Infant mortality is still a major cause of concern in our country, most of which is attributed to conditions like birth asphyxia, pneumonia, birthing complications, neonatal infections, diarrhea, malaria, and malnutrition. Infant mortality is defined as the deaths of children who are less than one year of age. Typically, this is measured by Infant Mortality Rate (IMR) which is the total number of deaths per 1000 live births. Factors other nutrition also influence the IMR. Socio-economic status, disruption of traditional lifestyles, scarcity of doctors, low access to clean water and sanitation facilities, illiteracy and exploitation are some of those factors.
Describing India’s condition, Jashodhara Dasgupta, the Saviour Advisor of Sahayog, a non-profit voluntary organisation working to promote gender equality and women’s health, said that every pregnancy is a “financially catastrophic expenditure.” The government had initiated Anganwadi projects and rural development projects across the country to support economically marginalised families. Granting women employment raises their status and autonomy. Almost one third women in India are married before the age of 18. Delivery of child at home (domiciliary) without proper medical assistance is still prevalent. All these also factors contribute to the spiraling IMR in India. Much infant mortality happens due to premature childbirth which could be avoided with proper medical planning. Additionally, according to data from IndiaSpend, 48.2 million children in India are stunted due to malnutrition.
Ashok Kumar, Director of Central Bureau of Health Intelligence (CBHI) said, “Vaccination programme is not being implemented properly in slums and rural areas. Delhi hospitals receive a number of patients whose parents may have migrated from other states and they may not be vaccinated. There may be more cases than what we have reported as many sectors don’t send the actual figures.” A recent RTI document revealed that over 40% children did not get their DPT shots due to shortage of the vaccine. According to available data, around 3, 01,000 children were meant to be vaccinated in 2008-09 but only 1, 31,829 got the DPT shots. More recently, the Baba Raghav Das (BRD) Medical College in Uttar Pradesh’s Gorakhpur witnessed more than 85 tragic infant deaths due to a shortage in oxygen supply in August, 2017. Such instances shatter the public perception and government agencies need to be more active to avoid such instances.
Atindra Nath Das, Regional Director of Child Rights and You (CRY) (East) informed BE, “It should be mentioned that we are still far from ensuring a healthy and well-nourished childhood for all of our children. Children suffering from growth retardation as a result of poor diet and infections are often victims of malnourishment at a very young age. Malnutrition essentially means ‘bad nourishment’ or under-nourishment.”
In India, seven lakh new-borns die each year. The rate of neo natal death is 29/1,000 births in India. In 2018, the infant mortality rate stands at 39.1 deaths/1,000 live births. The rate for male is 38 deaths/1,000 live births and the same for female is 40.4 deaths/1,000 live births.
The United Nations has predicted that the infant mortality rates per 1,000 births will be 40 within 2015–2020. The pace of decline accelerated in India over the past 10 years, with the IMR registering an annual decline of 3.24% per annum in India. According to the fourth National Family Health Survey (NFHS-4, 2015-16) “The overall health status of Indians has improved substantially with a sharp decline in maternal and child mortality, fertility rate and malnutrition over the past decade.” However, despite the remarkable improvement recorded by India, some states like Bihar, Madhya Pradesh and Meghalaya continue to project a grim picture.
India has several Acts and seven schemes that promise maternity benefits. The ‘Maternity Benefit Act’, 1961, and the ‘National Food Security Act’, 2013 are important legislations related to the prevention of infant deaths. The Maternity Benefit Scheme, 2016, was a key advocate of the same. Pradhan Mantri Matri Vandana Yojana, which came later, restricts the benefits for the first living child. It only provides `5000 and contradicts the National Food Security Act, which guarantees a minimum of `6000 for every delivery. There are also the Mines and Plantation Act and Builders and Other Construction Workers Act that are aimed to secure the maternal rights for unorganised sectors.
The National Health Mission’s ‘Respectful Maternal Care’ aimed to defend the universal rights of child bearing women in seeking and receiving maternity care before during and after childbirth is a step in the right direction. That project was initiated to prevent delivery at home and to reduce the rate of child and mother death at the time of delivery.
In 2014, Union Ministry of Health initiated a scheme for pregnant women and new born babies. That tried to ensure Vitamin – K injection to all new born babies free to cost. It also aimed to have kangaroo mother care in all hospitals in the country. Additionally, this scheme allowed midwives to give injections to pregnant women and also aimed to provide free iron folic acid tablets to pregnant women. This scheme was inaugurated by the then Health Minister Harsh Vardhan. According to many sectoral experts, this scheme had some positive impact.
Talking about the condition of government hospitals in West Bengal, Dr. Soumyadip Saha, Medical Officer, Institute of Post Graduate Medical Education and Research and SSKM Hospital informed BE, “The scenario in government hospitals in regard to MMR & IMR in West Bengal has improved in the last five years owing to bold steps taken by the TMC government. MMR and IMR have both come down to 113 & 25 from 141 & 32 (2011) respectively. From just six sick newborn care units (SNCU) in May 2011, the state now has 48 functioning SNCUs. There was not even a single sick neonatal stabilization unit (SNSU) in May 2011. Now 280 such units have been set up.”
CRY is an important stakeholder
According to Atindra Nath Das, “CRY’s programming approach for Health and Nutrition focuses on access to quality primary health care for all mother and children and aims on providing improved access to nutrition and development for children below five years. CRY and its partner NGOs work closely with the ICDS centres on availability of infrastructure and equipment and growth monitoring of children. They also build capacity of the Anganwadi workers. CRY’s nutritional programme focuses on ensuring right to nutritious food for all children.”
According to the organisation, health outcomes should be linked to economic growth. With all these challenges and opportunities, health should be given priority while setting any developmental agenda. Accountability in our public health system needs to be established. Departments which are responsible for sanitation, clean drinking water, last-mile connectivity in remote areas, awareness programmes all fall under the purview of public health and need to have better accountability in delivering healthcare.