Lok Sabha Question No. 1814 (UNSTARRED), answered on 2018-07-27
Subject: MMR and IMR
Ministry: HEALTH AND FAMILY WELFARE
Asked by: MOHAMMAD SALIM, RAMEN DEKA, LALLU SINGH, MD. BADARIDDOZA KHAN

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

## LOK SABHA UNSTARRED QUESTION NO. 1814 TO BE ANSWERED ON 27 th JULY, 2018

## MMR AND IMR

## 1814. SHRI MOHD. SALIM:

SHRI RAMEN DEKA:

SHRI LALLU SINGH:

SHRI MD. BADARUDDOZA KHAN:

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

- (a) whether the Government has taken any cognizance of the 2018 UNICEF report on Infant Mortality Rate (IMR), Maternal Mortality Rate (MMR) and Neonatal Mortality Rate (NMR);
- (b)  if  so,  the  details  thereof  and  the respective  mortality  rates  estimated  by  the Government during the last three years State/UT - wise including children covered by Indradhanush in Assam;
- (c) the details of expenditure incurred/ amount sanctioned and allocated by the Government for dealing with the schemes concerned;
- (d) whether the Government has initiated any mechanism or policy for dealing with the problems of said schemes and if so, the details thereof;
- (e) the schemes/programmes/f undslaunched/released to check said mortality rates during the last three years, State/UT wise;and
- (f) the steps taken/being taken by the Government to address the said issues and to accelerate the pace of reduction of MMR, IMR and NMR in the country?

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

(SHRI ASHWINI KUMAR CHOUBEY)

- (a)& (b): Maternal  and  Child  Survival  is  one  of  the  top  most  priorit iesunder  National Health Mission (NHM) of Government of India.

As per the 'Every Child Alive -The urgent need to end new -born deaths' published by UNICEF in 2018, India ranks 12 th in the 52 low middle income countries of the world on the basis of new - born mortality. However, as per Sample Registration System report of Registrar General  of  India,  The  Neo - natal  Mortality  Rate  (NMR)  is  24  per  1000  live  births,  Infant Mortality Rate (IMR) is 34 per 1000 live births in the year 2016 and Maternal Mortality R 130 per 100000 live births (2014 - 16).

The State/ UT wise, Infant Mortality Rate (IMR), Maternal Mortality Rat io(MMR) and Neonatal Mortality Rate (NMR) for last 3 years is placed at Annexure 1 - 3.

As on 23rd July 2018, a total of 3.89 lakhs children have been covered in Assam un various  phases  of  Mission  Indradhanus h  including  Gram  Swaraj  Abhiyan/Extended  Gram Swaraj Abhiyan.

(c) to (f): The  state  wise  allocation  and  expenditure  of  funds  under  the National  Health Mission , for the period 2015- 16 to 2017 - 18 are placed at Annexure 4.

PublicHealth is a state subject, however to reduce maternal and child mortality, various programmes and schemes under National Health Mission being implemented by States/ UTs are as follows:

