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What is Infant Mortality Rate ?
Infant mortality rate is defined as the number of children dying
before the age of one. It is counted per thousand. An IMR of 47
therefore means, out of 1000 children born, 47 die before the
age of one. This inclues the number of children who are born dead.
In the past few year's India's IMR has been dropping by 3 points
consistently.
India's IMR in 2011 is estimated to be 44 against 47 in year 2010
and 50 in year 2009.
India is committeed to Millennium Development Goals. The MDG 2015
target for India is 30. Even if we continue dropping IMR @ 3 per
annum, our IMR for 2015 would be 35.
Experts from the social sector believe that there is no need
for the government to get worried and share wrong numbers indicating
that we are close to achieving our IMR commitment. Doing so, infact,
would be detrimental, because our entire planning and focus would
be on showing numbers rather than achieving permanent change.
MDG gives us great direction and is a great motivator.
Causes of Infant Deaths
The medical causes of infant deaths in India 2001-03 as given
by the Registrar General of India, Ministry of Home Affairs, are
Perinatal conditions (46%)
Respiratory infections (22%)
Diarrhoeal disease (10%)
Other infectious and parasitic diseases (8%)
Congenital anomalies (3.1%).
Read more on challenges and solutions
(a) the number of infant/child mortality
cases reported during each of the last three years and the current
year, State/UT-wise and year-wise;
(b) whether the infant/child mortality
rates are on rise in the country especially in tribal areas;
(c) if so, the details thereof and the
reasons therefor;
(d) the details of programmes/schemes
and incentives provided to States to check the high rate of mortality
cases indicating the funds allocated and utilised for the purpose
during the said period, State/UTwise; and
(e) the corrective measures taken by
the Government to bring down the infant mortality rate and achieve
the targets set for the Twelfth Five Year Plan?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(ABU HASEM KHAN CHOUDHURY)
(a) The number of infant/child mortality cases are not reported
at the national level.
However the state/UT wise Infant mortality rates (IMR) for three
years as per Sample Registration System report of Registrar General
of India is placed in annexure1
(b) & (c) No, The Infant Mortality Rate has shown consistent
3 point annual decline since 2008.
As per SRS report of Registrar General of India, IMR has declined
from 53 per 1000 live births in 2008 to 44 per 1000 live births
in 2011.
(d) & (e) State wise allocation and utilisation of funds
under Child Health are detailed in annexure2
Under National Rural Health Mission (NRHM), flagship programme
of the Ministry of Health and Family Welfare, Government of India,
the following interventions are implemented to reduce neonatal
and child mortality rates in the country:
1) Promotion of Institutional Delivery through Janani Suraksha
Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK): Promoting
Institutional delivery to ensure skilled birth attendance is key
to reducing both maternal and neo-natal mortality. JSY incentivizes
pregnant women to opt for institutional delivery and provides
for cash assistance. JSSK entitles all pregnant women to absolutely
free and zero expense delivery including caesarean section operation
in Government health facilities and provides for free to and fro
transport, food, drugs and diagnostics. Similar entitlements have
also been put in place for sick neonates.
2) Strengthening Facility based newborn care: Newborn care corners
(NBCC) are being set up at all health facilities where deliveries
take place to provide essential newborn care at birth to all new
born babies; Special New Born Care Units (SNCUs) at District Hospitals
and New Born Stabilization Units (NBSUs) at FRUs are being set
up for the care of sick newborn. As on date 399 SNCUs, 1542 NBSUs
and 11508 NBCCs are functional across the country.
3) Home Based Newborn Care (HBNC): Home based newborn care through
ASHA has recently been initiated to improve new born care practices
at the community level and for early detection and referral of
sick new born babies. The schedule of home visits by ASHA consists
of at least 6 visits in case of institutional deliveries, on days
3, 7, 14, 21, 28 & 42nd days and one additional visit within
24 hours of delivery in case of home deliveries. Additional visits
will be made for babies who are pre-term, low birth weight or
ill.
4) Capacity building of health care providers: Various trainings
are being conducted under National Rural Health Mission (NRHM)
to build and upgrade the skills of doctors, nurses and ANM for
early diagnosis and case management of common ailments of children
and care of newborn at time of birth. These trainings include
Integrated Management of Neo-natal and Childhood Illness(IMINCI)
and Navjaat Shishu Surakshta Karyakaram (NSSK). A total of 5.5
lakh health care workers have been trained in IMNCI in 471districts
and 88,428 health workers trained in NSSK so far.
