Fertility and Family planning

Over the six year period between NFSH1 and NFHS-2, the average number of children per women (TFR) has declined by about half a child.

Maharashtra's TFR is much lower than the current National TFR of 2.9.

• Rural women have half a child more on average than urban women
   
• Women aged 15-19 account for 26% of total fertility. This young age of child bear ing increases the health and morbidity risks for the mothers and children, and cont ributes to high fertility.

• Almost one third of married women want to stop childbearing (20%), postpone their next birth by at least two years (10%), or have already opted for sterilisation (52%)
   
• The preferences expressed by women indicate a need for contraceptive methods to both space and limit births.

• Knowledge of the Pill, IUD and condom has improved, but use of these methods (only 8% of users) remains low. These are useful for women who want to space their next births, a preference expressed by 10 percent of women.

• Research in low-income countries has  shown that spacing births by at least two years may prevent an average of one in four infant deaths.
   
• The picture that emerges from NFHS-2 data is one of good progress, but women still marry early having their first child soon after marriage, and use contraception only after completing their childbearing.

Few Contraceptive users receive essential information 

• Exposure to media is moderately high. About 62 percent saw or heard a message on family planning during the months before the survey. Nevertheless about 2 out of 5 women are not regularly exposed to family planning messages.
   
• Among women currently using contraception, few were told about other methods or side effect of their current method. This reflects a low quality of services.
   
• The situation is better for follow up services: about 75% of users received follow up after accepting their current method.

Public  medical sector remains an important source of contraceptives.

• 75% of users of modern contraceptives obtained their method from the public medical sector, the same as in NFHS-1 Government sources are particularly important in rural areas ( 86 %)
   
• In both urban and rural areas, the public medical sector is the main source of supply for sterilisation. However, in urban areas, 28 percent of female sterilisations occur in the private sector, compared to only 9 percent on the rural areas.

• Only half of the women report having a voice in decisions about their own health
   
• Younger women are much less likely than older women to participate in decisions about their own health care.
   
• Urban, non-slum women, and women with a middle school or higher education are more likely to be involved in decisions regarding their health care.

Maternal health services improve.

• 90 percent of mothers received at least one ante-natal check up from 1992 (85% of births)
   
• 75 percent of mothers received 2 or more doses of tetanus toxoid vaccine, up slightly from NFHS-1
   
• 85 percent of mothers received iron folic acid supplementation. Of those, only 84 percent received the recommended 3 month course.
   
• Professional assistance at delivery increased to 60% in NFHS-2.

• About two-fifths of women are malnourished, with a body Mass Index below 18.5 Kg/ m
   
• Nearly one -third of pregnant have moderate to severe Anaemia, compared to non- pregnant women.
   
• Anaemia can undermine women's health and is associated with an increased risk of maternal mortality and pregnancy loss. Anaemia may also lead to lower energy and reduced work capacity.

Child survival and Infant survival still a challenge

• Infant mortality declined from 58 deaths per 1000 births during 1984-1988 to 44 deaths in 1994-1998, an average rate of decline of 1.4 infant deaths per 1000 live births per year.
• Maharashtra has the seventh lowest infant mortality rate in the country, however, despite the decline, one every 23 infants die be fore age one and one in 17 die before reaching age five
   
• Infant mortality is 55 % higher among children born to mothers under age 20, than among children born to mothers age 20-29.

Immunisation coverage high

• Between NFHS-1 & NFHS-2, the proportion of children who received no immunisation dropped from 8% to 2%.
   
• The proportion of children who received at least one vaccine is nearly 98%, while 78% are fully immunised.
• Despite high rates, more than 1 in 3 of illiterate mothers and children belonging to schedule tribes are not fully immunised.

Many children are Anaemic

• Overall three-fourths of children under age three are Anaemic. Most of these children suffer from mild to moderate Anaemia.
   
• Anaemic children are at greater risk of infection, impaired mental skills, physical development and poor school performance. 

• Half of children under age three suffer from low weight for age-also called as under weight, a measure of both short and long term under nutrition.
   
• The same proportion are undernourished to the extent their growth has been stunted, they suffer from low height-for-age(40%)
  
  About one in five children have both low height and low weight, also called as Wasting.
   
• Wasting is associated with a failure to receive adequate nutrition in the period immediately before the survey and may be the result of seasonal variations in food supply or recent episodes of illness.
   
• The percentage of under weight children has remained unchanged since the early 1990's.
   
• Poor feeding practices begin in infancy. Only about two in five infants under four months are exclusively breastfed, and only 31 % of those aged 6-9 months are being fed solid and mushy foods. Starting food supplements at 6 months is critical for meeting Protein, Energy and micronutrient needs