- (1) Promotion  of  Institutional  deliveries  through  cash  incentive  under  Janani  Sura Yojana  (JSY)and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  which  entitles  all pregnant women(PW) delivering in public health institutions to absolutely free ante - natal check - ups,  delivery  including  Caesarean  section,  post - natal  care  and  treatment  of  sick infants till o ne 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,Establishing  Maternal  and  Chil d  Health (MCH)  Wings  in  high  caseload  facilities  to  improve  the  quality  of  care  provide mothers and children, establishment of Special Newborn Care Units (SNCU), Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for care of sick a nd small babies.
- (3) LaQshya a Labour Room quality improvement programme has been implemented in over 2100 health facilities across the country including medical colleges.
- (4) Home Based Newborn Care (HBNC) is provided by ASHAs to improve child rearing practice s. 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 Stillbirth Rate', by 2030.
- (5) PradhanMantriSurakshitMatritva Abhiyan (PMSMA) has be en implemented to provide fixed - day assured, comprehensive and quality antenatal care universally to all PW on the 9th of every month.
- (6) Universal screening of pregnant women including anaemic PW is carried out at all pu health facilities.180 iron and f olic acid (IFA) tablets are given in the ante natal and 1 IFA tablets are given in the post - natal period to all pregnant women. Of these who are found  to  be  clinically  anaemic,  are  given  double  doses  tablets  as  a  part  of  tr regimen.
- (7) Guidelines  on standardization  of  Labour  Rooms  and  creation  of  Obstetric  HDU  and Obstetric  ICU  at  District  Hospitals  and  Medical  Colleges  has  also  been  prepared disseminated to the States for improving quality of care during delivery and child b
- (8) Early initiation and exclusive breastfeeding for first six months and appropriate and Young Child Feeding (IYCF) practices are promoted in convergence with Ministr of  Women  and  Child  Development.  Village  Health  and  Nutrition  Days  (VHNDs)  are observ ed for provision of maternal and child health services and creating awarenes maternal  and  child  care  including  health  and  nutrition  education.  Mothers'  Absolute Affection  (MAA)  programmehas  been  implemented for  improving  breastfeeding practices  (Initi al  Breastfeeding  within  one  hour,  Exclusive  Breastfeeding  up  to  si months and complementary feeding up to two years) through mass media campaigns and capacity building of health care providers in health facilities as well as in commun
- (9) Universal  Im munization  Programme  (UIP)  is  provid ng vaccination  to  children  against many  life  threatening  diseases  such  as  Tuberculosis,  Diphtheria,  Pertussis, Tetanus,  Hepatitis  B  and  Measles.  'Mission  Indradhanush  and  Intensified  Mission Indradhanush' was laun ched to fully immunize children who are either unvac cinated or partially vaccinated. Measles Rubella Campaign has been undertaken in select States for children from 9 months to 15 years of age with the aim of eliminating Measles by 202
- (10) Name based track ing of mothers and children till two years of age (Mother and Chi Tracking  System)  is  done  to  ensure  complete  antenatal,  intranatal,  postnatal  car complete immunization as per schedule
- (11) Rashtriya Bal Swasthya Karyakram (RBSK) for health screening, early detection of bi defects,  diseases,  deficiencies,  development  delays  and  early  intervention  servic beenoperationalized to provide comprehensive care to all the children in the age group of 0- 18 years in the community.
- (12) Nutrition Rehabilitation Centres (NRCs) have been set up at public health facili treat  and  manage  the  children  with  Severe  Acute  Malnutrition  (SAM)  admitted  wit medical complications.
- (13) Iron  and  folic  acid  (IF A)  supplementation  for  the  prevention  of  anaemia  among  the vulnerable age groups, home visits by ASHAs to promote exclusive breast feeding a promote use of ORS and Zinc for mana gement of diarrhoea in children under Intensified Diarrhoea Control Fortnight (IDCF), administration of deworm tablets to all the children in the age group of 1 - 19 years during National Deworming Day (February and August) are carried out.
- (14) Health and nutrition education through Information, Education & Communication (IEC and Behav iour Change Communication (BCC) to promote healthy practices and create awareness to generate demand and improve service uptake.
- (15) To  tackle  the  problem  of  anaemia  due  to  malaria  particularly  in  pregnant  women  a children,  Long  Lasting  Insecticide  Nets  (LL INs)  and  Insecticide  Treated  Bed  Nets (ITBNs) are distributed in endemic areas.
- (16) Dietary counselling to pregnant women is provided during ante - natal visits through the existing network of sub -centres and primary health centres and other health facilities s well as through outreach activities at Village Health & Nutrition Days (VHNDs).
- (17) Various  trainings  are  being  conducted  to  build  and  upgrade  the  skills  of  health providers in basic and comprehensive obstetric care of mother during pregnancy, del and essential new - born care.

