Ministry of Health and India Family Welfare Government of India National Family Health 2005-06 Survey (NFHS-3) Volume I International Institute for Population Sciences Deonar, Mumbai 400 088 NATIONAL FAMILY HEALTH SURVEY (NFHS-3) 2005–06 INDIA VOLUME I September 2007 Suggested citation: International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS. For additional information about the 2005-06 National Family Health Survey (NFHS-3), please contact: International Institute for Population Sciences Govandi Station Road, Deonar, Mumbai - 400 088 Telephone: 022-2556-4883, 022-2558-3778 Fax: 022-2558-3778 E-mail: [email protected], [email protected] Website: http://www.nfhsindia.org For related information, visit http://www.iipsindia.org or http://www.mohfw.nic.in CONTRIBUTORS P.N. Mari Bhat Fred Arnold Kamla Gupta Sunita Kishor Sulabha Parasuraman P. Arokiasamy S.K. Singh H. Lhungdim In fond memory of the late Prof. P.N. Mari Bhat CONTENTS VOLUME I TABLES AND FIGURES....................................................................................................................xi FOREWORD..................................................................................................................................xxi PREFACE......................................................................................................................................xxiii ACKNOWLEDGEMENTS...............................................................................................................xxv SUMMARY OF FINDINGS...........................................................................................................xxix CHAPTER 1 INTRODUCTION 1.1 Background of the National Family Health Surveys....................................................1 1.2 Demographic Profile of India.....................................................................................2 1.3 Performance of Indian Economy................................................................................3 1.4 Performance of Social and Health Sectors..................................................................4 1.5 Population and Health Related Policies and Programmes...........................................5 1.6 Questionnaires..........................................................................................................8 1.7 Sample Design and Implementation........................................................................11 1.8 Recruitment, Training, and Fieldwork......................................................................16 1.9 Data Processing.......................................................................................................18 1.10 NFHS-3 Publications................................................................................................19 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age and Sex....................................................................21 2.2 Household Composition..........................................................................................23 2.3 Educational Attainment............................................................................................27 2.4 Household Characteristics.......................................................................................35 2.5 Household Possessions............................................................................................39 2.6 Wealth Index...........................................................................................................43 2.7 Birth Registration.....................................................................................................45 2.8 Children’s Work......................................................................................................47 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics......................................................................................53 3.2 Educational Attainment............................................................................................55 3.3 Literacy....................................................................................................................59 3.4 Exposure to Media...................................................................................................64 3.5 Employment Status..................................................................................................70 Contents | v CHAPTER 4 FERTILITY AND FERTILITY PREFERENCES 4.1 Fertility Levels..........................................................................................................77 4.2 Fertility Differentials and Trends..............................................................................79 4.3 Children Ever Born and Living.................................................................................86 4.4 Birth Order..............................................................................................................88 4.5 Birth Intervals..........................................................................................................88 4.6 Age at First Birth......................................................................................................91 4.7 Teenage Pregnancy and Motherhood......................................................................93 4.8 Desire for More Children.........................................................................................95 4.9 Ideal Number of Children.....................................................................................102 4.10 Sex Preference for Children..................................................................................103 4.11 Fertility Planning...................................................................................................107 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods..................................................................111 5.2 Ever Use of Contraceptive Methods......................................................................119 5.3 Current Use of Contraceptive Methods.................................................................120 5.3.1 Trends in Contraceptive Use.....................................................................125 5.3.2 Interstate Variation in Contraceptive Use..................................................128 5.3.3 Number of Children at First Use of Contraception....................................129 5.4 Use of Social Marketing Brands.............................................................................131 5.5 Sterilization...........................................................................................................134 5.5.1 Timing of Sterilization...............................................................................134 5.5.2 Interstate Variation in the Timing of Sterilization.......................................135 5.5.3 Methods Used before Sterilization............................................................136 5.6 Source of Family Planning Methods......................................................................137 5.6.1 Interstate