Lok Sabha Question No. 1155 (UNSTARRED), answered on 2019-06-28
Subject: IMR and SBR
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: Andimuthu Raja

## GOVERNMENT OF INDIA MINISTRY OF WOMEN & CHILD DEVELOPMENT

## LOK SABHA UNSTARRED QUESTION NO. 1155

TO BE ANSWERED ON 28.06.2019

## IMR AND SBR

## 1155.    SHRI A. RAJA:

Will the Minister of WOMEN AND CHILD DEVELOPMENT be pleased to state:

- (a) the  programmes/schemes  implemented/operational  to  reduce  Infant  Mortality  Rate (IMR), Still Birth Rate (SBR) and to rectify the nutritional deficiencies of old age people across the country, State/UT-wise including Tamil Nadu;
- (b) the details of the funds sanctioned, allocated and utilised under these programmes/schemes  during  the  last  three  years  and  the  current  year  across  the country, State/UT-wise including Tamil Nadu;
- (c) the details of the target set and the achievements made under this so far;
- (d) the details of the number of cases covered under these programmes/schemes across the country;
- (e) whether the Government is proposing to make any amendment under these schemes; and
- (f) if so, the details thereof and the reasons therefor?

## ANSWER

## MINISTER OF WOMEN AND CHILD DEVELOPMENT (SHRIMATI SMRITI ZUBIN IRANI)

- (a) to  (d):  Public  Health  is  a  State  subject.  However,  to  reduce  infant  mortality  and  still birth, various programmes and schemes under National Health Mission are implemented by States/ UTs as follows:
- i. Promotion  of  Institutional  deliveries  through  cash  incentive  under  Janani  Suraksha Yojana  (JSY)  and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  entitles  all  pregnant women  (PW)  delivering  in  public  health  institutions  to  free  ante-natal  check-ups, delivery including Caesarean section, post-natal care and treatment of sick infants till one year of age.
- ii. Strengthening of delivery points for providing comprehensive and quality Reproductive, Maternal,  Newborn,  Child  and  Adolescent  Health  (RMNCH+A)  Services,  ensuring essential newborn care at all delivery points, establishment of Special Newborn Care Units (SNCU), Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for care of sick and small babies. India Newborn Action Plan (INAP) was launched in  2014  to  make  concerted  efforts  towards  attainment  of  the  goals  of  'Single  Digit

Neonatal  Mortality  Rate'  and  'Single  Digit  Still  birth  Rate,'  by  2030.  Comprehensive Lactation  Management  Centres  (CLMCs)  at  facilities  with  SNCU  and  Lactation Management  Units  (LMUs)  at  Sub-district level are made  functional to  ensure availability  of  Human  Milk  for  feeding  small  newborns.  Home  Based  Newborn  Care (HBNC) and Home Based Care of Young Children (HBYC) are provided by ASHAs to improve child rearing practices.