## Annexure - I

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

| Status of Neo - natal Mortality Rate   |   Status of Neo - natal Mortality Rate |   Status of Neo - natal Mortality Rate |   Status of Neo - natal Mortality Rate |
|----------------------------------------|----------------------------------------|----------------------------------------|----------------------------------------|
| States                                 |                                   2014 |                                   2015 |                                   2016 |
| India                                  |                                     26 |                                     25 |                                     24 |
| Andhra Pradesh                         |                                     26 |                                     24 |                                     23 |
| Assam                                  |                                     26 |                                     25 |                                     23 |
| Bihar                                  |                                     27 |                                     28 |                                     27 |
| Chhattisgarh                           |                                     28 |                                     27 |                                     26 |
| Delhi                                  |                                     13 |                                     14 |                                     12 |
| Gujarat                                |                                     24 |                                     23 |                                     21 |
| Haryana                                |                                     23 |                                     24 |                                     22 |
| Himachal Pradesh                       |                                     25 |                                     19 |                                     16 |
| Jammu & Kashmir                        |                                     26 |                                     20 |                                     18 |
| Jharkhand                              |                                     25 |                                     23 |                                     21 |
| Karnataka                              |                                     20 |                                     19 |                                     18 |
| Kerala                                 |                                      6 |                                      6 |                                      6 |
| Madhya Pradesh                         |                                     35 |                                     34 |                                     32 |
| Maharashtra                            |                                     16 |                                     15 |                                     13 |
| Orissa                                 |                                     36 |                                     35 |                                     32 |
| Punjab                                 |                                     14 |                                     13 |                                     13 |
| Rajasthan                              |                                     32 |                                     30 |                                     28 |
| Tamil Nadu                             |                                     14 |                                     14 |                                     12 |
| Telangana                              |                                     25 |                                     23 |                                     21 |
| Uttar Pradesh                          |                                     32 |                                     31 |                                     30 |
| Uttarakhand                            |                                     26 |                                     28 |                                     30 |
| West Bengal                            |                                     19 |                                     18 |                                     17 |

| Status of Maternal Mortality Ratio   | Status of Maternal Mortality Ratio   | Status of Maternal Mortality Ratio   |
|--------------------------------------|--------------------------------------|--------------------------------------|
|                                      | 2011- 13                             | 2014- 16                             |
| India                                | 167                                  | 130                                  |
| Uttar Pradesh/Uttarakhand            | 285                                  | 201                                  |
| Kerala                               | 61                                   | 46                                   |
| Madhya Pradesh / Chhattisgarh        | 221                                  | 173                                  |
| Assam                                | 300                                  | 237                                  |
| Bihar/Jharkhand                      | 208                                  | 165                                  |
| Haryana                              | 127                                  | 101                                  |
| Andhra Pradesh                       | 92                                   | 74                                   |
| Odisha                               | 222                                  | 180                                  |
| Karnataka                            | 133                                  | 108                                  |
| Gujarat                              | 112                                  | 91                                   |
| Rajasthan                            | 244                                  | 199                                  |
| Tamil Nadu                           | 79                                   | 66                                   |
| Punjab                               | 141                                  | 122                                  |
| West Bengal                          | 113                                  | 101                                  |
| Maharashtra                          | 68                                   | 61                                   |
| Telangana                            | N/A                                  | 81                                   |
| Other states                         | 126                                  | 97                                   |