5) Management of Malnutrition: Emphasis is being laid on reduction
of malnutrition which is an important underlying cause of child
mortality. 647 Nutritional Rehabilitation Centres have been established
for management of Severe Acute Malnutrition(SAM). Iron and Folic
Acid is also provided to children for prevention of anaemia. Recently,
weekly Iron and Folic Acid is proposed to be initiated for adolescent
population. As breastfeeding reduces infant mortality, exclusive
breastfeeding for first six months and appropriate infant and
young child feeding practices are being promoted in convergence
with Ministry of Woman and Child Development.
6) Village Health and Nutrition Days (VHNDs) are also being organized
for imparting nutritional counseling to mothers and to improve
child care practices
7) Universal Immunization Program (UIP): Vaccination against
seven diseases is provided to all children under UIP. Government
of India supports the vaccine program by supply of vaccines and
syringes, cold chain equipments and provision of operational costs.
UIP targets to immunize 2.7 crore infants against seven vaccine
preventable diseases every year. 21 states with more than 80%
coverage have incorporated second dose of Measles in their immunization
program. Pentavalent vaccine has been introduced in two states
of Kerala and Tamil Nadu and proposed to be scaled up in six more
states. Year 2012-13 has been declared as ‘Year of intensification
of Routine Immunization’. India has achieved a historic milestone
by remaining polio free for one full year now. WHO has taken India
off the list of polio endemic countries.
8) Mother and Child Tracking System: A name based Mother and
Child Tracking System has been put in place which is web based
to enable tracking of all pregnant women and newborns so as to
monitor and ensure that complete services are provided to them.
States are encouraged to send SMS alerts to beneficiaries reminding
them of the dates on which services are due and generate beneficiary-wise
due list of services with due dates for ANMs on a weekly basis.
ANNEXURE
(a) whether the Government has taken
note of a recent report of the United Nations which attributes
various factors such as malnutrition, poverty and mismanagement
as major causes for high infant/child/ maternal mortality rates
in the country;
(b) if so, the facts in this regard
along with the reaction of the Government thereto;
(c) the extent to which the target set
under the Millennium Development Goal (MDG) has been achieved
so far in respect of bringing down infant/child /maternal mortality
rates in the country; and
(d) the details of the corrective measures
taken or proposed by the Government in order to meet the target
under MDG to reduce infant/child/maternal mortality rates and
provide better maternal care facilities, particularly in rural
and tribal areas of the country?
ANSWER
MINISTER OF THE STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI SUDIP BANDYOPADHYAY)
(a) & (b) As per the WHO/UNICEF 2012 report “Countdown to
2015 on Maternal, Newborn & Child Survival” poor maternal
nutrition contributes to at least 20% of maternal deaths, and
increase the probability of other poor pregnancy outcome, including
new born deaths. Malnutrition is one of the major underlying cause
of Infant/Child mortality in India and about one third of child
deaths are attributed to under nutrition.
(c) MDG 4: Reduce child mortality by two third
Target: IMR <28 per 1000 live births
Achievement: 47 per 1000 live births (SRS 2010)
Target: Under 5 MR< 39 per 1000 live births
Achievement: 59 per 1000 live births (SRS 2010)
MDG5: : Reduce by three quarters the maternal mortality ratio
Target: MMR<100 per 1,00,000 live births
Achievement: 212 per 1,00,000 live births (SRS 2007-09)
(d) The following interventions under RCH progamme of NRHM are
being implemented.
(1) Prevention and treatment of Anaemia by supplementation with
Iron and Folic Acid tablets during pregnancy and lactation.
(2) Name Based Tracking of Pregnant Women to ensure complete
antenatal, intranatal and postnatal care
(3) Operationalizing Community Health Centers as First Referral
Units (FRUs) and Primary Health Centers
(24X7) for round the clock maternal care services.)
(4) Promotion of Institutional Delivery through Janani Suraksha
Yojana (JSY) and Janani Shishu Suraksha Karyakram (JSSK): Promoting
Institutional delivery to ensure skilled birth attendance is key
to reducing both maternal and neo-natal mortality.
(5) 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.
(6) 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
(7) Capacity building of health care providers: Various trainings
are being conducted under National Rural Health Mission (NRHM)
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 & management of common ailments
in children.
