Steps Taken to Reduce IMR and MMR

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The Pharma Times News Bureau
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New Delhi, Feb 28, 2015: As per Sample Registration System (SRS), 2013 reports published by Registrar General of India the Infant Mortality Rate (IMR) of India is 40 per 1000 live births and as per Sample Registration System (SRS), 2011-13 reports Maternal Mortality Ratio (MMR) is 167 per 1,00,000 live births in the Country.

Under the Millennium Development Goal (MDG) 4 target is to reduce Child Mortality by two-third between 1990 and 2015. In case of India, it translates into a goal of reducing Infant mortality rate from 88 per thousand live births in 1990 to 29 in 2015.

Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 & 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.

State/UT-wise infant mortality rate and maternal mortality ratio is given below:-

States/UTs-wise status of infant mortality rate (IMR) and

maternal mortality ratio (MMR) in India

Sr. No States/UTs IMR (SRS 2013) MMR(SRS 2011-13)
1 A & N Islands 24 –
2 Andhra Pradesh 39 92
3 Arunachal Pradesh 32 –
4 Assam 54 300
5 Bihar 42 208
6 Chandigarh 21 –
7 Chhattisgarh 46 221
8 Dadra & Nagar Haveli 31 –
9 Daman & Diu 20 –
10 Delhi 24 –
11 Goa 9 –
12 Gujarat 36 112
13 Haryana 41 127
14 Himachal Pradesh 35 –
15 Jammu & Kashmir 37 –
16 Jharkhand 37 208
17 Karnataka 31 133
18 Kerala 12 61
19 Lakshadweep 24 –
20 Madhya Pradesh 54 221
21 Maharashtra 34 68
22 Manipur 10 –
23 Meghalaya 47 –
24 Mizoram 35 –
25 Nagaland 18 –
26 Odisha 51 222
27 Puducherry 17 –
28 Punjab 26 141
29 Rajasthan 47 244
30 Sikkim 22 –
31 Tamil Nadu 21 79
32 Telangana 39 92
33 Tripura 26 –
34 Uttar Pradesh 50 285
35 Uttarakhand 32 285
36 West Bengal 31 113
India 40 167

Source : Sample registration System (SRS), RGI office, 2013 & 2011-13 reports

Under National Health Mission, the following interventions are being implemented to reduce infant mortality rate and maternal mortality ratio in the Country:

  1. Promotion of institutional deliveries through JananiSurakshaYojana.
  2. Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24×7 basic and comprehensive obstetric care services.
  3. Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care.
  4. Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
  5. Antenatal, intranatal and postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia.
  6. Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
  7. Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.
  8. Adolescent Reproductive Sexual Health Programme (ARSH) – Especially for adolescents to have better access to family planning, prevention of sexually transmitted Infections, Provision of counselling and peer education.
  9. Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.

10. JananiShishuSurakshaKaryakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment.

11. Universal Immunization Programme (UIP): Vaccination protects children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Infants are thus immunized against seven vaccine preventable diseases every year. The Government of India supports the vaccine programme by supply of vaccines and syringes, cold chain equipment and provision of operational costs.

12. Strengthening Facility based newborn care: Newborn care corners (NBCC) are being set up at all health facilities where deliveries take place; Special New Born Care Units (SNCUs) and New Born Stabilization Units (NBSUs) are also being set up at appropriate facilities for the care of sick newborn including preterm babies.

13. Home Based Newborn Care (HBNC): Home based newborn care through ASHA has been initiated to improve new born practices at the community level and early detection and referral of sick new born babies

14. Capacity building of health care providers: Various trainings are being conducted under National Health Mission (NHM) to build and upgrade the skills of health care providers in basic and comprehensive obstetric care of mother during pregnancy, delivery and essential newborn care.

15. Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been established for management of severe acute malnutrition in children.

16. India Newborn Action Plan (INAP) has been launched to reduce neonatal mortality and stillbirths.

17. Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin for possible serious bacillary infection.