| State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   | State-wise Release and Expenditure under NHM for the F.Y. 2015-16 to 2017-18   |
|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|--------------------------------------------------------------------------------|
| S. No.                                                                         | States                                                                         | 2015-16                                                                        | 2015-16                                                                        | 2016-17                                                                        | 2016-17                                                                        | Rs. in crore 2017-18                                                           | Rs. in crore 2017-18                                                           |
| S. No.                                                                         | States                                                                         | Release                                                                        | Exp                                                                            | Release                                                                        | Exp                                                                            | Release                                                                        | Exp                                                                            |
| 1                                                                              | Andaman & Nicobar Islands                                                      | 37.54                                                                          | 11.72                                                                          | 44.90                                                                          | 28.92                                                                          | 33.94                                                                          | 32.84                                                                          |
| 2                                                                              | Andhra Pradesh                                                                 | 659.04                                                                         | 1,105.70                                                                       | 629.55                                                                         | 1,287.04                                                                       | 875.06                                                                         | 1,463.74                                                                       |
| 3                                                                              | Arunachal Pradesh                                                              | 163.80                                                                         | 147.41                                                                         | 160.60                                                                         | 165.42                                                                         | 261.70                                                                         | 165.75                                                                         |
| 4                                                                              | Assam                                                                          | 997.59                                                                         | 1,212.25                                                                       | 1,046.09                                                                       | 1,337.40                                                                       | 1,392.66                                                                       | 1,374.94                                                                       |
| 5                                                                              | Bihar                                                                          | 1,269.67                                                                       | 1,731.85                                                                       | 1,040.59                                                                       | 1,619.20                                                                       | 1,557.40                                                                       | 1,820.05                                                                       |
| 6                                                                              | Chandigarh                                                                     | 24.66                                                                          | 21.75                                                                          | 21.47                                                                          | 20.61                                                                          | 20.35                                                                          | 26.72                                                                          |
| 7                                                                              | Chhattisgarh                                                                   | 423.31                                                                         | 769.33                                                                         | 586.97                                                                         | 999.33                                                                         | 825.76                                                                         | 1,180.27                                                                       |
| 8                                                                              | Dadra & Nagar Haveli                                                           | 14.63                                                                          | 15.79                                                                          | 17.12                                                                          | 17.36                                                                          | 19.14                                                                          | 19.76                                                                          |
| 9                                                                              | Daman & Diu                                                                    | 10.66                                                                          | 10.14                                                                          | 11.53                                                                          | 10.24                                                                          | 10.67                                                                          | 10.63                                                                          |
| 10                                                                             | Delhi                                                                          | 176.56                                                                         | 150.05                                                                         | 241.98                                                                         | 155.15                                                                         | 268.39                                                                         | 249.12                                                                         |
| 11                                                                             | Goa                                                                            | 17.30                                                                          | 25.44                                                                          | 26.13                                                                          | 37.38                                                                          | 26.07                                                                          | 40.08                                                                          |
| 12                                                                             | Gujarat                                                                        | 714.39                                                                         | 1,293.03                                                                       | 863.66                                                                         | 1,395.67                                                                       | 1,221.83                                                                       | 1,593.16                                                                       |
| 13                                                                             | Haryana                                                                        | 318.21                                                                         | 519.47                                                                         | 335.55                                                                         | 535.09                                                                         | 384.25                                                                         | 637.75                                                                         |
| 14                                                                             | Himachal Pradesh                                                               | 249.14                                                                         | 283.90                                                                         | 212.49                                                                         | 346.58                                                                         | 370.89                                                                         | 397.57                                                                         |
| 15                                                                             | Jammu & Kashmir                                                                | 375.34                                                                         | 428.38                                                                         | 362.42                                                                         | 419.55                                                                         | 550.42                                                                         | 521.86                                                                         |
| 16                                                                             | Jharkhand                                                                      | 423.93                                                                         | 602.61                                                                         | 454.64                                                                         | 633.54                                                                         | 735.99                                                                         | 753.03                                                                         |
| 17                                                                             | Karnataka                                                                      | 772.15                                                                         | 1,173.31                                                                       | 714.09                                                                         | 1,291.49                                                                       | 1,345.50                                                                       | 1,917.28                                                                       |