- iii. Early initiation  and exclusive breastfeeding for first six months and appropriate Infant and Young Child Feeding (IYCF) practices are promoted in convergence with Ministry of  Women  and  Child  Development.  Village  Health  and  Nutrition  Days  (VHNDs)  are observed for provision of maternal and child health services and creating awareness on maternal  and  child  care  including  health  and  nutrition  education.  Mothers'  Absolute Affection  (MAA)  programme  for  improving  breastfeeding  practices  (Early  Initiation Breastfeeding within one hour, Exclusive Breastfeeding up to six months and initiation of complementary feeding at six months of age with continued breastfeeding up to two years or beyond) through mass media campaigns and capacity building of health care providers in health facilities as well as in communities.
- iv. Universal  Immunization  Programme  (UIP)  is  supported  to  provide  vaccination  to children against life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio,  Tetanus,  Hepatitis  B,  Measles,  Rubella,  Pneumonia  and  Meningitis  caused  by Haemophilus Influenzae B. 'Mission Indradhanush and Intensified Mission Indradhanush'  was  launched  to  immunize  children  who  are  either  unvaccinated  or partially vaccinated, i.e., those that have not been covered during the rounds of routine immunization for various reasons.
- v. LaQshya a Labour Room quality improvement programme is implemented in over 2100 health facilities across the country including medical colleges.
- vi. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) is implemented to provide fixedday  assured,  comprehensive  and  quality  antenatal  care  universally  to  all  pregnant women on the 9 th  of every month.
- vii. Universal screening of pregnant women including anaemic pregnant women is carried out at all public health facilities and 180 iron & folic acid (IFA) tablets are given in the antenatal and 180 IFA tablets are given in the post-natal period to all pregnant women. Double doses tablets are given as a part of treatment regimen to those found to be clinically anaemic.
- viii. Guidelines  on  standardization  of  Labour  Rooms  and  creation  of  Obstetric  HDU  and Obstetric ICU at District Hospitals and Medical Colleges has also been prepared and disseminated to the States for improving quality of care during delivery and child birth.
- ix. Name based tracking of mothers and children till two years of age (Mother and Child Tracking System) is done to ensure complete antenatal, intranatal, postnatal care and complete immunization as per schedule.
- x. Rashtriya Bal Swasthya Karyakram (RBSK) for health screening, early detection of birth defects, diseases, deficiencies, development delays and early intervention services has been operationalized to provide comprehensive care to all the children in the age group of 0-18 years in the community.
- xi. Nutrition Rehabilitation Centres (NRCs) have been set up at public health facilities to treat  and  manage  the  children  with  Severe  Acute  Malnutrition  (SAM)  admitted  with medical complications.
- xii. Iron  and  folic  acid  (IFA)  supplementation  for  the  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  in  children  under Intensified Diarrhoea Control Fortnight (IDCF), administration of de-worming tablets to all  the  children  in  the  age  group  of  1-19  years  during  National  De-worming  Day (February and August) are carried out.
- xiii. Health and nutrition education through Information, Education & Communication (IEC) and Behaviour Change Communication (BCC) to promote healthy practices and create awareness to generate demand and improve service uptake.
- xiv. To tackle the problem of anaemia due to malaria, particularly in pregnant women and children,  Long  Lasting  Insecticide  Nets  (LLINs)  and  Insecticide  Treated  Bed  Nets (ITBNs) are distributed in endemic areas.
- xv. Dietary counseling to pregnant women is provided during ante-natal visits through the existing network of sub-centres and primary health centres and other health facilities as well as through outreach activities at Village Health & Nutrition Days (VHNDs).
- xvi. Various trainings are conducted to build and upgrade the skills of healthcare providers in  basic  and  comprehensive  obstetric  care  of  mother  during  pregnancy,  delivery  and essential new-born care.

The details of Fund released for Reproductive and Child Health Program under National Health Mission for last three financial years (2016-17, 2017-18 and 2018-19) is at Annexure-I .

Under  National  Health  Policy,  2017,  Infant  Mortality  Rate  (IMR)  target  for  the year 2019 is 28 per 1000 live births and Still Birth Rate is Single Digit by 2025.

As per latest Sample Registration System bulletin of Registrar General of India, the  Infant  Mortality  Rate  is  33  per  1000  live  births  at  National  level  in  2017  ( at Annexure-II ) and Still Birth rate is 4 per 1000 birth in 2016 ( at Annexure-III ).

Status of Key Maternal and Child Health Indicators for the year 2018-19 is at Annexure-IV .

- (e) & (f): At present, there is no proposal to make amendment under the said scheme.