18. Intensified Diarrhoea Control Fortnight was observed in August 2014 focusing on ORS and Zinc distribution for management of diarrhoea and feeding practices.

19. Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest infant mortality (UP, MP, Bihar and Rajasthan).

State/UT-wise allocation of funds and expenditure during each of the last three years and current year is given below:-

 

States/UTs-wise SPIP Approval and Expenditure under Maternal Health for F.Y. 2011-12 to 2014-15

Rs. In Lakhs
S. No. States / UTs 2011-12 2012-13 2013-14 2014-15
SPIP Approval Expenditure SPIP Approval Expenditure SPIP Approval Expenditure SPIP Approval Expenditure up to 31.12.2014
1 Bihar

25,851.86

24,628.25

33,648.05

34,929.70

57,799.07

43,236.25

53,586.41

8,075.53
2 Chhattisgarh

8,302.14

6,100.49

9,935.17

5,842.64

11,644.17

6,520.47

8,455.42

1,232.60
3 Himachal Pradesh

751.28

503.34

2,442.60

1,129.22

1,004.33

2,140.70

1,850.45

746.19
4 J&K

2,406.76

2,675.47

4,115.40

4,040.05

4,263.02

5,478.60

5,710.79

1,560.33
5 Jharkhand

10,047.41

5,955.63

15,825.94

7,930.82

14,095.90

10,354.26

15,052.81

3,459.32
6 Madhya Pradesh

25,709.57

21,096.32

26,474.90

25,428.96

32,087.44

29,800.56

26,859.37

4,366.54
7 Orissa

12,288.67

12,341.45

18,029.81

13,478.66

16,596.26

14,723.62

13,953.96

5,204.89
8 Rajasthan

18,514.77

18,806.25

32,377.91

25,739.42

34,505.46

27,084.38

33,700.11

10,565.29
9 Uttar Pradesh

71,620.85

43,364.99

72,223.89

49,447.79

70,227.81

60,350.43

71,388.65

19,512.02
10 Uttarakhand

1,787.90

2,241.40

3,171.99

3,085.61

3,377.79

3,467.17

3,943.30

1,668.87
11 Arunachal Pradesh

172.90

138.06

283.09

180.83

451.95

301.20

572.63

35.63
12 Assam

11,561.35

9,452.87

14,374.31

13,581.92

16,621.84

13,642.00

22,028.59

4,450.53
13 Manipur

293.59

184.49

644.43

225.06

713.71

486.83

913.25

292.59
14 Meghalaya

175.47

132.95

822.86

243.66

685.89

111.24

1,084.11

302.16
15 Mizoram

319.39

134.70

480.22

207.07

427.59

347.83

447.14

44.97
16 Nagaland

333.24

203.49

620.79

364.40

704.33

514.70

736.71

24.90
17 Sikkim

89.29

69.57

183.57

80.55

187.33

165.26

146.88

50.95
18 Tripura

1,226.47

689.01

1,433.98

929.64

1,245.37

1,055.02

1,681.23

137.78
19 Andhra Pradesh

3,434.51

2,373.74

8,811.45

5,519.20

13,830.58

4,945.64

8,240.16

2,526.45
20 Telangana

0.00

0.00

0.00

0.00

0.00

0.00

7,963.19

586.00
21 Goa

151.55

73.88

202.55

170.61

198.96

126.69

258.18

10.79
22 Gujarat

5,171.09

3,749.80

9,023.68

5,710.45

6,423.77

6,124.60

7,464.73

2,674.26
23 Haryana

1,085.97

1,096.03

2,983.48

1,960.02

3,096.08

2,899.59

3,269.47

785.71
24 Karnataka

4,937.48

4,582.69

7,867.50

6,953.84

11,221.25

8,678.38

11,560.00

1,304.69
25 Kerala

1,730.66

943.35

3,875.86

4,226.18

3,780.85

4,985.39

3,740.99

1,692.95
26 Maharashtra

6,423.25

4,664.68

11,016.12

9,518.80

18,178.50

11,593.83

18,695.29

4,210.61
27 Punjab

1,336.38

1,542.68

3,723.22

2,057.55

3,723.68

2,922.97

3,683.13

1,236.04
28 Tamilnadu

4,034.13

3,056.75

14,772.87

9,485.98

16,095.73

12,767.13

17,249.17

3,146.61
29 West Bengal

8,474.51

9,866.23

20,343.20

14,461.61

23,752.26

15,278.77

26,298.38

7,284.68
30 Andaman & Nicobar Island

8.09

29.85

116.90

8.20

107.10

61.49

45.03

1.22
31 Chandigarh

