DISTRICT NUTRITION PROFILE Darbhanga, Bihar DISTRICT DEMOGRAPHIC PROFILE1 Total Population 3,937,385

52.3% 47.7% MALE FEMALE 9.7% 90.3% URBAN RURAL Darbhanga ranks 556th 15.6% 0.1% 84.3% amongst 599 districts in India2 SC ST OTHERS DISTRICT DEVELOPMENT INDEX (2015)

THE STATE OF NUTRITION IN DARBHANGA3,4,5 49%

CHILDREN 69.9 STUNTED 63.5

49 48.3 43.9 16.6% 41.1 CHILDREN 31.2 30.4 20.8 WASTED 16.6 7.9 9.5 41.1% 0.8 0.6 Children stunted Children wasted Children Children with any Women Children with Adults who are CHILDREN (<5 yr) (%) (<5 yr) (%) underweight anemia underweight (BMI birthweight obese in the UNDERWEIGHT NFHS 4 (2015-2016) NFHS 4 (2015-2016) (<5 yr) (%) (0-59 mo) (%) <18.5) <2500gms district NFHS 4 (2015-2016) NFHS 4 (2015-2016) (15-49 yr) (%) (0-2 mo) (%) (18-59 yr) (%) NFHS 4 (2015-2016) CHHNS 7 (2015) CAB (2014) Darbhanga Bihar

CHANGES OVER TIME IN ANEMIA3,5,6,7

97.6 78 80.7 63.5 PREVALENCE OF 99.7 ANEMIA AMONGST 69.9

CHILDREN UNDER-SIX No Data 79.2 DECREASED IN THE DISTRICT BETWEEN !2002 AND 2016 DLHS 2 (2002-2004)^ NFHS 3 (2005-2006)^^ CAB (2014)^^ NFHS 4 (2015-2016)^^ ^Children 0-71 months with <11 g/dl Darbhanga Bihar ^^Children 0-59 months with <11 g/dl

Page 1 13 HOW CAN NUTRITION IMPROVE? WHAT FACTORS CAUSE UNDERNUTRITION? The most crucial period for child nutrition is Optimum fetal and child nutrition and development from pre-pregnancy to the second year of life2 IMMEDIATE CAUSES 100 Breastfeeding, nutrient rich foods, and eating routine 90 Feeding and caregiving practices, parenting stimulation 80 Low burden of infectious diseases 70 60 UNDERLYING CAUSES Food security: availability, economic access and use of food 50 Feeding and caregiving resources (maternal, household and 40 community level) 30 Access to and use of health services, a safe and hygienic environment Window of Too late 20 opportunity 10 Percentage of child stunting of child stunting (%)Percentage BASIC CAUSES 0 Knowledge and evidence Politics and governance Leadership, capacity and financial resources Social, economic, political, and environmental context Age of child (in months) (national and global) Child undernutrition is caused by inadequacies in food, health and care for infants and young children, especially in the first two years of life (immediate causes). Inadequate food, health and care arise from food insecurity, unsanitary living conditions, low status of women, and poor health care (underlying causes). These are, in turn, caused by social inequity, economic challenges, poor political will and leadership to address these causes (basic causes). Interventions to address undernutrition must address these multiple causes of undernutrition and do so in an equitable manner. IMMEDIATE CAUSES OF UNDERNUTRITION IMMUNIZATION & INFANT AND YOUNG CHILD FEEDING3 DISEASE BURDEN3 SUPPLEMENTATION3

70.7 61.4 61.7 62.3 53.5 52.9 44.7 45.2 34.9 34.1 30.7 22.6 15.2 7.3 10.4 5.1 4.9 2.5

Children breastfed Children exclusively Children who Children who Children with full Children who got Children suffering Children with Children showing within one hour of breastfed received any achieve minimum immunization vitamin A from diarrhoea in diarrhoea treated symptoms of ARI birth (0-6 mo) (%) solid/semi solid diet diversity coverage supplementation the last 2 weeks with ORS (<5 yr) (%) (<3 yr) (%) NFHS 4 (2015-2016) food in the last 24 (6-23 mo) (%) (12-23 mo) (%) (9-59 mo) (%) (<5 yr) (%) (<5 yr) (%) NFHS 4 (2015-2016) NFHS 4 (2015-2016) hours NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) (6-8 mo) (%) NFHS 4 (2015-2016)

ADOLESCENT & MATERNAL HEALTH3,5

100.0 Areas for action: 99.2 • Poor state of infant and young child feeding: Very few infants are 62.3 breastfed within on hour of birth, diet diversity rates are poor 58.3 • Less than half of children suffering from diarrhoea receive ORS • Alarming levels of anaemia among adolescent girls 34.6 • Less than half of women in the district report having received ANC in 25.4 the first trimester

