| MMR
India's MDG target for MMR is per 100 000 live births.
While India must ensure that every district focuses on its target,
here is a list of districts which have MMR of over 400 as per
the 2009 statistics.
DevelopedNation.org urges Funding Agencies, Corporate Foundations
and HHNIs / HNIs / NRIs to focus their energies on supporting
government in these districts, as also building the capacity of
the NGOs and communities in these districts. We are in the process
of identifynig local / district level NGOs and would be happy
to recommend the same.
MMR above 400
Assam
Dibrugarh, Golaghat, Jorhat, Sibsagar and Tinsukia : All have
430 MMR
Madhya Pradesh
Dindori, Shahdol and Umaria : All have 435 MMR
Uttar Pradesh
Basti, Sant Kabir Nagar, Siddharthnagar : All have 412 MMR
Bahraich, Balrampur, Gonda, Shrawasti : All have 434 MMR
Bareilly, Budaun, Pilibhit, Shahjahanpur : All have 437 MMR
Allahabad, Fatehpur, Kaushambi, Pratapgarh : All have 442 MMR
Ambedkar Nagar, Barabanki, Faizabad, Sultanpur : All have 451
MMR
(a) the present status of Maternal Mortality
Rate (MMR) along with incidents of mortalities of pregnant women
and infants reported in the country during the last three years
and the current year, State-wise including Haryana;
(b) whether the Government has any proposal
to provide free health care for pregnant women and infants under
NRHM;
(c) if so, the details thereof;
(d) whether universal toll free number
is proposed country-wise for providing transport or ambulance
service to pregnant women and sick infants;
(e) if so, the details thereof and if
not, the reasons therefor; and
(f) the action plan of the Government
to upgrade the existing medical system and set up additional such
units in the country to control these deaths?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(ABU HASEM KHAN CHOUDHURY)
(a) As per the latest data on maternal mortality in the country,
available from the report of Registrar General of India - Sample
Registration System (RGI-SRS) - 2007-09, the Maternal Mortality
Ratio of India is 212 per 100,000 live births.
The RGI-SRS provides MMR for the country and major states at
3-year intervals. The latest state-wise MMR including that for
Haryana available for the period 2007-09 is placed at Annexure
-1.
As per the latest data on Infant Mortality Rate available from
the report of Registrar General of India-Sample Registration System
(RGI-SRS) 2011, Infant Mortality Rate (IMR) in the country is
44 per 1000 live births. Data on IMR for the country and state
wise is provided by SRS at yearly intervals.
The State-wise IMR including that for Haryana for the years 2009,2010,
2011 is placed at Annexure-II.
(b) & (c) Under the overall umbrella of National Rural Health
Mission, Government of India has launched Janani Shishu Suraksha
Karyakaram (JSSK) on 1st June, 2011, which entitles all pregnant
women delivering in public health institutions to absolutely free
and no expense delivery, including caesarean section.
Similar entitlements have been put in place for all sick new-borns
accessing public health institutions for treatment till 30 days
after birth.
Under this scheme, all pregnant women accessing public health
institutions are entitled for free drugs and consumables, free
diagnostics, free blood wherever required, and free diet up to
3 days for normal delivery and 7 days for C-section. This initiative
also provides for free transport from home to institution, between
facilities in case of a referral and drop back home.
Such entitlements are also available for sick newborns upto 30
days after birth.
(d) & (e): Under National Rural Health Mission, a universal
toll free number has not yet been proposed for the whole country
for providing transport or ambulance service to pregnant women
and sick infants.
Referral transport for pregnant women and sick neonates is being
provided by the States as per their local needs, using different
models which include a network of emergency response vehicles
using toll free number, government ambulances, available transport
under public private partnership etc.
(f) Under the National Rural Health Mission, the key steps taken
for upgrading the existing medical system and bring down the number
of maternal & Infant deaths are :
# 16801 ‘Delivery Points’ have been identified for comprehensive
strengthening to provide quality Reproductive, Maternal Newborn
& Child Health Services.
# Capacity building of health care providers in skilled attendance
at birth, basic and comprehensive obstetric and newborn care,
infant and newborn care.
# Promotion of institutional deliveries through Janani Suraksha
Yojana.
# Antenatal, Intranatal and Postnatal care including Iron and
Folic Acid supplementation to pregnant & lactating women for
prevention and treatment of anaemia.