********

|         | States                    |         |             | 2017-18   | 2017-18   | 2018-19   | 2018-19   |            |                 |
|---------|---------------------------|---------|-------------|-----------|-----------|-----------|-----------|------------|-----------------|
| Sl. No. | States                    | Release | 2016-17 Exp | Release   | Exp       | Release   | Exp       | Allocation | 2019-20 Release |
| 1       | Andaman & Nicobar Islands | 14.83   | 7.33        | -         | 3.74      | 0.50      | 4.00      | 4.32       | -               |
| 2       | Andhra Pradesh            | 176.58  | 393.22      | 140.04    | 174.05    | 117.00    | 250.79    | 119.42     | -               |
| 3       | Arunachal Pradesh         | 58.18   | 46.62       | 31.44     | 29.89     | 49.34     | 33.13     | 38.92      | -               |
| 4       | Assam                     | 361.14  | 567.06      | 283.47    | 245.80    | 319.24    | 305.40    | 218.86     | -               |
| 5       | Bihar                     | 331.28  | 745.16      | 307.29    | 699.23    | 248.23    | 780.99    | 248.78     | -               |
| 6       | Chandigarh                | 9.67    | 9.03        | 2.53      | 1.62      | 2.72      | 2.52      | 3.64       | -               |
| 7       | Chhattisgarh              | 151.89  | 263.57      | 139.63    | 237.14    | 98.44     | 248.50    | 102.81     | 62.46           |
| 8       | Dadra & Nagar Haveli      | 5.51    | 9.41        | 3.52      | 2.87      | 3.79      | 2.92      | 3.90       | -               |
| 9       | Daman & Diu               | 4.65    | 5.33        | -         | 1.18      | 1.46      | 2.15      | 2.91       | -               |
| 10      | Delhi                     | 104.44  | 65.49       | 32.20     | 18.38     | 30.88     | 18.40     | 33.63      | -               |
| 11      | Goa                       | 3.65    | 7.43        | 3.59      | 3.23      | 2.93      | 5.19      | 3.37       | -               |
| 12      | Gujarat                   | 216.04  | 405.75      | 168.25    | 376.97    | 146.23    | 456.40    | 146.24     | -               |
| 13      | Haryana                   | 77.63   | 178.25      | 59.89     | 85.97     | 51.74     | 106.49    | 52.66      | 31.55           |
| 14      | Himachal Pradesh          | 66.61   | 78.52       | 46.95     | 54.98     | 43.81     | 56.42     | 45.19      | 27.09           |
| 15      | Jammu & Kashmir           | 133.74  | 216.82      | 133.95    | 85.49     | 96.85     | 106.50    | 100.97     | 59.54           |
| 16      | Jharkhand                 | 154.98  | 286.62      | 125.45    | 214.75    | 96.62     | 248.76    | 105.00     | -               |
| 17      | Karnataka                 | 215.96  | 340.33      | 173.21    | 224.59    | 131.89    | 245.83    | 146.08     | 86.23           |
| 18      | Kerala                    | 90.14   | 165.37      | 76.25     | 114.53    | 64.48     | 137.89    | 64.48      | -               |
| 19      | Lakshadweep               | 1.19    | 1.45        | 0.65      | 0.48      | 0.72      | 1.01      | 0.84       | -               |
| 20      | Madhya Pradesh            | 361.74  | 849.97      | 297.24    | 682.07    | 233.97    | 707.50    | 244.72     | 124.58          |
| 21      | Maharashtra               | 399.98  | 499.52      | 264.88    | 382.23    | 256.88    | 424.96    | 257.44     | -               |
| 22      | Manipur                   | 27.95   | 31.29       | 37.23     | 24.35     | 27.10     | 36.51     | 24.97      | -               |
| 23      | Meghalaya                 | 39.51   | 48.99       | 39.16     | 29.23     | 35.44     | 36.24     | 26.46      | -               |
| 24      | Mizoram                   | 15.77   | 32.93       | 21.64     | 14.63     | 20.02     | 18.29     | 14.30      | -               |
| 25      | Nagaland                  | 27.29   | 35.62       | 24.29     | 16.33     | 24.60     | 23.56     | 18.26      | -               |
| 26      | Orissa                    | 179.64  | 398.29      | 138.72    | 316.77    | 134.97    | 351.85    | 134.97     | 81.99           |
| 27      | Puducherry                | 15.28   | 9.61        | 7.48      | 4.20      | 4.25      | 4.90      | 5.65       | -               |
| 28      | Punjab                    | 84.99   | 176.81      | 74.51     | 79.75     | 56.54     | 106.35    | 57.55      | -               |
| 29      | Rajasthan                 | 364.19  | 551.62      | 298.62    | 465.00    | 241.57    | 551.72    | 246.16     | -               |
| 30      | Sikkim                    | 7.76    | 12.91       | 8.14      | 3.48      | 5.68      | 6.23      | 6.49       | -               |
| 31      | Tamil Nadu                | 217.40  | 496.25      | 196.28    | 254.65    | 140.48    | 272.48    | 146.95     | 86.97           |
| 32      | Tripura                   | 39.57   | 36.83       | 18.25     | 46.01     | 37.45     | 40.51     | 26.46      | -               |
|         |                           | 658.87  | 1,435.70    | 567.80    |           |           |           | 495.60     |                 |
| 33      | Uttar Pradesh             |         |             | 55.71     | 1,205.68  | 459.91    | 1,281.44  |            | -               |
| 34      | Uttarakhand               | 82.00   | 113.74      |           | 102.86    | 61.65     | 85.72     | 61.77      | 37.20           |
| 35      | West Bengal               | 252.44  | 686.35      | 191.72    | 511.36    | 158.20    | 434.83    | 170.66     | -               |

