Lok Sabha Question No. 83 (UNSTARRED), answered on 2018-02-02
Subject: MMR and IMR
Ministry: HEALTH AND FAMILY WELFARE
Asked by: JYOTIRADITYA MADHAVRAO SCINDIA, SUSHMITA DEV, SHOBHA KARANDLAJE, PRATHAP SIMHA, RODMAL NAGAR, DUSHYANT CHAUTALA

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 83 TO BE ANSWERED ON   2 ND FEBRUARY,  2018

## MMR AND IMR

## 83. SHRI JYOTIRADITYA M. SCINDIA:

KUMARI SUSHMITA DEV:

KUMARI SHOBHA KARANDLAJE:

SHRI PRATHAP SIMHA:

SHRI NAGAR RODMAL:

SHRI DUSHYANT CHAUTALA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether the Government has noticed United Nations warning about the abysmally high Infan and Maternal Mortality Rate (MMR & IMR) in India;
- (b) if so, the details of MMR and IMR in India, State - wise along with the action taken on such warnings;
- (c) whether th e UNICEF has also revealed that one in every 21 children being born in India dying before reaching their fifth birthday and if so, the details thereof;
- (d) whether India has achieved the Millennium Development Goal target of reducing MMR an IMR and i f so, the details thereof; and
- (e) the steps taken/being taken by the Government to address the issue of maternal deaths accelerate the pace of reduction of MMR and IMR in the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (SHRI ASHWINI KUMAR CHOUBEY)

- (a) to (c): As per Sample Registration System Report of Registrar General of India, the In Mortality Rate (IMR) is 34 per 1,000 live births in 2016 and Maternal Mortality Ratio (MM 167 per 1,00,000 live births in 2011 - 13 at national level. The Under 5 Mortality Rate (U5MR) is 39 per 1,000 live births in 2016 at national level. The State - wise details are enclosed as annexure I, II, & III respectively .
- (d) : As per the latest report of the Registr ar General of India, Sample Registration System (RGI- SRS),  Maternal  Mortality  Ratio  (MMR)  of  India  has  shown  a  decline  from  212  per

100,000 live births in the period 2007 - 09 to 167 per 100,000 live births in the period 2011 - 13. India's rate of decline of MMR between 2007 - 09 and 2011 - 13 is 5.7%. With the same rate of decline, it is estimated that India would have achieved the MDG target of 139 maternal per 100,000 live births. Similarly under MDG - 4,  the  Under  5  Mortality  Rate  target  is  42  per 1000 li ve births and India has achieved U5MR of 39 per 1000 live birth as per SRS, 2016 rep

(e) : Government  of  India  has  adopted  the  Reproductive,  Maternal,  Newborn,  Child  and Adolescent Health Strategy (RMNCH+A) to improve maternal and child health out comes. The RMNCH+A strategy recognize that child health and survival is inextricably linked to women's health across all life stages.

Under  National  Health  Mission,  the  following  interventions  are  being  implemented reduce Infant Mortality Rate and Maternal Mortality Ratio all across the country:

(1) Promotion  of  Institutional  deliveries  through  cash  incentive  under  Janani  Sura Yojana  (JSY)  and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  which  entitles  all  pregnan women delivering in public health ins titutions to absolutely free ante - natal check - ups, delivery including Caesarean section, post - natal care and treatment of sick infants till one year of age

(2) Strengthening of delivery points for providing comprehensive and quality Reproduct Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Services, ensuring essential newborn care at all delivery points, establishment of Special Newborn Care Units (SNC Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for care of sic and  small  babies.  Home  Based  Newborn  Care  (HBNC)  is  being  provided  by  ASHAs  to improve child rearing practices. India Newborn Action Plan (IANP) was launched in 2014 make concerted  efforts  towards  attainment  of  the  goals  of  'Single  Digit  Neonatal  Mortalit y Rate' and 'Single Digit Stillbirth Rate', by 2030.

