Lok Sabha Question No. 855 (UNSTARRED), answered on 2018-12-14
Subject: Child Sex Ratio
Ministry: WOMEN AND CHILD DEVELOPMENT
Asked by: MANOJ RAJORIA, RAMSINH PATALYABHAI RATHWA

## GOVERNMENT OF INDIA MINISTRY OF WOMEN & CHILD DEVELOPMENT

## LOK SABHA UN-STARRED QUESTION NO. 855

TO BE ANSWERED ON 14.12.2018

## CHILD SEX RATIO

855. DR. MANOJ RAJORIA: SHRI RAMSINH RATHWA:

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

- (a) whether the Government is aware that Scheduled Tribe population particularly children and mothers in India  suffers  from  high  degree  of  malnutrition,  if  so,  the  details  thereof  during  the  last  three  years, State/UT-wise;
- (b) the steps taken by the Government to tackle this situation;
- (c) whether the Government has accorded priority to provide better healthcare facilities especially to the tribal women and children in the country and if so, the details thereof and if not, the reasons therefor; and
- (d) the steps taken by the Government for improving the Maternal Mortality Rate due to malnutrition and declining Child Sex Ratio in respect of the tribal population?

## ANSWER

## MINISTER OF STATE IN THE MINISTRY OF WOMEN AND CHILD DEVELOPMENT (DR. VIRENDRA KUMAR)

- (a): As per the recent report of National Family Health Survey (NFHS) - 4 conducted by Ministry of Health and  Family  Welfare  in  2015-16,  45.3%  Scheduled  Tribe  children  under  5  years  of  age  are underweight, 43.8% are stunted and 76.8% are anaemic. Further, 31.7% Scheduled Tribe women (1549 years of age) have chronic energy deficiency (BMI less than 18.5) and 59.8% are anaemic.  The State-wise details are at Annexure-I & II.
- (b): This Ministry is implementing several schemes and programs like Anganwadi Services, Scheme for Adolescent  Girls  and  Pradhan  Mantri  Matru  Vandana  Yojna  under  the  Umbrella  Integrated  Child Development Services Scheme as direct targeted interventions to address the problem of malnutrition throughout  the  country  including  for  Tribal  population.  Government  has  also  set  up  POSHAN Abhiyaan, which aims to prevent and reduce prevalence of stunting, underweight and anaemia among children (0-6 years), prevalence of anaemia among women (15-49 years) and reduction in prevalence of low birth weight in the country in a time bound manner.
- (c): The  National  Health  Mission  (NHM)  framework  provides  for  a  separate  chapter  for  Health  in  tribal areas. The Framework allows innovative approaches and differential norms for Tribal areas.
- All  tribal  districts  whose  composite health index is below the State average have been identified as high priority districts and receive more resources per capita under the NHM as compared to the rest of the districts in the State.
- State governments have been advised to provide higher allocation to the high priority districts in the ratio of 1:1.3 per unit of population.
- All  Aspirational Districts have been included into high priority districts and out of 256 identified new high priority district, 101 are tribal districts.
- (d): Under the National Health Mission (NHM), following are some of the important steps taken to reduce maternal deaths in the country:
- Janani  Suraksha  Yojana  (JSY),  a  demand  promotion  and  conditional  cash  transfer  scheme  is implemented with the objective of reducing Maternal and Infant Mortality by encouraging institutional deliveries.
- Under Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is entitled to free delivery, including caesarean section in public health institutions. This also includes free transport, diagnostics, medicines, other consumables, food and blood, if required.
- Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched to provide fixed-day assured comprehensive and quality antenatal care universally to all pregnant women on the 9 th  of every month. While antenatal care is routinely provided to pregnant women, special ANC services are provided by OBGY specialists/ Radiologist/ Physicians at government health facilities under PMSMA.
- 'LaQshya - Labor room Quality improvement Initiative' launched on 11 th  Dec 2017.
- Special provision of birth waiting homes under NHM in tribal areas.
- Maternal  Death  Surveillance  and  Response  (MDSR)  is  implemented  to  take  corrective  action  for averting maternal deaths.
- Funds  are  provided    for strengthening  of 'Delivery Points' for  provision  of    comprehensive Reproductive,  Maternal,  New  Born    Child  Health  and  Adolescent  (RMNCH+A)  services.  Placing quality emergency obstetric care services   at 'Delivery Points' is a priority area.
- Maternal and Child Health (MCH) Wings are established at high caseload facilities.
- Operationalization  of  Comprehensive  Abortion  Care  Services  and  services  for  Reproductive  Tract Infections and Sexually Transmitted Infections (RTI/STI.
- Mother  and  Child  Tracking  System  (MCTS)  and  Mother  and  Child  Tracking  Facilitation  Centre (MCTFC), a name-based web-enabled system to track every pregnant women and child.
- Operational  guidelines  for  Universal  screening  of  Gestational  Diabetes  Mellitus,  screening  for hypothyroidism  for  high  risk  group  during  pregnancy,  training  of  General  Surgeons  for  performing Caesarean Section, calcium supplementation & de-worming during pregnancy and promotion of birth companion during delivery have been disseminated.
- Monthly Village Health and Nutrition Days (VHND) are organized as an outreach activity at Anganwadi centres for provision of maternal and child care including nutrition.
- Over 10 lakhs Accredited Social Health Activists (ASHAs) have been engaged to facilitate access of health care services by the community, particularly pregnant women.
- Under  the  National  Iron+  Initiative,  iron  and  folic  acid  supplementation  is  given  across  life  stages including pregnant, lactating women and adolescent girls.
- Regular IEC/BCC is conducted.