Note: (1) As there is no relevance of Allocation after the closure of the Financial Year, it has not been provided.

(2) The above releases relate to Central Govt. Grants & do not include State share contribution.

(3) Expenditure includes expenditure against central Release, State release & unspent balances at the beginning of the year. Expenditure for the F.Y. 2018-19 (up to 31.03.2019 as per FMR) are provisional.

(4) RCH Flexible Pool includes RI (cash grant), PPI (cash grant) and NIDDCP.

## Statement  referred  to  in  reply  to  part  (a  to  d)  of  the  Lok  Sabha  Unstarred  1155  to  be answered on 28.06.2019

## State-wise Infant Mortality Rate (IMR) in India, SRS 2017

| States/UTs           |   IMR (2017) |
|----------------------|--------------|
| India                |           33 |
| Andaman & Nicobar    |           14 |
| Andhra Pradesh       |           32 |
| Arunachal Pradesh    |           42 |
| Assam                |           44 |
| Bihar                |           35 |
| Chandigarh           |           14 |
| Chhattisgarh         |           38 |
| Dadra & Nagar Haveli |           13 |
| Daman & Diu          |           17 |
| Delhi                |           16 |
| Goa                  |            9 |
| Gujarat              |           30 |
| Haryana              |           30 |
| Himachal Pradesh     |           22 |
| Jammu & Kashmir      |           23 |
| Jharkhand            |           29 |
| Karnataka            |           25 |
| Kerala               |           10 |
| Lakshadweep          |           20 |
| Madhya Pradesh       |           47 |
| Maharashtra          |           19 |
| Manipur              |           12 |
| Meghalaya            |           39 |
| Mizoram              |           15 |
| Nagaland             |            7 |
| Odisha               |           41 |
| Puducherry           |           11 |
| Punjab               |           21 |
| Rajasthan            |           38 |
| Sikkim               |           12 |
| Tamil Nadu           |           16 |
| Telangana            |           29 |
| Tripura              |           29 |
| Uttar Pradesh        |           41 |
| Uttarakhand          |           32 |
| West Bengal          |           24 |