Variation in the Role of the Public Sector...................................140 5.6.2 Cost of Contraception...............................................................................141 5.7 Informed Choice..................................................................................................142 5.7.1 State Level Variations in Informed Choice.................................................143 5.8 Contraceptive Discontinuation..............................................................................145 5.8.1 State Level Variation in Discontinuation Rates...........................................146 5.9 Future Use of Contraception.................................................................................147 5.10 Reasons for Not Intending to Use a Contraceptive Method in the Future..............148 5.11 Preferred Method of Contraception for Future Use...............................................149 5.12 Exposure to Family Planning Messages..................................................................150 5.13 Knowledge and Information among Non-Users about Family Planning..................153 5.14 Husband’s Knowledge of Wife’s Use of Contraception.........................................155 5.15 Men’s Attitudes about Contraception....................................................................155 5.16 Need for Family Planning.....................................................................................157 vi | Contents CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Introduction.........................................................................................................161 6.2 Current Marital Status...........................................................................................161 6.3 Age at First Marriage.............................................................................................163 6.4 Age at First Sexual Intercourse..............................................................................167 6.5 Recent Sexual Activity...........................................................................................170 6.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility..................................174 6.7 Menopause..........................................................................................................176 6.8 Non-Live Births.....................................................................................................176 CHAPTER 7 INFANT AND CHILD MORTALITY 7.1 Infant and Child Mortality.....................................................................................179 7.2 Levels and Trends.................................................................................................179 7.3 Socioeconomic Differentials.................................................................................183 7.4 Demographic Differentials....................................................................................183 7.5 State Differentials.................................................................................................186 7.6 Perinatal Mortality................................................................................................187 7.7 High-Risk Fertility Behaviour.................................................................................190 CHAPTER 8 MATERNAL HEALTH 8.1 Antenatal Care......................................................................................................192 8.1.1 Health Problems during Pregnancy...........................................................192 8.1.2 Antenatal Care Provider ...........................................................................193 8.1.3 Number and Timing of Antenatal Care Visits.............................................196 8.1.4 Components of Antenatal Care.................................................................198 8.1.5 Antenatal Care Services and Information...................................................199 8.1.6 Male Involvement in Antenatal Care.........................................................201 8.1.7 Antenatal Care Indicators by State............................................................203 8.1.8 Ultrasound Testing during Pregnancy........................................................205 8.2 Delivery Care.......................................................................................................208 8.2.1 Place of Delivery......................................................................................208 8.2.2 Information Given to Men........................................................................211 8.2.3 Assistance during Delivery........................................................................214 8.2.4 Delivery Characteristics.............................................................................216 8.3 Postnatal Care......................................................................................................216 8.3.1 Timing of First Postnatal Check-up............................................................216 8.3.2 Type of Provider of First Postnatal Check-up.............................................218 8.4 Postpartum Complications....................................................................................219 8.5 Maternal Care Indicators by State.........................................................................220 8.6 Trends in Maternal Care Indicators.......................................................................221 Contents | vii CHAPTER 9 CHILD HEALTH 9.1 Child’s Size at Birth...............................................................................................224 9.2 Vaccination Coverage...........................................................................................227 9.2.1 Trends in Vaccination Coverage................................................................232 9.3 Child Morbidity and Treatment.............................................................................233 9.3.1 Acute Respiratory Infection.......................................................................234 9.3.2 Fever........................................................................................................237 9.3.3 Diarrhoea.................................................................................................239 9.3.4 Diarrhoea Treatment................................................................................240 9.4 Feeding Practices and Knowledge of ORS Packets................................................246 9.5 Disposal of Children’s Stools.................................................................................250 9.6 Utilization of ICDS................................................................................................252 9.6.1 Coverage of Anganwadi Centres................................................................253 9.6.2 Utilization of ICDS by Children in Areas Covered by an Anganwadi Centre....................................................................................255 9.6.3 Utilization of ICDS by Pregnant and Lactating