Lok Sabha Question No. 3255 (UNSTARRED), answered on 2020-03-13
Subject: Infant and Maternal Mortality
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Manoj Rajoria, Vijay Baghel

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

## LOK SABHA UNSTARRED QUESTION NO. 3255 TO BE ANSWERED ON 13 TH MARCH, 2020

## INFANT AND MATERNAL MORTALITY

## 3255. DR. MANOJ RAJORIA: SHRI VIJAY BAGHEL:

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

- (a) the increase in percentage in maternal mortality rate in rural and urban areas of t separately during the last three years and the current year;
- (b) whether the infant m ortality rate is very high in the country;
- (c) if so, the details thereof and the reasons therefor, State/UT - wise; and
- (d) the reformative steps taken by the Government to improve healthcare facilities in rural and to control maternal and infant mortality rate in the country and the funds allocated this regard?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALT H AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

- (a):    As per the latest report of Sample Registration System (SRS) released by Registrar of India (RGI), Maternal Mortality Ratio (MMR) of India has reduced by 8 points from 130, 100,000 liv e births in 2014 - 16 to 122 in 2015 - 17.

Year  wise,  rural  and  urban  disaggregated  mortality  data  are  not  provided  by  Sam registration  System.  However,  State -wise  Maternal  Mortality  Ratio  as  per  SRS'  2015 - 17  is placed at Annexure - I.

- (b) & (c ) : As per the latest report of Sample Registration System (SRS) released by Registrar General of India (RGI), Infant Mortality Rate of India has reduced by 25 points from 58 pe live births in 2005 to 33 per 1,000 live births in 2017.

The State/ UT wise Infant Mortality Rate is placed at Annexure - II.

- (d) : In order to address Maternal and Infant mortality, the Government of India is supp all  States/UTs  under  National  Health  Mission  in  implementation  of  Reproductive,  Mater Newborn, Child, A dolescent health and Nutrition (RMNCAH+N) strategy, which has following interventions:

## Interventions for improving maternal health :

- Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality
- Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out - of - pocket expenses for pregnant  women  and  sick  infants  (up  to  one  year  of  age).    Under  JSSK,  every  pregn woman is entitled to free delivery, including caesarean section, in public health ins This also includes free trans port, diagnostics, medicines, other consumables, diet and bloo (if required).
- Pradhan  Mantri  Surakshit  Matritva  Abhiyan (PMSMA)  Under  PMSMA,  all  pregnant women are provided fixed day, free of cost assured and quality Antenatal Care.  As p the campa ign, a minimum package of antenatal care services (including investigations drugs) is being provided to the beneficiaries on the 9 th day of every month.
- Surakshit Matratva Ashwasan( SUMAN) a comprehensive multipronged  and coordinated policy approach w ith an aim to assured, dignified, respectful and quality healthcare at n and zero tolerance for denial of services for every women and newborn visiting public facilities  in order to end all preventable maternal and newborn deaths and morbidit ies and provide positive birthing experience
- Comprehensive Abortion Careservices are being strengthened through trainings of health care  providers,  supply  of  drugs,  equipments,  Information  Education  and  Communicatio (IEC) etc.
- Monthly Village Health and Nutrition Days (VHND) as an outreach activity at Anganwadi centers for provision of maternal and child care including nutrition in convergence w ICDS.
- Midwifery programme has been initiated in 2018 to create a cadre for Nurse Practitione Midwi fery who are skilled in accordance to International Confederation of Midwives (I competencies and  capable  of  providing compassionate  women -centred,  reproductive, maternal and new - born health care services.
- Capacity building is undertaken of MBBS doctors in Anesthesia (LSAS) and Obstetric Care including  C - section  (CEmONC)  skills  to  overcome  the  shortage  of  specialists  in  the disciplines, particularly in rural areas.
- Skill Labs with earmarked skill stations for different tra ining programs are established to enhance the quality of training. Five National and over 100 State level Skills labs operational for conducting training.
- Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of c are provided to mothers and children.
- Obs HDU&ICU -Operationalization of Obstetric ICU/HDU in a high case load tertiary ca facilities across country to handle complicated pregnancies
- Delivery Points -Over 25,000 'Delivery Points' across the country have been strengthened in terms of infrastructure, equipment, and trained manpower for provision of comprehen RMNCAH+N services.
- Functionalisation of FRUs : Provision of Emergency Obstetric care at FRUs is being done by operationalizing FRUs. While operation alizing, the thrust is on the critical components such as manpower, blood storage units, referral linkages etc.
- LaQshya - LaQshya programme aims to improve the quality of care in Labour room and Maternity operation theatres to ensure that pregnant women r eceive respectful and quality care during delivery and immediate post - partum.
- Regular  IEC/BCC  is  conducted  for  early  registration  of  ANC,  regular  ANC,  institutio delivery, nutrition, and care during pregnancy etc.
- Over 10 lakhs Accredited Social Health Activists (ASHAs) have been engaged to facilitate access of health care services by the community, particularly pregnant women.
- Maternal Death Surveillance Review (MDSR) is being implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.
- Name  Based  Web  enabled  Tracking  of  Pregnant  Women  and  New  born  babies  so  as  to ensure provision of regular and complete services to them.
- MCP Card and Safe Motherhood Booklet are being distributed to the pregnant women for educating them on dietary diversification and promotion of consumption of IFA