(8) Adolescent Reproductive Sexual Health Programme (ARSH)– Specially
for adolescents to have better access to family planning, prevention
of Sexually transmitted Infections, Provision of counselling and
peer education.
(a) whether attention of the Government
has been drawn to the United Nation’s (UN) ``State of the World’s
Children`` report 2008 which states that India has the highest
mortality rate in the world ;
(b) if so, the reaction of the Government
thereto;
(a) the details of infant mortality
rate in urban and rural areas separately, State-wise and its comparison
with developing countries;
(b) whether the Government has assessed
the reasons for high incidence of infant mortality in the country
and if so, the details thereof; and
(e) the details of the corrective actions
taken/proposed to be taken to attain zero infant mortality rate
in the country?
ANSWER
THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI GHULAM NABI AZAD)
(a)to(e): A statement is laid on the Table of the House.
STATEMENT REFERRED TO IN REPLY TO LOK SABHA STARRED QUESTION
NO. 507 FOR 11TH MAY, 2012
(a)&(b): As per “The State of the World’s Children” report
2008 from UNICEF, India ranks 49th as per under five mortality
rate. Further as per the latest report published by UNICEF in
2012, India ranks 46th in under five mortality rate. The Government
has taken cognizance of it and is assiduously accordingly working
to reduce the child mortality rate through a range of interventions
under NRHM.
(c) According to Sample Registration System 2010 of Registrar
General of India, Infant Mortality rate in rural area is 51 per
1000 live births whereas in urban area IMR is 31 per 1000 live
births. State wise details and comparison with developing countries
are annexed.
(d) The prominent causes of death among infants are perinatal
conditions (46%), respiratory infections (22%), diarrhoeal disease
(10%), other infectious and parasitic diseases (8%), and congenital
anomalies (3.1%).
(e) Under the National Rural Health Mission, the following key
interventions are being implemented to bring down the mortality
rate of children across all the States of the country:
(1) Promotion of Institutional Delivery through Janani Suraksha
Yojana (JSY) : Promoting Institutional delivery by skilled birth
attendant is key to reducing both maternal and neo-natal mortality.
(2) Emphasis on facility based newborn care at different levels
to reduce Child Mortality: Setting up of facilities for care of
Sick Newborn such as Special New Born Care Units (SNCUs), New
Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs)
at different levels is a thrust area under NRHM.
(3) Capacity building of health care providers: Various trainings
are being conducted under NRHM to train doctors, nurses and ANM
for early diagnosis and case management of common ailments of
children and care of mother during pregnancy and delivery. These
trainings are on IMNCI, NSSK, SBA, LSAS, EMOC, BMOC etc.
(4) Management of Malnutrition: 657 Nutritional Rehabilitation
Centres have been established for management of severe acute malnutrition.
(5) Appropriate infant and young child feeding practices are
being promoted in convergence with Ministry of Woman and Child
Development. Village Health and Nutrition Days VHNDs are organized
for imparting nutritional counselling to mothers and to improve
child care practices.
(6) Universal Immunization Programme: 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 equipments and provision
of operational costs.
(7) Janani Shishu Suraksha Karyakaram (JSSK): A new initiative
namely Janani Shishu Suraksha Karyakaram has been launched on
1st June, 2011, which 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 newborns accessing public health institutions for treatment
till 30 days after birth.
(8) Home based new born care HBNC: Home based newborn care through
ASHAs has been initiated by providing incentive of Rs. 250. The
purpose of Home Based New Born Care is to improve new born practices
at the community level and early detection and referral of sick
new born babies.
(9) Mother and Child Tracking System: A name based Mother and
Child Tracking System has been put in place which is web based
to ensure registration and tracking of all pregnant women and
new born babies so that provision of regular and complete services
to them can be ensured.
ANNEXURE
(a) whether the infant mortality rate
in the tribal areas of the country is relatively higher;
(b) if so, the details thereof alongwith
the reasons therefor, State-wise;
(c) the extent to which the National
Rural Health Mission (NRHM) has helped in addressing this issue;
(d) whether the Government proposes
to start a new programme to tackle this serious problem; and
(e) if so, the details thereof?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI SUDIP BANDYOPATHYAY)
(a) & (b): The annual Sample Registration System (SRS) does
not collect disaggregated data on infant mortality for population
groups. However, as per National Family Health Survey (NFHS-3)
conducted in 2005-06, Infant Mortality Rate in Schedule Tribes
was estimated to be 62.1 per 1000 live births in comparison to
infant mortality rate in the General population as 57 per thousand
live births. The main reasons are low institutional deliveries,
weak health seeking behaviour and shortage of human resource in
the tribal areas.