# Mother and Child Protection Card in collaboration with the
Ministry of Women and Child Development to monitor service delivery
for mothers and children.
# Engagement of 8.71 lakhs Accredited Social Health Activists
(ASHAs) to generate demand and facilitate accessing of health
care services by the community.
# Village Health and Nutrition Days in rural areas as an outreach
activity, for provision of maternal and child health services.
# Home based new born care (HBNC) through ASHA to improve new
born practices at the community level and early detection and
referral of sick new born babies.
# Strengthening Facility Based Newborn Care: New Born Care Corners
(NBCC) are being set up at all health facilities where deliveries
take place to provide essential newborn care at birth; 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.
# Early detection and appropriate management of Diarrheal and
Acute Respiratory diseases.
# Infant and Young Child Feeding.
# Immunization against vaccine preventable diseases.
# Janani Shishu Suraksha Karyakaram (JSSK) to eliminate any out
of pocket expenses for pregnant women delivering in public health
institutions and sick newborns accessing public health institutions
for treatment till 30 days after birth.
# 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.
# 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 equipment 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’.
# Mother and Child Tracking System: A web enabled name based
Mother and Child Tracking System has been put in place for tracking
of all pregnant women and newborns so as to monitor and ensure
that complete services are provided to them.
ANNEXURE
(a) whether a large number of women
are dying at the time of their first delivery in the Government
health centres in several parts of the country;
(b) if so, the details of such deaths
reported in the Government hospitals and health centres during
the last three years and the current year, State/UT-wise and year-wise;
(c) whether all pregnant women in rural
areas are not covered by Janani Suraksha Yojana (JSY) and Janani
Shishu Suraksha Karyakaram (JSSK); and
(d) if so, the details thereof and the
reasons therefor along with the action taken by the Government
to bring down the deaths of women during their first delivery?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(ABU HASEM KHAN CHOUDHURY)
(a)& (b) Data on maternal mortality in the country is available
from the latest report of Registrar General of India - Sample
Registration System (RGI-SRS) - 2007-09, on the basis of which,
the Maternal Mortality Ratio of India has declined from 254 to
212 per 100,000 live births during the period 2004-06 to 2007-09.
Data on the number of maternal deaths at the time of first delivery
at Government health centres is not available from this Report.
RGI - SRS provides State wise MMR at 3 year intervals, the latest
being available for the period 2007-09 for major States (Annexure).
(c) & (d) All pregnant women are not covered by Janani Suraksha
Yojana (JSY). Under this scheme, States are classified into Low
Performing States (LPS) and High Performing States (HPS) on the
basis of institutional delivery rates. States of Uttar Pradesh,
Uttarakhand, Madhya Pradesh, Chhattisgarh, Bihar, Jharkhand, Rajasthan,
Odisha, Assam and Jammu & Kashmir where rate of institutional
delivery is low are classified as Low Performing States and the
remaining States/UTs where rates of institutional delivery are
of at satisfactory levels are classified as High Performing States.
In LPS, all pregnant women are covered under the JSY. However,
JSY benefit in HPS is available to pregnant women from BPL/SC/ST
households who have attained age of 19 years or above and upto
two live births only.
The Janani Shishu Suraksha Karyakaram (JSSK) Scheme entitles
all pregnant women delivering in public health institutions including
those of rural areas to absolutely free and no expense delivery,
including caesarean section and covers all pregnant women accessing
Government Health facilities.
Under the National Rural Health Mission, the key steps taken
to bring down the number of maternal deaths including those during
the first delivery are :
# Promotion of institutional deliveries through Janani Suraksha
Yojana.
# Capacity building of health care providers in basic and comprehensive
obstetric care.
# Operationalisation of sub-centers, Primary Health Centers,
Community Health Centers and District Hospitals for providing
24x7 basic and comprehensive obstetric care services.
# Name Based web enabled tracking of Pregnant Women to ensure
antenatal, intranatal and postnatal care has been introduced.
# Mother and Child Protection Card in collaboration with the
Ministry of Women and Child Development to monitor service delivery
for mothers and children.
# Antenatal, Intranatal and Postnatal care including Iron and
Folic Acid supplementation to pregnant & lactating women for
prevention and treatment of anaemia.
# Engagement of 8.71 lakhs Accredited Social Health Activists
(ASHAs) to generate demand and facilitate accessing of health
care services by the community.