## Interventions for improving Child health:

1. Strengthening  essential  newborn  care  at  all  delivery  points,  establishment  of ck Newborn  Care  Units  (SNCU),  Newborn  Stabilization  Units  (NBSU)  and  Kangaroo Mother Care (KMC) units for care of sick and small babies.
2. Home Based Newborn Care (HBNC) and Home-Based Care of Young Children (HBYC) by ASHAs to improve child rearing practices and to identify sick new - born and young children.
3. Early initiation and exclusive breastfeeding for first six months and appropriate fant and  Young  Child  Feeding  (IYCF)  practices  are  promoted  under  Mothers'  Absolute Affection (MAA) in convergence with Ministry of Women and Child Development.
4. Universal Immunization Programme (UIP) is being supported to provide vaccination t children  a g inst  life  threatening  diseases  such  as  Tuberculosis,  Diphtheria,  Pert Polio,  Tetanus,  Hepatitis  B,  Measles,  Rubella,  Pneumonia  and  Meningitis  caused Haemophilus  Influenzae  B.  The  Rotavirus  vaccination  has  also  been  rolled  out  in country  for prevention  of  Rota - viral  diarrhoea.  Mission  Indradhanush  is  targeted  to immunize children who are either unvaccinated or partially vaccinated i.e. those th not  been  covered  during  the  rounds  of  routine  immunization  for  various  reaso Intensified M ission Indradhanush (IMI) 2.0 is rolled - out as per road - map for achieving 90% full immunization coverage across the country.
5. Nutrition Rehabilitation Centres (NRCs) have been set up at public health facili treat  and  manage  the  children  with  Severe Acute  Malnutrition  (SAM)  admitted  with medical complications.
6. Defeat Diarrhoea (D2) initiative has been launched for promoting ORS and Zinc use a eliminating the diarrhoeal deaths by 2025.
7. Social Awareness and Actions to Neutralize Pneumonia Successful ly (SAANS) initiative for reduction of Childhood morbidity and mortality due to Pneumonia.
8. Anaemia Mukt Bharat (AMB) strategy as a part of Poshan Abhiyan aims to strengthen the  existing  mechanisms  and  foster  newer  strategies  to  tackle  anaemia,  which  inc ude testing  &  treatment  of  anaemia  in  school  going  adolescents  &  pregnant  women addressing  non  nutritional  causes  of  anaemia  and  a  comprehensive  communication strategy.
9. All the children from 0 to 18 years of age are screened for 30 health conditions cl ssified into 4Ds Diseases, Deficiencies, Defects and Developmental delay under 'Rashtriya Bal Swasthya Karyakaram' (RBSK) to improve the quality of survival and to reduce out of pocket expenditure of families. District early intervention centre (DEIC) at district health facility level are established for confirmation and management of the 4D's.

The Fund allocation and utilization State/ UT wise under RCH Flexible pool since 20 -17 is placed at Annexure III .

………………..

## ANNEXURE-I

## State-wise Maternal Mortality Ratio (MMR) as per SRS 2015-17

|   Sl. No | India/States                   | 2015-17     |
|----------|--------------------------------|-------------|
|        1 | Andhra Pradesh                 |             |
|        2 | Assam                          | 74          |
|        3 |                                | 229 165     |
|        4 | Bihar Jharkhand Gujarat        | 76 87       |
|        5 |                                |             |
|        6 | Haryana                        |             |
|        7 | India                          | 98 122      |
|        8 | Karnataka Kerala               |             |
|        9 |                                | 97 42       |
|       10 | Pradesh                        | 188 141     |
|       11 | Madhya Chhatisgarh Maharashtra |             |
|       12 |                                |             |
|       13 |                                | 55          |
|       16 | Odisha Punjab                  | 168 122 186 |
|       14 | Rajasthan Tamil                |             |
|       15 | Nadu                           | 63          |
|       16 |                                |             |
|       17 | Telangana Uttarakhand Uttar    | 76 89       |
|       18 | Pradesh                        | 216 94      |
|       19 |                                |             |
|       20 | West Bengal                    |             |

