Yet again confirming the prevalence of child marriages in India, a new health survey has revealed that more boys than girls are getting married before the legal age of 21 years.

The survey has also revealed that every fourth girl marrying in rural Rajasthan and every fifth in Bihar and Jharkhand are below the legal age of 18 years.

The Mean age at marriage of females varies from 19.7 in Rajasthan to 22 years in Uttarakhand. For males, the mean marriage age is 22.2 in Rajasthan and a maximum of 27.6 in Assam.

The survey also reveals for the first time that a woman on an average gives birth to more than three children in Uttar Pradesh, Bihar, Jharkhand and Rajasthan, with the highest of 5.9 children reported in Shrawasti district of Uttar Pradesh.

The Total Fertility Rate (TFR), the average number of children born to a woman during her entire reproductive span, is 3.6 for Uttar Pradesh and 3.7 for Bihar, where women in rural areas in both these states have a TFR of 3.9.

The Annual Health Survey was conducted by the Office of Registrar General, India in all the 284 districts (as per 2001 Census) in eight Empowered Action Group States of Bihar, Jharkhand, Uttar Pradesh, Uttarakhand, Madhya Pradesh, Chhattisgarh, Orissa and Rajasthan, besides Assam for a three year period 2007 to 2009, carried out in 2010 and 2011.

These nine states account for about 48 per cent of the total population, 59 per cent of total births, 70 per cent of Infant Deaths, 75 per cent of Under-5 Deaths and 62 per cent of Maternal Deaths in the country. They are the high focus states in view of their relatively higher fertility and mortality, Registrar General and Census Commissioner of India, C Chandramouli said.

The survey also reveals that usage of contraceptive methods by married women varies from 37.6 per cent in Bihar to 64.5 per cent in Rajasthan. Sitapur district in Uttar Pradesh has reported the least contraceptive usage (21.9 per cent) among married women, while 79.2 per cent in Ganganagar district of Rajasthan use some form of contraceptives.

At least 98 districts in surveyed states are reporting less than 50 per cent current usage of any method of family planning and only 12 districts - Damoh, Betul, Jabalpur (MP), Baleshwar (Odisha), Ganganagar, Hanumangarh, Jhunjhunu, Alwar, Udaipur, Dungarpur, Banswara (Rajasthan) and Jhansi (UP) feature in 70 per cent and above category. Incidentally, 35 out of 37 districts in Bihar have reported less than 50 per cent usage of any method of family planning.

The unmet need of contraceptives (i.e. women who want to stop having children or to postpone the next pregnancy for at least two years, but are not using contraceptives) varies from a minimum of 19.6 per cent in Rajasthan to 39.2 per cent in Bihar. The rural-urban gap on this indicator is prominent in Jharkhand, Bihar and Uttar Pradesh.

Baleshwar district (6.1 per cent) in Odisha and Sitapur district (61.3 per cent) in Uttar Pradesh are the two extremes across 284 districts on the unmet need of contraceptives. Incidentally, only 69 out of 284 districts the total unmet need for family planning is below 20 per cent, while Bihar and Uttar Pradesh dominate in 40 per cent and above category.

Uttar Pradesh has fared poorly in ante-natal care and immunisation of children. Across 284 districts, less than 1 per cent coverage of full ANC has been reported in Balrampur district of Uttar Pradesh, while Jagatsinghpur of Odisha reported the maximum (36 per cent).

Uttar Pradesh has reported the minimum coverage of 3.9 per cent while Chhattisgarh the maximum (19.5 per cent) of full ante-natal care, which comprises of three or more check-ups and at least one TT injection alongwith iron and folic acid consumption in first 100 days.

Institutional delivery is below 60 per cent in 170 districts out of 284. Balrampur (Uttar Pradesh) recorded the least of 16.8 per cent and Indore (Madhya Pradesh) the most of 92.5 per cent. Jharkhand reported the minimum of 47.1 per cent and Madhya Pradesh the maximum of 82.2 per cent safe deliveries.

About one-fourth of the districts have reported less than 50 per cent of safe deliveries. Of 14 districts reporting 90 per cent and above safe deliveries, 10 belong to Madhya Pradesh. Incidentally, at least every fifth mother did not receive any post-natal check-up across all annual health survey states. On immunisation, 90 districts reported below 50 per cent of full immunisation.

The minimum immunisation was observed in Rayagada (11.9 per cent) of Odisha and the maximum in Kanker (93.2 per cent) of Chhattisgarh.

All states except Uttar Pradesh have at least half of their children aged 12-23 months fully immunised. Uttar Pradesh has reported the minimum percentage (45.3 per cent) of children fully immunised whereas Uttarakhand the maximum (75.4 per cent).

Chandramauli said 161 indicators in all are available from Annual Health Survey (AHS) baseline, which include those on fertility, sex ratio, marriage, mortality and mother and child care, besides those on abortion, family planning practices, disability, housing and personal habits. He said the fieldwork for the baseline survey was carried out during July 2010 to March 2011.

Chandramauli said with present coverage, AHS is the largest demographic survey in the world and is two-and-half times that of the Sample Registration System.