(3) Early initiation and exclusive breastfeeding for first six months and appropriate and  Young  Child  Feeding  (IYCF)  practices  are  promoted  in  convergence  with  Ministry  o Women and Child Developmen t. Village Health and Nutrition Days (VHNDs) are observed for provision of maternal and child health services and creating awareness on maternal and care including health and nutrition education. Ministry of Health and Family Welfare lau MAA - Mot hers' Absolute Affection programme in August 2016 for improving breastfeeding practices (Initial Breastfeeding within one hour , Exclusive Breastfeeding up to six months and complementary Breastfeeding up to two years) through mass media and capacity build ing of health care providers in health facilities as well as in communities.

(4) Universal Immunization Programme (UIP) is being supported to provide vaccination t children  against  many  life  threatening  diseases  such  as  Tuberculosis,  Diphtheria,  Pe Polio, Tetanus, Hepatitis B and Measles. Pentavalent vaccine has been introduced all acr country and Mission Indradhanush and Intensified Mission Indradhanush has been launched fully immunize children who are either unvaccinated or partially vacc inated; those that have not  been  covered  during  the  rounds  of  routine  immunization  for  various  reasons.  Mea Rubella Campaign is being undertaken in select States for children from 9 months to 15 of age with the aim of eliminating Measles by 2020.

- (5) Name based tracking of mothers and children till two years of age (Mother and Ch Tracking System) is done to ensure complete antenatal, intranatal, postnatal care and c immunization as per schedule.
- (6) Rashtriya Bal Swasthya Karyakram (RBSK) fo r health screening, early detection of birth defects, diseases, deficiencies, development delays including disability and early int services has been Operationalized to provide comprehensive care to all the children in group of 0 - 18 years in the community.
- (7) Some other important interventions are Iron and folic acid (IFA) supplementation fo prevention of anaemia among the vulnerable age groups, home visits by ASHAs to promote exclusive breast feeding and promote use of ORS and Zinc for management of diarrhoea children.
- (8) Capacity building of health care providers: Various trainings are being conducted National Health Mission (NHM) to build and upgrade the skills of health care provide basic  and  comprehensive  obstetric  care  of  mother  during  pregnancy,  delivery  and  esse newborn care.
- (9) Capacity  building  of  Graduate  doctors  in  Anesthesia (LSAS)  and  Obstetric  Care including C - section (EmOC) skills to overcome the shortage of specialists in these discip particularly in rural areas.
- (10) Establishing  Maternal  and  Child  Health  (MCH)  Wings  in  high  caseload  facilities improve the quality o f care provided to mothers and children.
- (11) Health and nutrition education through Information, Education & Communication (IEC and Behaviour Change Communication (BCC) to promote dietary diversification, inclusion iron folate rich food as well as food items that promotes iron absorption.
8. (12)To  tackle  the  problem  of  anaemia  due  to  malaria  particularly  in  pregnant  women  a children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITBNs) being distributed in endemic areas.
9. (13)Safe Motherhood Booklet is being distributed to the pregnant women for educating th on dietary diversification and promotion of consumption of IFA.
10. (14)Low performing districts have been identified as High Priority Districts (HPDs) w entitles  them  to receive  high  per  capita  funding,  relaxed  norms,  enhanced  monitoring  an focused supportive supervisions and encouragement to adopt innovative approaches to add their peculiar health challenges.

……….

