154 

37 

(7) 

211 

110 

34 

61 

260 

289 

(19) 

(13) 

55 

266 

107 

98 

93 

(23) 

54 

95 

172

prevalence of degrees of anaemia by residence, marital status and caste/tribe of the 

adolescents. Moderate to acute type of anaemia were more seen amongst educated girls. 

Twenty percent girls belonging to households with high standard of living were suffering 

from acute anaemia as against 18 percent of girls belonging to low and 13 percent of girls 

from medium standard of living households. 

Table 9.4 ANAEMIA AMONG ADOLESCENT GIRLS 

Percentage of adolescent girls (aged 10-19 years) classified as having iron-deficiency anaemia by degree of anaemia, 

according to selected background characteristics, Ahmedabad district of Gujarat, RCH, 2002. 


Age (in years) 

10–14 

15–19 

Marital status 

Currently married 

Not currently married 


Rural 

Urban 

Religion 

Hindu 

Muslim 

Other 

Caste/tribe 

SC/ST 

Other 

Education 

Illiterate 1 

1–9 

10+ 


Low 

Medium 

High 

Percentage of 

adolescent girls with 

any anaemia 

100.0 

99.4 

94.7 

100.0 

98.0 

100.0 

99.6 

100.0 

100.0 

100.0 

99.6 

96.3 

100.0 

100.0 

100.0 

98.9 

100.0 

Percentage of adolescent girls with 

Mild 

anaemia 

22.7 

31.1 

21.1 

28.0 

31.4 

26.8 

28.0 

24.0 

26.7 

20.9 

28.7 

Moderate 

anaemia 

61.7 

48.9 

52.6 

54.3 

58.8 

53.3 

52.6 

64.0 

66.7 

58.1 

53.6 

Severe 

anaemia 

15.6 

19.4 

21.1 

17.6 

7.8 

19.8 

19.0 

12.0 

6.7 

20.9 

17.4 

Number of 

adolescent 

girls 

Total 99.7 27.6 54.2 17.9 308 

Note: Haemoglobin level between 10.0-11.9 g/dl is mild anaemia, 8.0-9.9 g/dl is moderate anaemia and below 8.0 g/dl 

is severe anaemia. 

1 


SC/ST: Scheduled Caste/Scheduled Tribe 



Prevalence of anaemia among pregnant women aged 15-44 years by background 

characteristics are shown in Table 9.5. As outlined earlier in this section anaemia is 

classified into three categories - mild, moderate and severe on the basis of haemoglobin 

levels 8.0-10.9 g/dl, 5.1-7.9 g/dl and less than 5.0 g/dl respectively. The recommended 

haemoglobin count for classifying a pregnant woman as non-anaemic is 11.0 g/dl or more. 

25.9 

24.4 

36.8 

32.1 

32.2 

24.9 

55.6 

57.1 

46.1 

50.0 

54.0 

54.9 

14.8 

18.5 

17.1 

17.9 

12.6 

20.2 

128 

180 

(19) 

289 

51 

257 

268 

25 

(15) 

43 

265 

27 

205 

76 

28 

87 

193

Table 9.5 ANAEMIA AMONG PREGNANT WOMEN 

Percentage of pregnant women (age 15-44 years) classified as having iron-deficiency anaemia by degree of anaemia 

according to residence Ahmedabad district of Gujarat, RCH, 2002. 


Percentage of 

pregnant women 

with any anaemia 

Percentage of pregnant 

women with 

Mild 

anaemia 

Moderate 

anaemia 

Number of 

pregnant 

women 


Rural 

Urban 

100.0 

97.2 

71.4 

58.3 

28.6 

38.9 

(7) 

36 

Total 97.7 60.5 37.2 43 

Note: Haemoglobin level between 8.0-10.9 g/dl is mild anaemia, 5.0-7.9 g/dl is moderate anaemia and below 5.0 g/dl is 

severe anaemia. 


In the district, almost all 

pregnant women in the 

sampled households were 

found to be anaemic. 

Among those anaemic 

pregnant women, 61 percent 

are mildly anaemic and 37 

percent are moderately 

anaemic. There were no 

cases of severe anaemia 

amongst pregnant women in 

the district (Figure 9.1). 

Urban women are more 

vulnerable to anaemia with 

39 percent of the urban 

women moderately anaemic 

as compared to 29 percent of 

moderately anaemic rural women. The whole analysis indicates that there is an urgent 

need to make people aware about the ill effect of anaemia and the need to control it 

through better nourishment. Only a healthy and well-nourished woman can give birth to a 

healthy child and in turn will help in making a healthy nation. 