8.30

5.31

109.23

6.33

5.66

5.97

6.72

1.98
32 Dadar& Nagar Haveli

45.70

22.18

57.34

25.24

42.06

46.77

136.10

11.61
33 Daman & Diu

17.44

1.59

42.15

7.46

16.29

16.04

19.69

9.60
34 Delhi

1,300.67

147.02

1,933.76

232.22

810.55

336.43

1,001.90

218.24
35 Lakshadweep

16.96

12.53

19.48

10.58

20.42

10.87

23.33

11.82
36 Puducherry

67.13

66.75

399.80

112.19

568.92

282.70

390.46

111.51
India Total

2,29,696.73

1,80,953.80

3,22,387.50

2,47,332.47

3,68,511.92

2,90,863.78

3,72,157.74

87,555.86

SPIP- State Programme Implementation Plan

States/UTs-wise SPIP Approval and Expenditure under Child Health for F.Y. 2011-12 to 2014-15

Rs. In Lakhs
S. No. States / UTs 2011-12 2012-13 2013-14 2014-15
SPIP Approval Expenditure SPIP Approval Expenditure SPIP Approval Expenditure SPIP Approval Expenditure up to 31.12.2014
1 Bihar 2,238.37 559.10 7,994.21 1,377.22 5,393.69 2,929.51 1,240.69 731.27
2 Chhattisgarh 764.20 306.85 1,403.11 543.47 1,053.40 612.30 1,170.49 437.51
3 Himachal Pradesh – 20.45 182.79 153.04 117.62 729.44 723.84 1,006.17
4 J&K 3,698.75 379.76 271.47 134.99 1,192.95 468.29 647.76 312.80
5 Jharkhand 646.43 286.44 1,040.57 296.56 1,905.04 883.34 1,851.56 519.78
6 Madhya Pradesh 1,612.30 1,682.59 3,086.54 2,672.08 4,244.62 3,974.20 3,408.46 2,017.80
7 Orissa 443.69 145.62 1,233.57 788.94 1,114.75 622.06 1,562.70 351.55
8 Rajasthan 270.70 340.15 3,416.94 808.22 2,187.88 1,114.49 2,440.05 541.26
9 Uttar Pradesh 1,799.07 130.36 1,516.15 558.10 1,234.83 445.58 1,790.09 299.93
10 Uttarakhand 110.75 250.49 233.33 249.54 150.50 201.89 215.41 87.46
11 Arunachal Pradesh – 0.40 212.70 61.87 137.83 64.80 126.49 10.94
12 Assam 410.04 414.15 1,474.33 776.09 2,575.66 1,568.67 3,003.88 990.86
13 Manipur 26.20 15.24 93.76 11.80 38.13 74.84 177.08 134.02
14 Meghalaya 12.12 13.49 283.01 34.91 178.22 12.90 364.50 38.45
15 Mizoram 23.81 1.18 62.50 17.34 140.10 78.16 86.45 6.77
16 Nagaland 33.86 38.11 199.34 63.84 178.90 46.39 128.97 9.11
17 Sikkim 25.43 5.27 62.50 15.36 49.01 50.54 64.91 30.56
18 Tripura 200.48 68.41 221.21 56.63 58.07 88.35 255.55 99.23
19 Andhra Pradesh 1,604.14 88.36 4,656.98 866.21 2,144.84 604.91 1,234.37 427.91
20 Telangana – – – – – – 755.59 72.58
21 Goa 10.28 191.02 43.28 32.46 45.80 14.69 69.58 8.35
22 Gujarat 1,178.55 1,595.02 4,616.99 2,521.96 2,799.58 1,658.45 2,110.41 797.91
23 Haryana 742.61 426.85 484.79 180.92 568.26 560.96 573.59 295.75
24 Karnataka 587.73 229.01 897.08 553.49 478.10 302.37 1,024.33 113.37
25 Kerala 46.13 18.97 1,231.82 1,046.48 401.69 310.24 198.13 104.29
26 Maharashtra 2,931.06 2,639.75 2,602.04 2,204.45 1,773.38 2,656.63 2,408.12 623.93
27 Punjab 287.00 132.67 742.00 394.24 295.35 47.73 784.41 431.84
28 Tamil Nadu 17.21 – 5,946.94 20.15 561.50 1,062.79 656.00 662.67
29 West Bengal 1,286.83 409.61 3,593.78 919.29 1,441.89 1,119.11 3,245.09 1,225.84
30 Andaman & Nicobar Island – – 55.45 – 5.98 – 29.20 –
31 Chandigarh 14.58 – 14.03 0.02 0.40 0.18 3.08 0.25
32 Dadra & Nagar Haveli 7.21 0.64 21.01 3.42 10.20 3.82 23.60 0.33
33 Daman & Diu 2.50 0.17 6.60 0.33 0.00 – 0.46 0.32
34 Delhi 61.47 3.05 409.20 24.40 86.70 19.12 152.60 14.17
35 Lakshadweep 0.20 – 47.00 – 4.52 – 15.20 0.27
36 Puducherry 13.30 9.29 3.20 3.50 14.96 5.71 15.60 0.05
Grand Total 21,107.00 10,402.47 48,360.22 17,391.32 32,584.35 22,332.48 32,558.24 12,405.30