Other States

96

## Annexure: II

| Infant Mortality Rate   | Infant Mortality Rate   |   Infant Mortality Rate |
|-------------------------|-------------------------|-------------------------|
| S. N.                   | States / UTs            |                    2017 |
|                         | INDIA                   |                      33 |
| 1                       | Andhra Pradesh          |                      32 |
| 2                       | A&N Islands             |                      14 |
| 3                       | Arunachal Pradesh       |                      42 |
| 4                       | Assam                   |                      44 |
| 5                       | Bihar                   |                      35 |
| 6                       | Chandigarh              |                      14 |
| 7                       | Chhattisgarh            |                      38 |
| 8                       | D&N Haveli              |                      13 |
| 9                       | Daman & Diu             |                      17 |
| 10                      | Delhi                   |                      16 |
| 11                      | Goa                     |                       9 |
| 12                      | Gujarat                 |                      30 |
| 13                      | Haryana                 |                      30 |
| 14                      | Himachal Pradesh        |                      22 |
| 15                      | J & K                   |                      23 |
| 16                      | Jharkhand               |                      29 |
| 17                      | Karnataka               |                      25 |
| 18                      | Kerala                  |                      10 |
| 19                      | Lakshadweep             |                      20 |
| 20                      | Madhya Pradesh          |                      47 |
| 21                      | Maharashtra             |                      19 |
| 22                      | Manipur                 |                      12 |
| 23                      | Meghalaya               |                      39 |
| 24                      | Mizoram                 |                      15 |
| 25                      | Nagaland                |                       7 |
| 26                      | Odisha                  |                      41 |
| 27                      | Puducherry              |                      11 |
| 28                      | Punjab                  |                      21 |
| 29                      | Rajasthan               |                      38 |
| 30                      | Sikkim                  |                      12 |
| 31                      | Tamil Nadu              |                      16 |
| 32                      | Telangana               |                      29 |
| 33                      | Tripura                 |                      29 |
| 34                      | Uttar Pradesh           |                      41 |
| 35                      | Uttarakhand             |                      32 |
| 36                      | W. Bengal               |                      24 |

Sl. No.

## Annexure - III

Statement showing Release & Expenditure under RCH Flexible Pool (including RI, PPI and NIDDCP) from the F.Y. 2016-17 to 2019-20