## Statement  referred  to  in  reply  to  part  (a  to  d)  of  the  Lok  Sabha  Unstarred  1155  to  be answered on 28.06.2019

| Status of Still Birth Rate as per SRS, 2016   | Status of Still Birth Rate as per SRS, 2016   | Status of Still Birth Rate as per SRS, 2016   |
|-----------------------------------------------|-----------------------------------------------|-----------------------------------------------|
| Sr. No                                        | State/UTs                                     | Still Birth Rate (SRS 2016)                   |
| 1                                             | Bihar                                         | 3                                             |
| 2                                             | Chhattisgarh                                  | 10                                            |
| 3                                             | Himachal Pradesh                              | 24                                            |
| 4                                             | Jammu & Kashmir                               | 2                                             |
| 5                                             | Jharkhand                                     | 0                                             |
| 6                                             | Madhya Pradesh                                | 8                                             |
| 7                                             | Odisha                                        | 13                                            |
| 8                                             | Rajasthan                                     | 3                                             |
| 9                                             | Uttar Pradesh                                 | 3                                             |
| 10                                            | Uttarakhand                                   | 9                                             |
| 11                                            | Arunachal Pradesh                             | -                                             |
| 12                                            | Assam                                         | 2                                             |
| 13                                            | Manipur                                       | -                                             |
| 14                                            | Meghalaya                                     | -                                             |
| 15                                            | Mizoram                                       | -                                             |
| 16                                            | Nagaland                                      | -                                             |
| 17                                            | Sikkim                                        | -                                             |
| 18                                            | Tripura                                       | -                                             |
| 19                                            | Andhra Pradesh                                | 3                                             |
| 20                                            | Goa                                           | -                                             |
| 21                                            | Gujarat                                       | 6                                             |
| 22                                            | Haryana                                       | 5                                             |
| 23                                            | Karnataka                                     | 6                                             |
| 24                                            | Kerala                                        | 6                                             |
| 25                                            | Maharashtra                                   | 4                                             |
| 26                                            | Punjab                                        | 6                                             |
| 27                                            | Tamil Nadu                                    | 3                                             |
| 28                                            | Telangana                                     | 1                                             |
| 29                                            | West Bengal                                   | 3                                             |
| 30                                            | A & N Islands                                 | -                                             |
| 31                                            | Chandigarh                                    | -                                             |
| 32 Dadra & Nagar                              | Haveli                                        | -                                             |
| 33                                            | Daman & Diu                                   | -                                             |
| 34                                            | Delhi                                         | 4                                             |
| 35                                            | Lakshadweep                                   | -                                             |
| 36                                            | Puducherry                                    | -                                             |
|                                               | India                                         | 4                                             |

Annexure-IV Statement  referred  to  in  reply  to  part  (a  to  d)  of  the  Lok  Sabha  Unstarred  1155  to  be answered on 28.06.2019