# Village Health and Nutrition Days in rural areas as an outreach
activity, for provision of maternal and child health services.
# Health and nutrition education to promote dietary diversification,
inclusion of iron and folate rich food as well as food items that
promote iron absorption.
# Janani Shishu Suraksha Karyakaram (JSSK) has been launched
on 1st June, 2011, to eliminate any out of pocket expense for
pregnant women delivering in public health institutions and sick
newborns accessing public health institutions for treatment till
30 days after birth.
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 there is an increase in
the case of maternal deaths in the country;
(b) if so, the details thereof;
(c) whether there is any proposal to
institute maternal death audits; and
(d) if not, the reasons therefor?
ANSWER
THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE
(SHRI SUDIP BANDYOPADHYAY)
(a) & (b) As per the periodic survey reports of Registrar
General of India-Sample Registration System (RGI-SRS), Maternal
Mortality Ratio (MMR) in the country has declined from 254 per
100,000 Live Births in 2004-06 to 212 per 100,000 Live Births
in 2007-09 which translates into a decline in absolute numbers
of maternal deaths from approximately 67,000 to 56,000.
(c) & (d) Under the National Rural Health Mission (NRHM),
one of the key interventions under Maternal Health is implementation
of “Maternal Death Review (MDR)” at the health facilities and
in the community and formation of MDR Committees at district level
and a task force at State Level. The process of Maternal Death
Review has been initiated by the states for which guidelines and
tools have been disseminated to the states by Government of India.
(a) whether a
number of children in the country die every year due to measles,
maternal and neo-natal tetanus;
(b) if so, the details thereof alongwith
the number of cases reported during the last three years and the
current year, State/UT-wise;
(c) whether the Government proposes
to immunize the mothers with maternal and neo-natal tetanus (MNT)
vaccine;
(d) if so, the details thereof; and
(e) the further action taken by the
Government for adoption of hygienic delivery and cord care practices
especially in rural India?
ANSWER
MINISTER OF THE STATE IN THE MINISTRY 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. 148 FOR 23RD MARCH, 2012
(a)&(b) As per report published by Central Bureau of Health
Intelligence (CBHI), Government of India, 54 deaths due to measles
and 12 deaths due to neo natal tetanus were reported in 2011.
The State/UT wise number of cases reported for measles and neonatal
tetanus during the last three years and current year is at annexure
A and B.
(c)&(d) Under Universal Immunization Programme, tetanus toxiod
vaccine is provided to children at 10 and 16 years of age. Pregnant
women are provided two doses of tetanus toxiod vaccine to prevent
neonatal and maternal tetanus
(e) Institutional delivery is being promoted for hygienic delivery
and improved cord care practices through implementation of several
interventions under National Rural Health Mission including Jannani
Suraksha Yojana (JSY) and Jannani Shishu Suraksha Karyakram (JSSK).
ANNEXURE
(a) whether infant, child and maternal
mortality rate in India is one of the highest in comparison to
other countries;
(b) if so, the reasons therefor alongwith
the number of cases of infant, child, maternal mortality reported
in rural and urban areas in the country including tribal areas
of Maharashtra during the last three years and the current year,
State/UT-wise;
(c) the details of various programmes/
schemes launched by the Government for the development of maternal
and child care facilities in the country;
(d) the details of funds allocated under
the above schemes during each of the last three years and current
year, State/UTwise;
(e) whether certain deficiencies have
been reported in the implementation of these programmes/schemes;
and
(f) if so, the details thereof and the
corrective measures 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): India ranks 49th position in Infant Mortality
Rate among 192 countries and 55th position among 136 countries
in Maternal Mortality Ratio in descending order. The state-wise
details of Infant Mortality Rate and Maternal Mortality Ratio
including Maharashtra are placed at Annexure 1 and 2.
(c) In the Reproductive and Child Health programme, under National
Rural Health Mission, the following interventions are implemented
to reduce child and maternal mortality rates:
(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. The Government of India supports the vaccine programme by
supply of vaccines and syringes, Cold chain equipments, provision
of operational costs.
(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 and 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.
(d): State/UTs wise details are at annexure 3.
(e) & (f): There is varied performance on the part of states
for implementing various Mother and Child Health interventions.
Technical support is being provided to states in the form of capacity
building and supportive supervision for accelerating program performance.
ANNEXURE
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