In­dia is worst on in­fant mor­tal­ity

Alive - - Contents - by T Ra­jagopalan

Noth­ing can be worse than this. Up­wards three lakh new­borns in In­dia take their last birth on the very first day of their ar­rival into this planet in which we all dwell. With this the coun­try ranks as num­ber one in terms of birth mor­tal­ity; its share in global first day deaths stands at 29%. The sor­row­ful and ap­palling state of In­dian health­care to which this speaks is fur­ther high­lighted by the stark fact that the next worst per­former - Nige­ria is a dis­tant sec­ond with less than 90,000 deaths a year and a 9% share of global deaths. These are some of the sta­tis­tics in the “State of the World’s Moth­ers” re­port re­leased by “Save the chil­dren” in re­cent times. With 20,000 deaths a year ago (1917), Bangladesh is not only bet­ter off then In­dia, but is also dozen na­tions that are de­vel­op­ing which have made the great­est strides in achiev­ing a sig­nif­i­cant de­cline in deaths be­tween 1990 and 2012. As one of the most pop­u­lous coun­tries, next only to China it is in­evitable In­dia may con­tinue to reg­is­ter greater num­ber of deaths even if it achieves an ap­pre­cia­ble de­cline in per­cent­age mor­tal­ity. Hence it must si­mul­ta­ne­ously adopt mul­ti­ple strate­gies and with greater ur­gency, for a sub­stan­tial re­duc­tion in the num­ber of new­born demises. Wonderful gain can be achieved by pre­vent­ing child­hood mar­riages as teenage preg­nan­cies im­mensely con­trib­ute to first day deaths.

Power stricken moth­ers in ru­ral ar­eas are an­other at risk group that calls for un­di­vided fo­cus. If poor health be­fore and dur­ing preg­nancy is al­ready a huge risk fac­tor, paucity of good med­i­cal care dur­ing preg­nancy ex­ac­er­bates it. This brings to spot­light the dire ne­ces­sity to have a greater per­cent­age of in­sti­tu­tional de­liv­er­ies. 40% of moth­ers de­liver at health­care fa­cil­i­ties in sub­Sara­han Africa.

Why itʼs on high?

Al­beit In­dia’s na­tional av­er­age of 73% is much higher than sub-Sa­ha­ran Africa’s why is neo-na­tional mor­tal­ity high in many states? For ex­am­ple Mad­hya Pradesh, Ut­tar Pradesh and Odisha have high new­born (0-7 days) deaths, in spite of hav­ing high in­sti­tu­tional de­liv­er­ies of 63% and 53% re­spec­tively. This un­palat­able fact is the ques­tion­able qual­ity of care of host of these fa­cil­i­ties.

The per­son­nel at­tend­ing to these de­liv­er­ies are quite of­ten not well trained and hence not pro­fi­cient in labour-room pro­to­cols. In­stances are not rare when newly ap­pointed nurses at­tend­ing to de­liv­er­ies cul­mi­nat­ing not only in the deaths of the still to be born chil­dren but also the deaths of moth­ers. Labour rooms are not al­ways fully equipped with es­sen­tial medicines, equip­ment and elec­tric­ity. All these oc­ca­sion in the in­con­gruity be­tween more fa­cil­i­ties but poor out come. States must there­fore em­u­late the Tamil Nadu model where women friendly pub­lic ser­vices are pro­vided by fully equipped health cen­tres with well trained nurse round the clock to en­sure safe de­liv­er­ies.

In­dia loses 4200 chil­dren un­der the age of five daily, this fig­ure still alarm­ing and un­ac­cept­able. A string of these deaths is pre­ventable. Added to this is the wide preva­lence of child mar­riages, anaemia among young women and to­tal lack of fo­cus on ado­les­cent san­i­ta­tion, all im­pact­ing child death rates.

Its share in global first day deaths stands at 29%.

Whereas In­dia in re­cent years has made no­table achieve­ments in bring­ing down deaths per 1000 live births (in­fant mor­tal­ity) deaths in less than 4 weeks of birth (neona­tal) and un­der five mor­tal­ity are the ar­eas that can doubt­less do with some more at­ten­tion.