Rs. In crore

| Sl. No.   | States                    | 2016-17   | 2016-17   | 2017-18   | 2017-18   | 2018-19   | 2018-19   | 2019-20   | 2019-20   |
|-----------|---------------------------|-----------|-----------|-----------|-----------|-----------|-----------|-----------|-----------|
| Sl. No.   | States                    | Release   | Exp       | Release   | Exp       | Release   | Exp       | Release   | Exp       |
| 1         | Andaman & Nicobar Islands | 14.92     | 7.42      | 0.29      | 4.03      | 0.88      | 4.38      | 0.45      | 2.19      |
| 2         | Andhra Pradesh            | 215.99    | 432.64    | 272.37    | 306.37    | 213.54    | 347.33    | 175.65    | 221.16    |
| 3         | Arunachal Pradesh         | 58.43     | 46.88     | 38.38     | 36.83     | 57.96     | 41.75     | 1.13      | 6.60      |
| 4         | Assam                     | 366.77    | 572.69    | 395.13    | 357.46    | 365.44    | 351.59    | 310.59    | 228.12    |
| 5         | Bihar                     | 413.76    | 827.65    | 775.44    | 1,167.38  | 425.87    | 958.63    | 431.85    | 699.41    |
| 6         | Chandigarh                | 9.93      | 9.29      | 3.46      | 2.54      | 3.71      | 3.51      | 3.62      | 2.15      |
| 7         | Chattisgarh               | 163.81    | 275.49    | 198.26    | 295.77    | 182.72    | 332.78    | 150.82    | 187.04    |
| 8         | Dadra & Nagar Haveli      | 5.65      | 9.55      | 4.05      | 3.40      | 4.16      | 3.29      | 1.09      | 1.64      |
| 9         | Daman & Diu               | 4.92      | 5.60      | 0.36      | 1.55      | 1.64      | 2.33      | 0.29      | 1.18      |
| 10        | Delhi                     | 112.03    | 73.09     | 71.07     | 57.25     | 46.78     | 34.30     | 20.23     | 26.52     |
| 11        | Goa                       | 10.49     | 14.27     | 7.76      | 7.40      | 4.49      | 6.75      | 3.13      | 4.60      |
| 12        | Gujarat                   | 234.80    | 424.51    | 321.56    | 530.28    | 273.88    | 584.05    | 204.52    | 269.31    |
| 13        | Haryana                   | 102.72    | 203.34    | 138.74    | 164.82    | 111.01    | 165.76    | 106.97    | 119.80    |
| 14        | Himachal Pradesh          | 69.80     | 81.71     | 76.51     | 84.54     | 63.25     | 75.86     | 56.31     | 43.09     |
| 15        | Jammu & Kashmir           | 138.86    | 221.94    | 163.73    | 115.26    | 111.79    | 121.44    | 91.01     | 65.04     |
| 16        | Jharkhand                 | 217.92    | 349.57    | 210.69    | 299.99    | 187.93    | 340.07    | 156.08    | 194.86    |
| 17        | Karnataka                 | 234.28    | 358.66    | 363.12    | 414.50    | 201.92    | 315.86    | 203.20    | 207.09    |
| 18        | Kerala                    | 97.44     | 172.67    | 156.03    | 194.31    | 99.95     | 173.36    | 74.47     | 95.97     |
| 19        | Lakshadweep               | 1.20      | 1.46      | 0.76      | 0.59      | 0.77      | 1.06      | 0.55      | 0.83      |
| 20        | Madhya Pradesh            | 393.73    | 881.95    | 517.47    | 902.30    | 380.86    | 854.40    | 375.08    | 634.36    |
| 21        | Maharashtra               | 431.19    | 530.73    | 443.10    | 560.45    | 363.03    | 531.10    | 360.15    | 328.50    |
| 22        | Manipur                   | 28.52     | 31.86     | 46.49     | 33.61     | 29.63     | 39.04     | 17.08     | 21.74     |
| 23        | Meghalaya                 | 40.78     | 50.26     | 45.92     | 35.99     | 39.86     | 40.66     | 23.80     | 33.78     |
| 24        | Mizoram                   | 15.99     | 33.16     | 26.06     | 19.05     | 21.38     | 19.66     | 13.15     | 11.38     |
| 25        | Nagaland                  | 28.33     | 36.66     | 28.04     | 20.08     | 26.41     | 25.37     | 9.81      | 12.97     |
| 26        | Orissa                    | 223.03    | 441.68    | 290.68    | 468.73    | 221.65    | 438.52    | 201.24    | 298.03    |
| 27        | Puducherry                | 21.13     | 15.46     | 10.69     | 7.41      | 4.71      | 5.37      | 6.12      | 2.73      |
| 28        | Punjab                    | 92.55     | 184.37    | 150.29    | 155.53    | 83.50     | 133.31    | 82.34     | 88.35     |
| 29        | Rajasthan                 | 393.53    | 580.96    | 472.92    | 639.30    | 375.50    | 685.65    | 354.40    | 441.04    |
| 30        | Sikkim                    | 7.81      | 12.96     | 9.40      | 4.74      | 6.10      | 6.65      | 4.68      | 3.17      |
| 31        | Tamil Nadu                | 253.33    | 532.17    | 379.55    | 437.92    | 245.80    | 377.80    | 233.94    | 224.42    |
| 32        | Tripura                   | 41.44     | 38.70     | 24.82     | 52.59     | 43.53     | 46.59     | 31.14     | 25.68     |
| 33        | Uttar Pradesh             | 878.45    | 1,655.28  | 1,077.80  | 1,715.68  | 865.87    | 1,687.39  | 924.05    | 1,208.47  |
| 34        | Uttarakhand               | 86.67     | 118.40    | 108.20    | 155.35    | 77.12     | 101.20    | 80.61     | 81.12     |
| 35        | West Bengal               | 317.43    | 751.34    | 383.04    | 702.68    | 244.61    | 521.23    | 259.76    | 359.50    |
| 36        | Telangana                 | 120.85    | 249.77    | 216.37    | 237.33    | 134.48    | 180.42    | 103.79    | 142.80    |
| 37        | Ladakh                    | -         | -         | -         | -         |           | -         | -         | -         |
|           | Grand Total               | 5848.49   | 10234.10  | 7428.56   | 10193.02  | - 5521.72 | 9558.46   | 5073.12   | 6294.63   |