| 18                                                                             | Kerala                                                                         | 315.35                                                                         | 644.09                                                                         | 452.36                                                                         | 744.98                                                                         | 586.52                                                                         | 934.60                                                                         |
| 19                                                                             | Lakshadweep                                                                    | 5.72                                                                           | 2.75                                                                           | 3.83                                                                           | 4.33                                                                           | 5.54                                                                           | 6.20                                                                           |
| 20                                                                             | Madhya Pradesh                                                                 | 1,156.95                                                                       | 2,071.36                                                                       | 1,490.75                                                                       | 2,066.38                                                                       | 1,696.56                                                                       | 2,313.93                                                                       |
| 21                                                                             | Maharashtra                                                                    | 1,142.64                                                                       | 1,791.17                                                                       | 1,252.55                                                                       | 1,804.67                                                                       | 1,707.60                                                                       | 2,192.88                                                                       |
| 22                                                                             | Manipur                                                                        | 115.19                                                                         | 108.55                                                                         | 79.07                                                                          | 81.40                                                                          | 163.05                                                                         | 102.15                                                                         |
| 23                                                                             | Meghalaya                                                                      | 107.50                                                                         | 138.83                                                                         | 161.13                                                                         | 152.85                                                                         | 189.02                                                                         | 169.14                                                                         |
| 24                                                                             | Mizoram                                                                        | 95.26                                                                          | 96.15                                                                          | 80.88                                                                          | 99.55                                                                          | 126.95                                                                         | 112.70                                                                         |
| 25                                                                             | Nagaland                                                                       | 106.37                                                                         | 82.56                                                                          | 95.92                                                                          | 95.17                                                                          | 134.86                                                                         | 95.61                                                                          |
| 26                                                                             | Orissa                                                                         | 669.77                                                                         | 1,222.92                                                                       | 728.58                                                                         | 1,299.27                                                                       | 1,216.22                                                                       | 1,514.45                                                                       |
| 27                                                                             | Puducherry                                                                     | 19.21                                                                          | 22.37                                                                          | 41.35                                                                          | 38.41                                                                          | 35.55                                                                          | 38.84                                                                          |
| 28                                                                             | Punjab                                                                         | 305.97                                                                         | 660.24                                                                         | 292.55                                                                         | 695.31                                                                         | 483.74                                                                         | 639.53                                                                         |
| 29                                                                             | Rajasthan                                                                      | 1,329.48                                                                       | 1,840.75                                                                       | 1,234.18                                                                       | 1,734.34                                                                       | 1,615.29                                                                       | 1,885.55                                                                       |
| 30                                                                             | Sikkim                                                                         | 41.54                                                                          | 51.23                                                                          | 41.72                                                                          | 50.62                                                                          | 55.40                                                                          | 43.48                                                                          |
| 31                                                                             | Tamil Nadu                                                                     | 1,110.31                                                                       | 1,650.45                                                                       | 788.68                                                                         | 1,852.90                                                                       | 1,293.97                                                                       | 2,285.56                                                                       |
| 32                                                                             | Tripura                                                                        | 238.39                                                                         | 220.87                                                                         | 343.47                                                                         | 360.85                                                                         | 662.42                                                                         | 711.04                                                                         |
| 33                                                                             | Uttar Pradesh                                                                  | 2,868.98                                                                       | 4,457.93                                                                       | 3,099.84                                                                       | 4,905.77                                                                       | 3,509.95                                                                       | 5,645.44                                                                       |
| 34                                                                             | Uttarakhand                                                                    | 378.53                                                                         | 438.08                                                                         | 325.86                                                                         | 411.00                                                                         | 493.67 1,232.81                                                                | 587.05                                                                         |
|                                                                                | Total                                                                          | 18,065.50                                                                      | 27,009.89                                                                      | 386.34 18,424.43                                                               | 689.02 29,250.11                                                               | 25,465.28                                                                      | 34,255.42                                                                      |
| 35 36                                                                          | West Bengal Telangana                                                          | 971.36 439.06                                                                  | 1,499.47 507.98                                                                | 755.60                                                                         | 1,863.33                                                                       | 356.16                                                                         | 2,154.34 618.38                                                                |

## Note:

2. Expenditure includes expenditure against central Release, State release & unspent balances at the beginning of the year.
1. The above releases relate to Central Govt. Grants & do not include State share contribution.