Mothers.............................263 CHAPTER 10 NUTRITION AND ANAEMIA 10.1 Nutritional Status of Children................................................................................267 10.2 Breastfeeding and Supplementation......................................................................274 10.2.1 Initiation of Breastfeeding.........................................................................275 10.2.2 Breastfeeding Status by Age......................................................................278 10.2.3 Duration and Frequency of Breastfeeding.................................................280 10.2.4 Types of Supplemental Food.....................................................................282 10.2.5 Infant and Young Child Feeding Practices.................................................284 10.3 Prevalence of Anaemia in Children.......................................................................287 10.4 Micronutrient Intake among Children...................................................................291 10.5 Salt Iodization.......................................................................................................295 10.6 Food Consumption of Women and Men..............................................................298 10.7 Nutritional Status of Women and Men..................................................................303 10.8 Anaemia among Women and Men.......................................................................309 CHAPTER 11 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 11.1 Knowledge of AIDS and Sources of Knowledge.....................................................315 11.1.1 Knowledge of HIV Prevention Methods....................................................321 11.1.2 Knowledge of Transmission.......................................................................324 11.1.3 Knowledge of HIV/AIDS Transmission from a Mother to Her Child...........330 11.1.4 Knowledge of HIV/AIDS across States.......................................................332 11.2 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS..........................334 11.3 Attitudes toward Negotiating Safer Sex.................................................................339 11.4 Higher-Risk Sex....................................................................................................342 11.4.1 Multiple Sexual Partners and Higher-Risk Sex...........................................343 11.4.2 Paid Sex...................................................................................................348 11.5 Testing for HIV.....................................................................................................351 viii | Contents 11.6 Reports of Recent Sexually Transmitted Infections................................................354 11.7 Blood Transfusions and Injections.........................................................................357 11.8 HIV/AIDS-Related Knowledge and Behaviour among Youth..................................362 11.8.1 Knowledge about HIV/AIDS and a Source for Condoms...........................362 11.8.2 Age at First Sex and Condom Use at First Sex...........................................367 11.8.3 Recent Sexual Activity among Unmarried Youth.......................................370 11.8.4 Higher-Risk Sex........................................................................................373 11.8.5 Age-Mixing in Sexual Relationships...........................................................375 11.8.6 HIV Testing...............................................................................................375 11.9 Attitudes toward Family Life Education in Schools.................................................377 CHAPTER 12 HIV PREVALENCE 12.1 Coverage of HIV Testing in NFHS-3......................................................................387 12.2 HIV Prevalence.....................................................................................................392 12.2.1 HIV Prevalence by Background Characteristics.........................................393 12.2.2 HIV Prevalence by Demographic Characteristics.......................................393 12.2.3 HIV Prevalence by Sexual Behaviour........................................................395 12.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk....................397 12.3 HIV Prevalence by State.......................................................................................399 12.4 HIV Prevalence among Couples............................................................................399 12.5 HIV Prevalence among Young People...................................................................401 12.6 Nonresponse Analysis...........................................................................................404 Chapter 12 Appendix.......................................................................................................406 CHAPTER 13 MORBIDITY AND HEALTH CARE 13.1 Tuberculosis (TB)..................................................................................................411 13.1.1 Prevalence of Tuberculosis (TB)................................................................411 13.1.2 Prevalence of Tuberculosis by Type of Housing and Fuel..........................412 13.1.3 Prevalence of Tuberculosis by State..........................................................415 13.1.4 Knowledge and Attitude toward Tuberculosis...........................................415 13.1.5 Knowledge and Attitude toward Tuberculosis by State..............................418 13.2 Health Problems...................................................................................................421 13.2.1 Health Problems by State..........................................................................425 13.3 Use of Tobacco....................................................................................................426 13.3.1 Use of Tobacco by Background Characteristics.........................................428 13.4 Use of Alcohol......................................................................................................429 13.4.1 Use of Tobacco and Alcohol by State........................................................432 13.5 Health Insurance Coverage...................................................................................434 13.6 Source of Health Care..........................................................................................436 13.6.1 Reasons for Not Using Government Facilities by State...............................437 13.7 Recent Visits to a Health Facility...........................................................................440 13.7.1 Recent Contacts with Health Workers.......................................................443 13.7.2 Matters Discussed with Health Workers....................................................444 13.7.3 Quality of Health Care Indicators by State................................................445 13.8 Problems in Accessing Health Care.......................................................................447 Contents | ix