| Status of Key Maternal and   | Status of Key Maternal and   | Status of Key Maternal and                                | Status of Key Maternal and               | Status of Key Maternal and                   | Status of Key Maternal and                       |
|------------------------------|------------------------------|-----------------------------------------------------------|------------------------------------------|----------------------------------------------|--------------------------------------------------|
|                              |                              | Number of pregnant women received 4 or more ANC check ups | Institutional deliveries (Public + Pvt.) | Number of New Borns Breast Fed within 1 hour | Number of fully immunized children (9-11 months) |
|                              | All India                    | 21,117,098                                                | 19,059,280                               | 18,180,464                                   | 22,424,715                                       |
| 1 2                          | A & N Islands Andhra Pradesh | 4,201 848,232                                             | 3,715 742,650                            | 3,318 710,998                                | 3,990 846,134                                    |
| 3                            | Arunachal Pradesh            | 9,516                                                     | 16,563                                   | 15,581                                       | 18,785                                           |
|                              | Assam                        | 566,773                                                   | 532,816                                  | 568,885                                      | 594,960                                          |
| 4                            |                              | 2,174,659                                                 | 1,695,938                                |                                              |                                                  |
| 5                            | Bihar                        |                                                           | 28,881                                   | 1,975,200                                    | 2,269,847                                        |
| 6                            | Chandigarh                   | 37,697                                                    |                                          | 22,204                                       | 18,240                                           |
| 7                            | Chhattisgarh                 | 566,395                                                   | 475,873                                  | 472,937                                      | 566,952                                          |
| 8                            | Dadra & Nagar Haveli         | 6,923                                                     | 9,035                                    | 7,767                                        | 8,386                                            |
| 9                            | Daman & Diu                  | 6,266                                                     | 3,854                                    | 2,567                                        | 5,314                                            |
| 10                           | Delhi                        | 408,418                                                   | 271,487                                  | 203,318                                      | 298,011                                          |
| 11                           | Goa                          | 18,154                                                    | 17,921                                   | 13,779                                       | 19,708                                           |
| 12                           | Gujarat                      | 1,143,833                                                 | 1,104,816                                | 1,000,237                                    | 1,148,695                                        |
| 13                           | Haryana                      | 439,932                                                   | 475,699                                  | 447,301                                      | 492,055                                          |
| 14                           | Himachal Pradesh             | 88,490                                                    | 76,598                                   | 72,829                                       | 101,629                                          |
| 15                           | Jammu & Kashmir              | 289,687                                                   | 188,700                                  | 175,122                                      | 203,457                                          |
| 16                           | Jharkhand                    | 748,568                                                   | 703,894                                  | 678,024                                      | 653,753                                          |
| 17                           | Karnataka                    | 1,123,482                                                 | 910,334                                  | 858,104                                      | 1,054,412                                        |
| 18                           | Kerala                       | 515,921                                                   | 483,145                                  | 442,833                                      | 462,429                                          |
| 19                           | Lakshadweep                  | 1,166                                                     | 845                                      | 734                                          | 1,024                                            |
| 20                           | Madhya Pradesh               | 1,386,210                                                 | 1,300,239                                | 1,265,252                                    | 1,400,603                                        |
| 21                           | Maharashtra                  | 1,892,039                                                 | 1,706,694                                | 1,565,102                                    | 1,825,849                                        |
| 22                           | Manipur                      | 29,019                                                    | 31,295                                   | 33,611                                       | 35,016                                           |
| 23                           | Meghalaya                    | 52,325                                                    | 48,622                                   | 74,786                                       | 41,966                                           |
| 24                           | Mizoram                      | 15,984                                                    | 16,893                                   | 19,963                                       | 15,651                                           |
| 25                           | Nagaland                     | 8,136                                                     | 16,179                                   | 16,493                                       | 14,114                                           |
| 26                           | Odisha                       | 584,695                                                   | 596,236                                  | 579,472                                      | 689,267                                          |
| 27                           | Puducherry                   | 67,567                                                    | 43,970                                   | 38,250                                       | 14,930                                           |
| 28                           | Punjab                       | 358,671                                                   | 364,370                                  | 298,355                                      | 373,867                                          |
| 29                           | Rajasthan                    | 908,721                                                   | 1,345,649                                | 1,193,821                                    | 1,379,951                                        |
| 30                           | Sikkim                       | 6,278                                                     | 7,042                                    | 5,972                                        | 7,629                                            |
| 31                           | Tamil Nadu                   | 962,931                                                   | 874,844                                  | 615,061                                      | 950,186                                          |
| 32                           | Telangana                    | 841,309                                                   | 517,090                                  | 388,525                                      | 602,561                                          |
| 33                           | Tripura                      | 40,820                                                    | 47,073                                   | 43,618                                       | 46,876                                           |
| 34                           | Uttar Pradesh                | 3,468,367                                                 | 2,984,292                                | 3,179,894                                    | 4,684,237                                        |
| 35 36                        | Uttarakhand West Bengal      | 125,803 1,369,910                                         | 128,043 1,287,985                        | 128,507 1,062,044                            | 182,628 1,391,603                                |