Data challenges: Women who received Anemia among Anemia among Where data are available, indicator definitions are non-standardized ANC in the first pregnant women adolescent girls • trimester (15-49 yr) (%) (10-19 yr) (%) and often differ from World Health Organisation recommendations (15-49 yr) (%) NFHS 4 (2015-2016) DLHS 2 (2002-2004) NFHS 4 (2015-2016)

Darbhanga Bihar

Page 2 UNDERLYING CAUSES OF UNDERNUTRITION

WOMEN’S STATUS3 WATER, SANITATION AND HYGIENE1,4,7

99.9 98.2

75.8 73.5 73.3

49.6 43.5 41.2 39.1 No Data 27.7 25.2 22.8 23.9 23.0 20.8 18.7 21.2 12.2 11.5

Women who are Women who Girls married 15-19 year old Total unmet needHouseholds with Households with Households Households Households literate completed 10 or when <18 years women who are for family access to access to practicing open disposing of child washing hands (15-49 yr) (%) more years of old mothers or planning improved improved defecation (%) stool in a sanitary with soap before schooling (20-24 yr) (%) pregnant methods among drinking water sanitation manner (%) meals (%)^ NFHS 4 (2015-2016) (15-49 yr) (%) (%) women sources (%) facilities (%) Census (2011) NFHS 4 (2015-2016) (15-49 yr) (%) NFHS 3 (2005-2006) CHHNS 7 (2015) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016) NFHS 4 (2015-2016)

FOOD SECURITY 9 SOCIO ECONOMIC CONDITIONS 1,9,14,15

53.2 55.2 48.1 49.4 47.3 49.2 50.9 48.1 39.4 34.1 34.8 34.1

15.8 16.4

Household share of Household share of Households in the Households Below Households ownership Households living in a Household access to expenditure on food food expenditure on district involved in Poverty Line (%) of agricultural land (%) pucca house (%) electricity (%) (%) cereals (%) agriculture (%) NSS 68th round (2011-2012) NSS 68th round (2011-2012) Census (2011) Census (2011) NSS 68th round (2011-2012) NSS 68th round (2011-2012) NSS 68th round (2011-2012) Darbhanga Bihar Areas for immediate action: • Very high rates of open defecation; critical need to increase awareness about washing hands with soap and ensuring access to using improved sanitation facilities • Early marriage of girls less than 18 years is highly prevalent; early marriage is related to poor health and nutrition outcomes for mothers and babies • Less than half of women in the district are literate • Very fe households lie i a pucca house ad hae access to electricity Data challenges: • Outdated data on open defecation • No district-level data on child stool disposal

BASIC CAUSES OF UNDERNUTRITION 1,8,9

97.8 91.7 66.0 57.2 46.1 50.4 38.1 44.4

Adult literacy rate (%) Households with access to primary/middle Households who demanded and received Households availing banking services (%) Census (2011) school (%) work through NREGA (%) Census (2011) DLHS 3 (2007-2008) NSS 68th round (2011-2012)

Darbhanga Bihar

• Per capita gross district domestic product of Darbhanga ranked 19th amongst 38 districts of Bihar in 2011-1215 • Bihars per capita icoe raked last amongst 32 major States/UTs in India in 2011-1216

• Action needs to be taken to improve adult literacy which is low • No data available on indicators of governance and political will to address nutrition Page 3 EVALUATION OF HEALTH AND NUTRITION SCHEMES3,4,8,9,12

91.3 91.7 83.3 86.8 63.8 47.1 37 32.7 31.0 No No Data 13.7 8.2 9.4 6.2

Institutional deliveries Home births attended by New born received check up Households (with 12-23 mo Households with access to Households with access to a Households that received (Women 15-49 yr) (%) skilled health personnel within 24 hours of child) with an Anganwadi worker (%) Sub-Health Centre (%) financial assistance for NFHS 4 (2015-2016) (Women 15-49 yr) (%) birth/delivery (%) immunization/MCP card (%) DLHS 3 (2007-2008) DLHS 3 (2007-2008) delivery and childcare (%) NFHS 4 (2015-2016) RSOC (2013-2014) CHHNS 7 (2015) CHHNS 7 (2015)

Areas for immediate action: • Access to skilled health personnel and Sub-Health Centres is very limited 42.6 40.3 43.9 34.4 • Less than half of eligible households receive any take home No No Data 21.7 ration • Poor access to financial assistance for delivery and child care Households that receive any Women who received THR Households with access to take home ration (%) during pregnancy (%) PDS (%) • Majority of households do not have PDS access CHHNS 7 (2015) RSOC (2013-2014) NSS 68th round (2011-2012) Data challenges: • Lack of data on assessing the implementation of government Darbhanga Bihar schemes FLW visits4 Last Trimester^ Within 1 week of delivery* Within 24 Less than Equal to More than Less than Equal to More than hours of

recommended recommended recommended recommended recommended recommended delivery

Bihar 4.1% 6.7% 22.5% 26.4% 5.7% 5.4% 34.1%

Darbhanga 7.9% 7.7% 15.3% 23.9% 2.9% 8.4% 29.9% ^2 recommended visits; *3 recommended visits