SPIP- State Programme Implementation Plan

Based on the UN Inter–Agency Expert Group’s MMR estimates in the publication “Trends in Maternal Mortality: 1990 to 2013″, the target for MMR is estimated to be 140 per 1,00,000 live births by the year 2015 taking a baseline of 560 per 100,000 live births in 1990. If the MMR declines at the same pace, India will achieve an MMR of 140 per 100,000 live births by 2015 and achieve the MDG target.

As per the information provided in the same report, 52 countries have MMR higher than that of India. Details are given below:-

International comparison of Maternal Mortality Ratio (MMR)

Sl. No. Country MMR per 1,00,000 live births
1 Sierra Leone 1100
2 Chad 980
3 Central African Republic 880
4 Somalia 850
5 Burundi 740
6 Democratic Republic of the Congo 730
7 South Sudan 730
8 Côte d’Ivoire 720
9 Guinea 650
10 Liberia 640
11 Niger 630
12 Cameroon 590
13 Guinea-Bissau 560
14 Nigeria 560
15 Mali 550
16 Malawi 510
17 Lesotho 490
18 Mozambique 480
19 Zimbabwe 470
20 Angola 460
21 Togo 450
22 Madagascar 440
23 Gambia 430
24 Ethiopia 420
25 Congo 410
26 United Republic of Tanzania 410
27 Afghanistan 400
28 Burkina Faso 400
29 Kenya 400
30 Eritrea 380
31 Ghana 380
32 Haiti 380
33 Sudan 360
34 Uganda 360
35 Comoros 350
36 Benin 340
37 Mauritania 320
38 Rwanda 320
39 Senegal 320
40 Swaziland 310
41 Equatorial Guinea 290
42 Zambia 280
43 Timor-Leste 270
44 Yemen 270
45 Guyana 250
46 Gabon 240
47 Dijibouti 230
48 Lao People’s Democratic Republic 220
49 Papua New making Guinea 220
50 Sao Tome and Principe 210
51 Bolivia (Plurinational) 200
52 Myanmar 200
53 India 190
54 Indonesia 190
55 Nepal 190
56 Bangladesh 170
57 Botswana 170
58 Cambodia 170
59 Pakistan 170
60 Guatemala 140
61 South Africa 140
62 Kiribati 130
63 Namibia 130
64 Solomon Islands 130
65 Suriname 130
66 Bhutan 120
67 Honduras 120
68 Morocco 120
69 Philippines 120
70 Tonga 120
71 Paraguay 110
72 Venezuela (Bolivarian Republic of ) 110
73 Dominican Republic 100
74 Nicaragua 100
75 Micronesia (Federated States of ) 96
76 Algeria 89
77 Peru 89
78 Democratic People’s Republic of Korea 87
79 Ecuador 87
80 Vanuatu 86
81 Panama 85
82 Trinidad and Tobago 84
83 Colombia 83
84 Cuba 80
85 Jamaica 80
86 Kyrgyzstan 75
87 Mauritius 73
88 Argentina 69
89 Brazil 69
90 El Salvador 69
91 Mongolia 68
92 Iraq 67
93 Turkmenistan 61
94 Fiji 59
95 Samoa 58
96 Cabo Verde 53