Annexure: I Status of Infant Mortality Rate

| State/UTs         | 2013   |   2014 |   2015 |   2016 |
|-------------------|--------|--------|--------|--------|
| India             | 40     |     39 |     37 |     34 |
| Bihar             | 42     |     42 |     42 |     38 |
| Chhattisgarh      | 46     |     43 |     41 |     39 |
| Himachal Pradesh  | 35     |     32 |     28 |     25 |
| Jammu & Kashmir   | 37     |     34 |     26 |     24 |
| Jharkhand         | 37     |     34 |     32 |     29 |
| Madhya Pradesh    | 54     |     52 |     50 |     47 |
| Odisha            | 51     |     49 |     46 |     44 |
| Rajasthan         | 47     |     46 |     43 |     41 |
| Uttar Pradesh     | 50     |     48 |     46 |     43 |
| Uttarakhand       | 32     |     33 |     34 |     38 |
| Arunachal Pradesh | 32     |     30 |     30 |     36 |
| Assam             | 54     |     49 |     47 |     44 |
| Manipur           | 10     |     11 |      9 |     11 |
| Meghalaya         | 47     |     46 |     42 |     39 |
| Mizoram           | 35     |     32 |     32 |     27 |
| Nagaland          | 18     |     14 |     12 |     12 |
| Sikkim            | 22     |     19 |     18 |     16 |
| Tripura           | 26     |     21 |     20 |     24 |
| Andhra Pradesh    | 39     |     39 |     37 |     34 |
| Goa               | 9      |     10 |      9 |      8 |
| Gujarat           | 36     |     35 |     33 |     30 |
| Haryana           | 41     |     36 |     36 |     33 |
| Karnataka         | 31     |     29 |     28 |     24 |
| Kerala            | 12     |     12 |     12 |     10 |
| Maharashtra       | 24     |     22 |     21 |     19 |
| Punjab            | 26     |     24 |     23 |     21 |
| Tamil Nadu        | 21     |     20 |     19 |     17 |
| Telangana         |        |     35 |     34 |     31 |
| West Bengal       | 31     |     28 |     26 |     25 |
| A & N Islands     | 24     |     22 |     20 |     16 |
| Chandigarh        | 21     |     23 |     21 |     14 |
| D & N Haveli      | 31     |     26 |     21 |     17 |
| Daman & Diu       | 20     |     18 |     18 |     19 |
| Delhi             | 24     |     20 |     18 |     18 |
| Lakshadweep       | 24     |     20 |     20 |     19 |
| Puducherry        | 17     |     14 |     11 |     10 |

(Source: Sample Registration System)

## Annexure: II

Status of Maternal Mortality Ratio

| State          |   MMR |
|----------------|-------|
| India          |   167 |
| Assam          |   300 |
| Bihar          |   208 |
| Jharkhand      |   208 |
| MP             |   221 |
| Chhattisgarh   |   221 |
| Orissa         |   222 |
| Rajasthan      |   244 |
| Uttar Pradesh  |   285 |
| Uttaranchal    |   285 |
| Andhra Pradesh |    92 |
| Karnataka      |   133 |
| Kerala         |    61 |
| Tamil Nadu     |    79 |
| Gujarat        |   112 |
| Haryana        |   127 |
| Maharashtra    |    68 |
| Punjab         |   141 |
| West Bengal    |   113 |

(Source: Sample Registration System, 2011 - 13)

Annexure: III Status of Under 5 Mortality Rate

| States           | 2013   |   2014 |   2015 |   2016 |
|------------------|--------|--------|--------|--------|
| India            | 49     |     45 |     43 |     39 |
| Andhra Pradesh   | 41     |     40 |     39 |     37 |
| Assam            | 73     |     66 |     62 |     52 |
| Bihar            | 54     |     53 |     48 |     43 |
| Chhattisgarh     | 53     |     49 |     48 |     49 |
| Delhi            | 26     |     21 |     20 |     22 |
| Gujarat          | 45     |     41 |     39 |     33 |
| Haryana          | 45     |     40 |     43 |     37 |
| Himachal Pradesh | 41     |     36 |     33 |     27 |
| Jammu & Kashmir  | 40     |     35 |     28 |     26 |
| Jharkhand        | 48     |     44 |     39 |     33 |
| Karnataka        | 35     |     31 |     31 |     29 |
| Kerala           | 12     |     13 |     13 |     11 |
| Madhya Pradesh   | 69     |     65 |     62 |     55 |
| Maharashtra      | 26     |     23 |     24 |     21 |
| Odisha           | 66     |     60 |     56 |     50 |
| Punjab           | 31     |     27 |     27 |     24 |
| Rajasthan        | 57     |     51 |     50 |     45 |
| Tamil Nadu       | 23     |     21 |     20 |     19 |
| Telangana        |        |     37 |     34 |     34 |
| Uttar Pradesh    | 64     |     57 |     51 |     47 |
| Uttarakhand      |        |     36 |     38 |     41 |
| West Bengal      | 35     |     30 |     30 |     27 |

(Source: Sample Registration System)