Data sources 1. Census of India. 2011. Primary Census Abstract. Accessed June 6, 2015, www.censusindia.gov.in/pca/default.aspx Census of India. 2011. Houselisting and Housing Census Data. Accessed March 18, 2015, www.censusindia.gov.in/2011census/hlo/HLO_Tables.html 2. Us-India Policy Institute. 2015. District Development and Diversity Index. Accessed July 2, 2015, http://www.usindiapolicy.org/updates/general-news/225-district-development-and-diversity-index- report 3. National Family Health Survey (NFHS-4), 2015-16, India. Mumbai: International Institute for Population Studies. 4. Concurrent Household Health and Nutrition Survey (Round-7), Concurrent Monitoring and Learning Unit, CARE India – Bihar 5. Census of India. 2014. Clinical, Anthropometric & Bio-chemical (CAB) survey. http://www.censusindia.gov.in/2011census/hh-series/HH-2/Bihar%20CAB%20Sample%20Characteristics%202014.pdf 6. Authors estimates based on District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India. International Institute for Population Studies. (IIPS). 2006. District Level Household Survey on Reproductive and Child Health (DLHS-2), 2002-04, India: Nutritional Status of Children and Prevalence of Anemia among Children, Adolescent Girls and Pregnant Women. Mumbai: IIPS. March 18, 2015, www.rchiips.org/pdf/rch2/National_Nutrition_Report_RCH-II.pdf 7. Authors estimates based on National Family Health Survey (NFHS-3), 2005-06, India. Mumbai: International Institute for Population Studies. 8. International Institute for Population Studies (IIPS). 2010. District Level Household Survey and Facility Survey (DLHS-3), 2007-08, India, Bihar. Mumbai: IIPS. Accessed June 28, 2015, http://rchiips.org/pdf/rch3/report/BH.pdf 9. Authors estimates based on Household Consumption Expenditure, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India Authors estimates based on Employment and Unemployment, National Sample Survey Office (NSSO) 68th Round, 2011-12. Ministry of Statistics and Program Implementation. Government of India 10. Finance Department, Government of Bihar. Economic Survey Report 2011-12: Gross District Domestic Product at Constant Prices (2005-06). Accessed March 18, 2015, http://finance.bih.nic.in/Documents/Reports/Economic-Survey-2012-EN.pdf 11. Government of India. 2014. State-wise Per Capita Income and Gross Domestic Product at current prices. Accessed July 2, 2015, http://pib.nic.in/archieve/others/2014/aug/d2014070801.pdf 12. UNICEF. 2013-2014. Rapid Survey on Children (RSoC). http://wcd.nic.in/RSOC/21.RSOC_Bihar.pdf 13. Robert E Black, Cesar G Victora, Susan P Walker, Zulfiqar A Bhutta, Parul Christian, Mercedes de Onis, Majid Ezzati, Sally Grantham-McGregor, Joanne Katz, Reynaldo Martorell, Ricardo Uauy, and the Materal ad Child Nutritio Study Group. . “Maternal and Child Undernutrition and Overweight in Low-Income and Middle-Icoe Coutries”. The Lancet 382 (9890), 427-451. 14. Planning Commission. 2013. Press note on poverty estimates, 2011-12. Government of India. Accessed March 18, 2015. http://planningcommission.nic.in/news/pre_pov2307.pdf 15. Government of Bihar. 2015. Economic Survey 2014-15. Accessed July 2,2015, http://finance.bih.nic.in/Documents/Reports/Economic-Survey-2015-EN.pdf 16. Government of India. 2014. State-wise Per Capita Income and Gross Domestic Product at current prices. Accessed July 2, 2015, http://pib.nic.in/archieve/others/2014/aug/d2014070801.pdf 17. Photo Credit: Stephan Rebernik. 2012. https://www.flickr.com/photos/stephanrebernik/7316902886/in/photolist-c9z3j3-84jAhD-dBqB49-bvwZKN-r9S16m-7hbFtw-ww5wR-k32J4Y-9EU6Yp-aMYGun- qRTqtX-ecqSzg-gqsndt-dgcPVa-rir84x-e7rvKp-4W6FEL-b4cBSB-5Fobvq-gkNLN6-97MFur-52bDg-aE6CHE-5CWZqw-89D8Wg-C2Xyr-5JVCfB-8HyAVb-95jZH-96TGaG-89Daqn-hZXBgK-btaPQj-d4x1D9- kF5uPx-97MTqk-89D9ia-pSsahb-3fr98n-47wCFN-5dVprx-zfuF1-dB9Zrp-ww5c6-sq8LAW-8kUfxq-9ydJB-kqG1vB-aashk1-7a41P1

This District Nutrition Profile was developed by Nitya George and Srabashi Ray for POSHAN. Version: 20-04- 2016