Steps Taken to Reduce IMR and MMR

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

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)

 

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