9.6 IODIZATION OF SALT 

Percent 

100 

80 

60 

40 

20 

0 

Figure: 9.1 

Anaemia among children, adolescent girls and 

pregnant women 

96.3 99.7 97.7 

60.1 


Consumption of salt fortified with iodine can prevent Iodine Deficiency Disorders, which 

are known to cause miscarriages, brain disorders, cretinism, and retarded psychomotor 

development. Under the Prevention of Food Adulteration Act, 1998, the minimum iodine 

content of edible salt is 30 parts per million (PPM) at the manufacturing level. A test kit 

was provided to each interviewer to measure the level of iodine content of salt consumed 

by the selected households. The test kit consists of stabilized starch solution, when a drop 

of which is put on edible salt it changes colour from light blue through dark violet as 

iodine level varies from 7 to 30 PPM. A confirmatory test is further carried out by putting 

a drop of acid-based solution on the starch based salt, if the colour does not change in the 

first test, the experimental result indicating the level of iodine content is finally recorded 

by matching the outcome of colour of the salt with that on the cover of the test kit. 

36.1 

0.0 

Children age 0-71 

months 

27.6 

54.2 

17.9 

Adolescent girls age 

10-19 years 

60.5 

37.2 

0.0 

Pregnant women aged 

15-44 

Any anaemia 

Mild aneamia 

Moderate anaemia 

Severe anaemia

Table 9.6 IODIZATION OF SALT 

Percentage distribution of households by degree of iodization of salt, according to selected background characteristics, 


Background Characteristic Not iodized 7 ppm 15 and 

higher ppm 

Residence 

Rural 

48.4 31.0 16.4 

Urban 

27.2 26.5 44.4 

Missing 

4.2 

1.9 

Total 

percent 

100.0 

100.0 

Number of 

households 

198 

809 

Caste# 

SC/ST 

Other 

43.3 

29.9 

20.8 

27.7 

33.0 

40.1 

2.9 

2.3 

100.0 

100.0 

127 

871 

Education 

Illiterate 

0-9@ years 

10 and above 

49.7 

34.5 

21.0 

22.6 

32.3 

24.5 

24.0 

29.9 

53.6 

3.7 

3.3 

1.0 

100.0 

100.0 

100.0 

169 

415 

423 


Low 

Medium 

High 

48.1 

41.0 

23.5 

37.1 

27.7 

25.6 

13.0 

29.8 

48.0 

1.8 

1.6 

2.9 

100.0 

100.0 

100.0 

Total 31.4 27.4 38.9 2.4 100.0 1007 

Note: ppm: Parts per million 


@ Literate person with no years of schooling are also included 

The percent distribution of households by degree of iodization of salt, according to 

background characteristics in Ahmedabad District, Gujarat, 2002 are shown in Table 9.6. 

It can be noticed that two-fifths of the households of this district (39 percent) use cooking 

salt that contains the minimum recommended 15 PPM or higher level of iodine and about 

31 percent households used salt that is not iodized at all. Use of minimum recommended 

iodized salt for cooking is used more by those in urban areas (44 percent), belonging to 

other caste (40 percent), literate with 10 and above years of schooling (54 percent) and 

belonging to high standard of living (48 percent) compared to this counterpart in rural 

areas (16 percent), illiterate (24 percent) and belonging to poor family (13 percent). 

102 

307 

598

ANNEXURE - II 

PSU 

NO. 

PSU NAME BLOCK NAME NO. OF 

RESIDENTIAL 

HOUSEHOLD 

POPULATION 

SIZE 

1 KAMATALAV DHANDHUKA 148 828 

2 INGOLI DHOLKA 289 1591 

3 NAVAGAM VIRAMGAM 210 1007 

4 TRENT VIRAMGAM 544 2739 

5 FEDRA DHANDHUKA 490 2615 

6 DADHANA VIRAMGAM 475 2404 

7 KASINDARA DASKROI 1186 6500 

8 LIHODA DEHGAM 996 5539

ANNEXURE – II 

USF NO. TOWN/CITY WARD BLOCK NO. POPULATION SIZE 

NAME 

1. 

VASTRAPUR (VP) 

2 10 3619 

2. VEJALPUR (VP) 18 10 4385 

3. AHMEDABAD (CANTT) 2 10 4895 

4. GHATLODIYA (NP) 4 10 5562 

5. DHANDHUKA (NP) 2 40 10777 

6. AHMEDABAD (MC) 3 10 20232 


8. KALI (NP) 1 20 29950 
























32. AHMEDABAD (MC) 38 10 161349

AHMEDABAD DISTRICT - Health and Family Welfare Department

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