(c) to (e): Under National Rural Health Mission, Government of
India has identified 264 high focus districts in 24 States/UTs
of the country. One of the criteria for selection of these districts
is having more than 35 percent population of SCs and STs in these
districts. States have been asked to prioritize resources in high
focus districts and special attention is being paid to them in
terms of deployment of human resources, infrastructure and service
delivery at health facilities in these districts.
Besides this, special schemes are being implemented focusing
on specific needs of the tribal districts. These schemes include
control of sickle cell anemia and severe acute malnutrition in
selected districts. In some tribal districts, birth waiting homes
have also been established for pregnant women visiting district
hospitals.
The Government of India has also initiated new schemes in the
last two years to reduce barriers to institutional care and reduce
out of pocket expenditure for pregnant women and sick neonates
which would benefit the marginalized population the most. These
schemes are :
(a) Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st
June 2011 to eliminate out of pocket expenditure and to ensure
service guarantee for pregnant women and sick neonates. It provides
completely free and cashless services to pregnant women including
normal deliveries and caesarean operations and sick newborns upto
30 days after birth in Government health institutions. The free
entitlement also include free drugs, free diagnostics, free diet
and free transport from home to health institutions and drop back
home.
(b) Home Based New Born Care (HBNC): As 56 percent of child deaths
take place in the first 28 days of birth, home based newborn care
through ASHA has been initiated by providing incentive of Rs.
250. The purpose of Home Based New Born Care is to improve new
born practices at the community level and early detection and
referral of sick new born babies. Free transport under JSSK is
aimed at bringing the sick neonates to health facilities in time.
(c) A name based Mother and Child Tracking System has been put
in place which is web based to ensure registration and tracking
of all pregnant women and new born babies so that provision of
regular and complete services to them can be ensured and both
mortality and morbidity are reduced.
(a) whether the Government has conducted
any study on female infant mortality in the country;
(b) if so, the findings of the study;
and
(c) the details of the campaign launched
against pre-natal sex determination tests in backward States and
other parts of the country including Odisha?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI SUDIP BANDYOPADHYAY)
(a)&(b) No such study has been conducted. However, as per
SRS 2010 report published by Registrar General of India, female
infant mortality rate is 49 per 1000 live births as against male
infant mortality rate of 46 per 1000 live births in India.
(c) The Pre-conception and Pre-natal Diagnostic Techniques (Prohibition
of Sex Selection) Act,1994 as amended in 2003, prohibits sex selection
before or after conception and regulates the misuse of medical
diagnostic techniques for the purpose of sex determination
The steps taken by Government of India to curb sex determination
through effective implementation of the PC & PNDT Act are
as mentioned below:
Central Supervisory Board (CSB) under the PNDT Act has been reconstituted.
The 17th and 18th meetings of CSB have been held at an interval
of six months on 4th June, 2011 and 14th January 2012.
Inspections by the National Inspection and Monitoring Committee
have been scaled up. NIMC has been reconstituted and apart from
inspections further empowered to oversee follow-up action by Appropriate
Authorities against organizations found guilty of violations under
the Act during inspections.
Government of India has notified important amendments in rules
under the Act, including :-
Amendment to Rule 11 (2) of the PC & PNDT Rules, 1996 to
provide for confiscation of unregistered machines and further
punishment under the Act.
Amendment to regulate the use of portable ultrasound equipment
and services offered by mobile genetic clinics.
Operational guidelines for Grant in Aid to Non-Governmental Organizations
have been revised to ensure targeted use of resources for awareness
generation of the Act.
States have been asked to take advantage of funding available
under NRHM for strengthening infrastructure and augmentation of
human resources required for effective implementation of the PC
& PNDT Act.
(a) whether the Government has taken
note of a report released recently by the UN Department of Economic
and Social Affairs (UNDESA) which inter alia describes higher
female infant mortality rates in India as compared to certain
other nations;
(b) if so, the details thereof and the
facts thereof;
(c) the number and percentage of female
mortality vis-a-vis male infant mortality during the last three
years and the current year, State/UT-wise; and
(d) the remedial measures taken/proposed
to be taken by the Government in this regard?