Additionally,  Ministry  of  Tribal  affairs  approves  projects  by  the  Project  Appraisal  Committee every year and funds are released under the 'Special Central Assistance (SCA) to Tribal Sub Scheme (TSS)' and State Grants under Article 275(1) to the concerned State Governments for improvement of Health  facilities  among  tribal  people  including  tribal  women.    The  concerned  States  have  been instructed that at least one-third of the total beneficiaries should be women/ girls.

In order to address the declining Child Sex Ratio, Beti Bachao Beti Padhao Scheme (BBBP) is implemented, which addresses the issues of women empowerment and aims to change mindsets to value girl child. It is a tri-ministerial effort of Ministries of Women and Child Development, Health & Family Welfare and Human Resource Development. The key elements of the scheme include nationwide  awareness  and  advocacy  campaign  and  multi-sectoral  interventions,  which  include  tighter enforcement of Pre-Conception & Pre-Natal Diagnostic Techniques (PC&PNDT) Act, Pre-Natal/ Post Natal care of mother, improve enrolment of girls in schools, construction of girl's toilets, community engagement/ training etc. The  Scheme  is  currently  implemented  in  all  640  districts  (as  per  census 2011) of the Country through Multi-sectoral intervention and alert District Media & Advocacy in 405 districts  and  alert  District  Media  &  Advocacy  in  235  districts.  The  scheme  is  administered  through District  appropriate  authority  by  providing  100%  financial  grant-in-aid  to  the  selected  districts  and funds are directly transferred to the concerned districts.

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## Statement referred to in reply to Part (a) of Lok Sabha Unstarred Q. No. 855 to be for 14.12.2018

Prevalence of Malnutrition among Scheduled Tribe Children (under 5 years) as per NFHS-3 and 4

| S. No.   | State              | Stunting   | Stunting   | Underweight   | Underweight   | Anaemia   | Anaemia   |
|----------|--------------------|------------|------------|---------------|---------------|-----------|-----------|
|          |                    | NFHS-3     | NFHS-4     | NFHS-3        | NFHS-4        | NFHS-3    | NFHS-4    |
| 1        | Andaman & Nicobar  | --         | --         | --            | --            | -         | -         |
| 2        | Andhra Pradesh     | 54.9       | 31.7       | 41.5          | 47.4          | 76.3      | 74.2      |
| 3        | Arunachal Pradesh  | 44.3       | 30.5       | 29.6          | 18.1          | 51.4      | 47.5      |
| 4        | Assam              | 38.1       | 28.2       | 18.2          | 18.5          | 77.2      | 37.4      |
| 5        | Bihar              | --         | 48.2       | --            | 46.8          | -         | 68        |
| 6        | Chandigarh         | --         | --         | --            | --            |           |           |
| 7        | Chhattisgarh       | 51.6       | 42.2       | 52.8          | 43.8          | 78        | 48.2      |
| 8        | Delhi              | --         | --         | --            | --            | -         | -         |
| 9        | Dadra Nagar Haveli | --         | --         | --            | --            | -         | -         |
| 10       | Daman & Diu        | --         | --         | --            | --            | -         | -         |
| 11       | Goa                | 35.9       | 25.7       | 43.9          | 24.4          | 25.4      | 44.4      |
| 12       | Gujarat            | 60.9       | 47.5       | 64.5          | 51.6          | 82.9      | 56.7      |
| 13       | Haryana            | --         | 32.5       | --            | 28.9          |           | 72.1      |
| 14       | Himachal Pradesh   | 28.1       | 22.3       | 25            | 20.3          | 63.3      | 67        |
| 15       | Jammu & Kashmir    | 39.5       | 32.3       | 35.7          | 26.3          | 61        | 49.4      |
| 16       | Jharkhand          | 54.5       | 48.8       | 64.3          | 55.1          | 79.5      | 78.4      |
| 17       | Karnataka          | 51         | 39.3       | 41.9          | 40.3          | 80.6      | 63.7      |
| 18       | Kerala             | --         | 23.9       | --            | 21.6          | -         | 49.9      |
| 19       | Lakshadweep        | --         | --         | --            | --            | -         | -         |
| 20       | Madhya Pradesh     | 56.4       | 48.2       | 71.4          | 51.5          | 82.5      | 76.1      |
| 21       | Maharashtra        | 57.8       | 45.4       | 53.2          | 49.4          | 67.6      | 59.4      |
| 22       | Manipur            | 45.6       | 34.3       | 24.2          | 12.6          | 40        | 19.8      |
| 23       | Meghalaya          | 55.4       | 44.3       | 48.5          | 28.6          | 65        | 40.1      |
| 24       | Mizoram            | --         | 27.2       | --            | 11.6          | -         | 18.6      |
| 25       | Nagaland           | 37.2       | 28.9       | 23            | 16.3          | -         | 21.8      |
| 26       | Odisha             | 57.2       | 45.5       | 54.4          | 48.5          | 80.1      | 58.4      |
| 27       | Punjab             | --         | --         | --            | --            | --        | --        |
| 28       | Puducherry         | --         | --         | --            | --            | --        | --        |
| 29       | Rajasthan          | 48.8       | 49.3       | 46.8          | 52.1          | 73.7      | 74        |
| 30       | Sikkim             | 45.2       | 29.6       | 18            | 14.2          | 59.9      | 58.3      |
| 31       | Tamil Nadu         | --         | 25.7       | --            | 33            | -         | 45.9      |
| 32       | Telangana          | --         | 34.7       | --            | 35.4          | -         | 66.5      |
| 33       | Tripura            | 30.7       | 24.9       | 36.5          | 20.9          | 77.1      | 54.8      |
| 34       | Uttar Pradesh      | 68.5       | 50.9       | 61.2          | 46            | 78.8      | 65.7      |
| 35       | Uttarakhand        | 47.9       | 34.9       | 50.4          | 29.9          | 72.4      | 61.7      |
| 36       | West Bengal        | 58.6       | 37.3       | 59.7          | 42            | 86.3      | 68.1      |
| 37       | India              | 53.9       | 43.8       | 54.5          | 45.3          | 76.8      | 66.3      |