97 Barbados 52
98 Jordan 50
99 Mexico 49
100 Syrian Arab Republic 49
101 Viet Nam 49
102 Occupied Palestinian Territory 47
103 Tunisia 46
104 Belize 45
105 Egypt 45
106 Saint Vincent and the Grenadines 45
107 Tajikistan 44
108 Georgia 41
109 Costa Rica 38
110 Bahamas 37
111 Uzbekistan 36
112 Saint Lucia 34
113 Romania 33
114 China 32
115 Maldives 31
116 Armenia 29
117 Malaysia 29
118 Sri Lanka 29
119 United States of America 28
120 Brunei Darussalam 27
121 Republic of Korea 27
122 Azerbaijan 26
123 Kazakhstan 26
124 Thailand 26
125 Russian Federation 24
126 Grenada 23
127 Iran (Islamic Republic of) 23
128 Ukraine 23
129 Bahrain 22
130 Chile 22
131 Albania 21
132 Republic of Moldova 21
133 Puerto Rico 20
134 Turkey 20
135 Lebanon 16
136 Saudi Arabia 16
137 Serbia 16
138 Libya 15
139 Hungary 14
140 Kuwait 14
141 Uruguay 14
142 Croatia 13
143 Latvia 13
144 Canada 11
145 Estonia 11
146 Lithuania 11
147 Luxembourg 11
148 Oman 11
149 Cyprus 10
150 France 9
151 Ireland 9
152 Malta 9
153 Bosnia and Herzegovina 8
154 New Zealand 8
155 Portugal 8
156 United Arab Emirates 8
157 United Kingdom 8
158 Germany 7
159 Montenegro 7
160 Slovakia 7
161 Slovenia 7
162 The former Yugoslav Republic of Macedonia 7
163 Australia 6
164 Belgium 6
165 Japan 6
166 Netherlands 6
167 Qatar 6
168 Singapore 6
169 Switzerland 6
170 Bulgaria 5
171 Czech Republic 5
172 Denmark 5
173 Greece 5
174 Austria 4
175 Finland 4
176 Iceland 4
177 Italy 4
178 Norway 4
179 Spain 4
180 Sweden 4
181 Poland 3
182 Israel 2
183 Belarus 1

 

Source: UN Inter–Agency “Trends in Maternal Mortality: 1990 to 2013″.

The Government of India has not undertaken any study to assess the ongoing programme/schemes to reduce the IMR and MMR. However, regular supportive supervision visits and Common Review Mission (CRM) have been conducted to assess the progress of ongoing interventions for improvement of infant and maternal health outcomes annually in the States/UTs.

Based on these assessments, States/UTs are guided to prepare Annual Program Implementation Plan (PIP) to focus on priority interventions to improve infant and maternal health outcomes in each State/UT.

To sharpen the focus on the low performing districts, 184 High Priority Districts (HPDs) have been identified for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.CCI Newswire

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