U5 MR

U5 MR and In­dian states, In re­cent times Un­der Five Mor­tal­ity Rate (U5MR) had come down dras­ti­cally, faster than world av­er­age. In­dia had reg­is­tered a fall of 48 be­tween 1990 and 2011. In terms of num­bers 2011 saw U5MR de­cline pre­cip­i­tously by roughly half to 60% live births.

This should be a wel­come im­prove­ment for the bat­tling in­fant deaths in the coun­try. But given the enor­mous size of the na­tion ac­com­plish­ments in slash­ing down mor­tal­ity are not re­gret­tably uni­form. While some states had faired ex­tremely there are oth­ers which have fallen far be­hind. While Ker­ala is in the fore­front in re­duc­ing the in­fant mor­tal­ity; Tamil Nadu, Ma­ha­rash­tra, Kar­nataka, Andhra Pradesh in­clud­ing Te­lan­gana have bucked the na­tional fall of 7.25% be­tween 2008 and 2014. Haryana and Bi­har with a dwin­dling rate of 7% have to just touch the na­tional av­er­age.

Among the big­ger States that fare badly are Jhark­hand and Mad­hya Pradesh with As­sam keep­ing company to them. West Ben­gal and Pun­jab, Jammu & Kash­mir, Ut­tar Pradesh, Ra­jasthan and Ch­hatis­garh are just be­low the na­tional av­er­age.

Just as there are vari­a­tions among States in cut­ting down child deaths, there are wide dis­par­i­ties within the States as well. For ex­am­ple in As­sam, the U5MR in Kokra­jhar is twice that of Dhe­maji district. In Ch­hatis­garh, U5MR in Durg is half that of the tribal dom­i­nated Sur­guja. Ditto is the story in Patna and Si­ta­marhi in Bi­har. While 53 chil­dren per 1000 live births die in Patna, the fig­ure is 106 for Si­ta­marhi. These dis­par­i­ties are even worse in Ra­jasthan and Jhark­hand. There are stand-alone dis­tricts in many States where deaths are ram­pant like Kand­hamal (145) in Odisha, Shrawasti (142) in Ut­tar Pradesh and Patna (140).

To sus­tain high rate of an­nual de­cline it can­not be things as usual. Each State will have to iden­tify a spe­cific goal to meet the tar­get like san­i­ta­tion, hy­giene and wa­ter sup­ply.

As per the na­tional sur­vey, ado­les­cents (15-19 years) con­trib­ute about a sixth of the ag­gre­gate fer­til­ity in the na­tion. With the large un­met re­quire­ment of con­tra­cep­tion nearly a quar­ter of the ado­les­cents (15-19 years) and low con­dom use by them in gen­eral, girls age band are at high risk con­trac­tion of sex­u­ally trans­mit­ted in­fec­tions, HIV and un­in­tended and un­planned preg­nan­cies. All these im­pact child mor­tal­ity rate.

Af­ford­able life sav­ing treat­ments re­mains in­ac­ces­si­ble to a large ma­jor­ity of In­dian kids and es­pe­cially in the poor­est of the poor bracket. All these chal­lenges can only met by the re­spec­tive state gov­ern­ments.

There­fore univer­sal­i­sa­tion of ma­ter­nal health and child ser­vices which in­clude spe­cial new­born care, dex­ter­ous de­liv­ery, im­mu­niza­tion and man­age­ment of di­ar­rhea ap­pears to be the only answer if In­dia has to ac­com­plish the high goals of re­duc­ing child mor­tal­ity.

With the large un­met re­quire­ment of con­tra­cep­tion nearly a quar­ter of the ado­les­cents (15-19 years) and low con­dom use by them in gen­eral, girls age band are at high risk con­trac­tion of sex­u­ally trans­mit­ted in­fec­tions, HIV and un­in­tended and un­planned preg­nan­cies. All these im­pact child mor­tal­ity rate. Af­ford­able life sav­ing treat­ments re­mains in­ac­ces­si­ble to a large ma­jor­ity of In­dian kids.

Health­care is a ba­sic right for the new born as well as the mother.

Univer­sal­i­sa­tion of ma­ter­nal health and child ser­vices are need of thehour in In­dia.

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