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Once an ancient centre of power, learning and culture where two world religions have their roots, the state of Bihar is now often recognized as one of the poorest in India.

With more than 100 million people, Bihar is the country’s third most populous state. Located in eastern India with Nepal to its north, more than 40 per cent of the population live below the poverty line, mainly in rural areas with inadequate access to health, education and other services.

Bihar’s infant and maternal mortality rates are among the highest in India, as is the state’s proportion of underweight, malnourished children younger than three years old. UNICEF and its government partners are currently making significant progress, however, with health and nutrition programmes like the innovative Dular (‘care and love’) Strategy. This initiative trains thousands of volunteer village women who counsel families on the benefits of exclusive breastfeeding and provide other information vital to the survival of children and mothers who are pregnant or nursing.

Bihar is one of India’s last few states where the deadly polio virus continues to cripple children for life. UNICEF supports one of the world’s most intensive immunization campaigns against the disease, ensuring 20 million children are now regularly immunized monthly in a range of places including homes, trains, transportation centres, brick kilns, markets, slum areas, schools, at religious and local festivals and even during annual floods in make-shift huts (Basas) across Bihar.

The state is prone to severe flooding during the monsoon season, resulting in hundreds of people killed and lives of countless others destroyed, along with their livestock, fields and other assets. UNICEF works with the State Government to build stockpiles of emergency supplies and helps communities prepare and plan for disasters.

UNICEF is also assisting Bihar with a range of other concerns, including its high rates of child labour, school dropouts, and low learning levels and illiteracy, particularly among girls, Muslims and scheduled caste children, who face discrimination in the education system and society in general.

Challenges and Opportunities

Although the great religions of Buddhism and Jainism both flourished in the ancient Magadha empires of Bihar, the state had floundered in past decades until a new state government recently improved law and order, re-started development of crucial infrastructure and put a fresh focus on a weak manufacturing sector. About 90 per cent of the population have subsisted on small farming operations.
Recent improved governance has led to better health services, a decline in poverty, greater emphasis on education and a reduction in crime and corruption. Dramatic jumps in full immunization coverage and safe childbirths at medical facilities are also encouraging.

Still, the challenge of development in Bihar continues to be enormous due to persistent poverty, social inequalities, caste discrimination, rapid urbanization and poor infrastructure.

Key challenges and opportunities

• More than have the state’s children are underweight, a proportion which is higher than the Indian average.
• More than three quarters of children under three are anaemic, while more than 90 per cent of adolescent girls are deficient in iron.
• Bihar has among the highest rates of infant and maternal mortality in India, largely due to inadequate health services in rural areas. This is in spite of the number of safer institutional childbirths dramatically increasing from about one fifth to almost one half after a cash incentive for mothers was recently introduced.
• Less than five per cent of new mothers give their first milk, or colostrum, laden with invaluable immunity against disease to newborns. Only about one third exclusively breastfeed their babies for the first six months.
• Fewer than one child out of four suffering from diarrhoea receives lifesaving oral rehydration salts and zinc tablets.
• More than half of students drop out before finishing Grade Five although primary school enrolment has steadily increased to about 99 per cent and most communities have schools nearby.
• Only half of children in Grade Five achieve basic competency and only 37% of children complete Grade Four in four years.
• About two thirds of women in the state are illiterate, while more than half the men are able to read and write.
• About half of Bihar’s girls marry before they are 18, which is significantly higher than the Indian average.
• Bihar is one of the most vulnerable states for the spread of HIV in India due to a high level of income-seeking migration, poverty-induced trafficking of women and girls, and low awareness of HIV/AIDS.
• Fewer than one in five rural households has access to a toilet facility.
• Although communities were once fully supplied with water sources, an aging and inadequate maintenance system is jeopardizing this, as is an increase in arsenic and fluoride contamination.
• Bihar accounts for about 10 per cent of child labour in India with many working illegally as domestic servants and in workshops and factories.

UNICEF in Action

UNICEF has a long history in Bihar, having worked there for 30 years in all major development areas for women and children.

With the reduction of child malnutrition rates as one of its priorities, UNICEF has supported the Dular Strategy and demonstrated significant improvements in nutritional status of children by encouraging early and exclusive breastfeeding, debunking myths about colostrum, and providing information on adequate nutrition for nursing mothers and older children.

Similarly UNICEF supported the Sankalp programme to ensure school enrolment and regular attendance of all out-of-school children. Advocacy efforts have led the Government of Bihar to upscale the Dular Strategy and Sankalp programme to all districts.

UNICEF is also supporting the statewide introduction of key child survival and maternal health initiatives like routine immunization for childhood diseases, zinc and oral rehydration salts for diarrhoea treatment, and the training of skilled birth attendants.

Other UNICEF initiatives include:
Child Survival

• To address high infant mortality rates, UNICEF has been working with the State Government to set up an extensive newborn care system that includes the creation of sick newborn care units in state districts, a neonatal stabilization unit at block levels and training of health workers in villages to help families identify and seek prompt treatment for neonatal and childhood illnesses.
• To eradicate polio, UNICEF supports a ‘Social Mobilization Network’ that consists of a dedicated team of hundreds of people from village to district levels, who identify households with children and ensure they are immunized.
• To help prevent the spread of HIV, young volunteers recruited by UNICEF and its partners educate peers and their communities about HIV/AIDS prevention.
• UNICEF is assisting in the government’s Total Sanitation Campaign to encourage people to build and use household toilet facilities and follow proper hygiene practices. Sanitation, hygiene and hand-washing education in schools is also supported along with water quality activities.
• To improve the quality of services being offered in health institutions, UNICEF is assisting the State Government to achieve standards set by the Family Friendly Hospital Initiative (FFHI) and building the capacity of care providers on critical skills through skills laboratories.


• UNICEF supports government programmes that increase access, enrolment, retention, achievement and completion rates in elementary schools. UNICEF focuses on bringing dropouts and excluded children, especially girls, Muslims and scheduled caste children, into schools.
• Working with systems that enhance teacher support and performance, UNICEF is assisting with improvements in quality education and learning achievements of students.

Child Protection

• Working in collaboration with the Child Labour Commission and various government departments, UNICEF is decreasing the numbers of working children and rehabilitating rescued child labourers and returning them to school.
• Communication strategies used by UNICEF are educating people about such risks as child trafficking and child marriage.

Emergency Preparedness and Response

• UNICEF works with the State Government to build stockpiles of emergency supplies in flood-prone districts.
• UNICEF also helps communities make emergency preparedness plans, and supplies them with tent shelters, clean water storage tanks, purification tablets, latrines and basic medicines.

UNICEF State Office for Bihar
No. 8, Pataliputra Colony
Patna 800 013
Bihar, India

Tel: 91 0612 2275-722, 2261-621, 2261-728, 2275-720  
Fax: 0612 2262-620
Email: patna@unicef.org



For every child
Health, Education, Equality, Protection