## Statement referred to in reply to Part (a) of Lok Sabha Unstarred Q. No. 855 to be for  14.12.2018

Prevalence of Malnutrition among Scheduled Tribe Women (15-49 years) as per NFHS-3 and 4

| S. No.   | State              | Underweight   | Underweight   | Anaemia   | Anaemia   |
|----------|--------------------|---------------|---------------|-----------|-----------|
| S. No.   | State              | NFHS-3        | NFHS-4        | NFHS-3    | NFHS-4    |
| 1        | Andaman & Nicobar  | -             | -             | -         | -         |
| 2        | Andhra Pradesh     | 43.5          | 28.8          | 69.1      | 71.8      |
| 3        | Arunachal Pradesh  | 12.7          | 6.4           | 41.6      | 35.8      |
| 4        | Assam              | 20            | 14.4          | 74.1      | 48.5      |
| 5        | Bihar              | -             | 29.2          |           | 64.4      |
| 6        | Chandigarh         | -             | -             | -         | -         |
| 7        | Chhattisgarh       | 50.3          | 34            | 74        | 55.9      |
| 8        | Delhi              | 34.6          | -             | 59.5      | -         |
| 9        | Dadra Nagar Haveli | -             | -             | -         | -         |
| 10       | Daman & Diu        | -             | -             | -         | -         |
| 11       | Goa                | 41.2          | 26.7          | 39.5      | 33.6      |
| 12       | Gujarat            | 61.6          | 40.6          | 74.2      | 59        |
| 13       | Haryana            | -             | 24.4          | -         | 64.8      |
| 14       | Himachal Pradesh   | 29.3          | 15.6          | 54.6      | 58.9      |
| 15       | Jammu & Kashmir    | 28.7          | 21            | 54.1      | 37.9      |
| 16       | Jharkhand          | 47.2          | 34.9          | 85        | 75        |
| 17       | Karnataka          | 48.7          | 23.6          | 56.8      | 46.8      |
| 18       | Kerala             | 42.6          | 20.1          | 51.9      | 48        |
| 19       | Lakshadweep        | -             | -             | -         | -         |
| 20       | Madhya Pradesh     | 49.8          | 34.4          | 73.9      | 64        |
| 21       | Maharashtra        | 51.6          | 38.3          | 58.9      | 53.9      |
| 22       | Manipur            | 11.9          | 7.1           | 28.4      | 20        |
| 23       | Meghalaya          | 12.1          | 11            | 47.9      | 50.8      |
| 24       | Mizoram            | -             | 8.3           | -         | 24.4      |
| 25       | Nagaland           | 16.0          | 11.6          | -         | 23        |
| 26       | Odisha             | 51.3          | 36.5          | 73.8      | 63.3      |
| 27       | Punjab             | -             | 10.7          |           | 69.2      |
| 28       | Puducherry         | -             | -             | -         | -         |
| 29       | Rajasthan          | 49.3          | 37.5          | 65        | 63        |
| 30       | Sikkim             | 9.6           | 4             | 58.6      | 34.6      |
| 31       | Tamil Nadu         | 60.2          | 18.2          | 36        | 54.9      |
| 32       | Telangana          | -             | 29.2          | -         | 66.2      |
| 33       | Tripura            | 23.7          | 14.2          | 74        | 55.3      |
| 34       | Uttar Pradesh      | 46.4          | 29.8          | 35.2      | 57.6      |
| 35       | Uttarakhand        | 49.5          | 21.5          | 71.4      | 55.6      |
| 36       | West Bengal        | 55.6          | 33.2          | 78        | 75.5      |
|          | India              | 46.6          | 31.7          | 68.5      | 59.9      |