ANSWER
MINISTER OF THE STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI GHULAM NABI AZAD)
(a) & (b) Demographic year Book 2009-10 of UN Department
of Economic and Social Affairs (UNDESA) published on 1 January,
2012 states disaggregated rural and urban infant mortality rate
across various countries in the world. However, there is no mention
of gender wise disaggregation of above data for India.
As per SRS 2010 report published by Registrar General of India
female infant mortality rate is 49 per 1000 live births as against
male infant mortality rate of 46 per 1000 live births in India.
(c) State/UT-wise Infant Mortality rate for male and female for
last three years as per SRS reports published by RGI is annexed.
(d) Under the National Rural Health Mission the following interventions
are implemented to bring down the mortality rate of children in
the country:
(1) Promotion of Institutional Delivery through Janani Suraksha
Yojana (JSY): Promoting Institutional delivery by skilled birth
attendant is key to reducing both maternal and neo-natal mortality.
There has been a phenomenal increase in number of institutional
deliveries since the launch of JSY and number of beneficiaries
has increased from 7.39 lacs in 2005 to 113.38 lacs in 2010-11.
Besides this infrastructure of health facilities is also being
strengthened for providing comprehensive obstetric care services
under NRHM.
(2) Emphasis on facility based newborn care at different levels
to reduce Child Mortality: Setting up of facilities for care of
Sick Newborn such as Special New Born Care Units (SNCUs), New
Born Stabilization Units (NBSUs) and New Born Baby Corners (NBCCs)
at different levels is a thrust area under NRHM. At present 340
SNCUs, 1210 NBSU and 9824 NBCCs are functional.
(3) Capacity building of health care providers: Various trainings
are being conducted under NRHM to train doctors, nurses and ANM
for early diagnosis and case management of common ailments of
children and care of mother during pregnancy and delivery. These
trainings are IMNCI, NSSK, SBA, LSAS, EMOC, BMOC etc.
(4) Management of Malnutrition: As malnutrition reduces resistance
of children to infections thus increasing mortality and morbidity
among children, emphasis is being laid under NRHM for management
of malnutrition. 558 Nutritional Rehabilitation Centres have been
established for management of severe acute malnutrition. As breastfeeding
reduces neo-natal mortality, exclusive breastfeeding for first
six months and appropriate infant and young child feeding practices
are being promoted in convergence with Ministry of Woman and Child
Development. Village Health and Nutrition Days (VHNDs) are organized
for imparting nutritional counselling to mother and to improve
child care practices.
(5) Universal Immunization Programme: 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. Government of India targets to immunise 2.7 crore infants
against seven vaccine preventable diseases every year. The Government
of India supports the vaccine programme by supply of vaccines
and syringes, Cold chain equipments and provision of operational
costs. Recently, GOI has introduced 2nd dose of measles vaccine
as measles kills estimated 1 lakh children per year in the country,
Hepatitis b programme has been expanded in all over the country
and Pentavalent vaccine in December 2011 in Tamil Nadu and Kerala.
India has achieved a historic milestone by remaining polio free
for one full year now. WHO has taken India off the list of polio
endemic country.
(6) New initiatives in last two years:
(a) Janani Shishu Suraksha Karyakram (JSSK) was launched on 1st
June 2011 and has provision for free transport, food, drugs and
diagnostics to all pregnant women and sick new born. The initiative
would further promote institutional delivery; eliminate out of
pocket expenses which act as a barrier to seeking institutional
care for mothers and sick new born.
(b) Home based new born care (HBNC): As 52 percent of child deaths
take place in the first 28 days of birth, home based newborn care
through ASHA has been initiated by providing incentive of Rs.
250. The purpose of Home Based New Born Care is to improve new
born practices at the community level and early detection and
referral of sick new born babies.
(c) Mother and Child Tracking System: A name based Mother and
Child Tracking System has been put in place which is web based
to ensure registration and tracking of all pregnant women and
new born babies so that provision of regular and complete services
to them can be ensured. One crore and eighty lakh mothers and
One crore and twenty two lakh children have been registered till
15th March, 2012. States are being encouraged to send SMS alerts
to beneficiaries reminding them of the dates on which services
are due as well as generate beneficiary wise lists of due services
with due dates for ANMs on a weekly basis.
ANNEXURE
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