Lok Sabha Question No. 2228 (UNSTARRED), answered on 2021-12-10
Subject: Maternal and Infant Mortality
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Guman Singh Damor, Sanjay Seth

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE

## DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 2228 TO BE ANSWERED ON 10 TH  DECEMBER, 2021

## MATERNAL AND INFANT MORTALITY

## 2228. SHRI GUMAN SINGH DAMOR; SHRI SANJAY SETH

## Will the MINISTER OF HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the State-wise comparative details of maternal and infant mortality rate during the last two years; if so, the details thereof;
- (b) whether any specific action plan has been proposed for the states having high maternal and infant mortality rate including Madhya Pradesh and Jharkhand and if so, the details thereof;
- (c) the steps being taken by the Government to minimize maternal and infant mortality rate and the achievements made thereof along with the funds allocated and spent therefor;
- (d) whether any specific scheme has been formulated for tribal dominated areas in this regard and if so, the details there of;
- (e) whether social system is being affected with decreasing number of girl child; and
- (f) if so, the details thereof and the efforts being made to check menace?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (DR. BHARATI PRAVIN PAWAR)

- (a) As per latest Sample Registration System (SRS) bulletin of Registrar General of India, the Maternal Mortality Ratio (MMR)  has declined from 122 in 2015-17 to 113 in 201618 and Infant Mortality Rate (lMR) has declined from 32 per 1,000 Live Births in 2018 to 30 per 1,000 Live Births in 2019. The State/UT wise details of MMR and IMR are placed at Annexure I
- (b) & (c) Health being a State Subject, the primary responsibility of provision of healthcare to all lies with respective State Governments. However, in order to bring down MMR & IMR,  Ministry  of  Health  and  Family  Welfare  (MoHFW)  supports  all  States/UTs  to implement  Reproductive,  Maternal,  Newborn,  Child,  Adolescent  health  and  Nutrition

(RMNCAH+N)  strategy  under  National  Health  Mission  (NHM)  based  on  the  annual Program Implementation Plans (PIP) submitted by States/ UTs.

Steps  taken  by  the  Government,  including  States  of  Madhya  Pradesh  &  Jharkhand,  to minimize maternal and infant mortality rate include:

1. Surakshit  Matritva  Aashwasan  (SUMAN) aims to provide assured, dignified, respectful and quality healthcare to every woman and newborn visiting the public health facility.  As  on  08.12.2021,  9971  public  health  facilities  have  been  notified  under SUMAN.
2. Janani  Suraksha  Yojana  (JSY) ,  a  demand  promotion  and  conditional  cash  transfer scheme  which  aims  at  promoting  institutional  delivery.  Approximately  one  crore beneficiaries have been benefited under JSY Scheme annually.
3. Janani  Shishu  Suraksha  Karyakram  (JSSK) Under  JSSK  every  pregnant  woman  is entitled to free delivery, including caesarean section, in public health institutions along with the provision of free transport, diagnostics, medicines, other  consumables  & diet. More than one crore pregnant women have been benefited annually under JSSK scheme in public health facilities.
4. Pradhan  Mantri  Surakshit  Matritva  Abhiyan  (PMSMA) provides  a  minimum package of antenatal care services including investigations and drugs on the 9 th day  of every  month.  As  on  08.12.2021,  more  than  3.02  crore  ANC  Checkups  conducted  and more than 25 lakhs High Risk Pregnancy have been identified under PMSMA.
5. LaQshya aims  to  improve  the  quality  of  care  in  labour  room  and  maternity  operation theatres  to  ensure  that  pregnant  women  receive  respectful  and  quality  care  during delivery  and  immediate  post-partum.  As  on  01.11.2021,  418  Labour  Room  and  345 maternity OT have been LaQshya national Certified.
6. Monthly  Village  Health,  Sanitation  and  Nutrition  Days  (VHSND): Community Outreach is envisaged through the Monthly Village Health, Sanitation and Nutrition Days (VHSND) for provision of maternal and child care services.
7. Delivery  PointsStrengthening  of  over  25,000  'Delivery  Points'  across  the  country  in terms of infrastructure, equipment, and trained manpower for provision of comprehensive RMNCAH+A services
8. Facility  Based New Born Care -Sick New-born care units (SNCUs) are established at District  Hospital and Medical college level and New-born Stabilization units (NBSUS) established at First Referral units (FRUs)/ Community Health Centres (CHC) for care of sick and small babies.
9. Under Home  Based  New-born  Care  (HBNC) and Home-Based  Care  of  Young Children  (HBYC) program,  home  visits  by  ASHAs  are  conducted  to  improve  child rearing practices and to identify sick New-born and young children in the community.
10. Early initiation and exclusive breastfeeding for first six months and appropriate Infant and  Young  Child  Feeding  (IYCF) practices  are  promoted  under Mothers'  Absolute Affection (MAA).
11. Social  Awareness  and  Actions  to  Neutralize  Pneumonia  Successfully  (SAANS) initiative has been launched for reduction of Childhood morbidity and mortality due to Pneumonia.
12. Universal Immunization programme (UIP) is  implemented 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.  The  Rotavirus  vaccination  has  also  been  rolled  out  in  the country for prevention of Rota-viral diarrhoea. Pneumococcal Conjugate Vaccine (PCV) has been introduced in all the States and UTs.
13. Children from 0 to 18 years of age are screened for 30 health conditions (i.e. Diseases, Deficiencies,  Defects  and  Developmental  delay)  under  " Rashtriya  Bal  Swasthya Karyakaram (RBSK) "  to  improve child survival. District Early Intervention Centre (DEIC) at district health facility level are established for confirmation and management of children screened under RBSK.
14. 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.
15. Intensified  Diarrhoea  Control  Fortnight /  Defeat  Diarrhoea  (D2)  initiative  has  been launched for promoting ORS and Zinc use and for reducing diarrheal deaths.
16. Several capacity building programs of health care providers are conducted for improving maternal and child survival and health outcomes.

The details of funds allocated and spent for this purpose is placed at Annexure 2

(d)  Under  NHM,  there  is  a  provision  to  formulate  specific  plans  and  allocate  additional resources  to  tribal  areas.  Some  of  the  specific  schemes/initiatives  formulated  for  tribal dominated areas are as follows:

1. Birth  Waiting  Homes  (BWH) are  established  in  remote  and  tribal  areas  to  promote institutional delivery and improve access to healthcare facilities
2. Outreach  camps are  provisioned  for  improving  the  reach  of  health  care  services especially  in  tribal  and  hard  to  reach  areas.  This  platform  is  used  to  increase  the awareness for the Maternal & Child health services, community mobilization as well as to track high risk pregnancies.
3. Performance based incentives  to  ANMs  (SBAs): ANMs  trained in SBA  are incentivized  for  attending  home  deliveries  in  pre-identified  and  notified  villages  in remote and inaccessible areas where it is difficult to bring a woman to the institution for delivery on account of geographical/climatic exigencies.

(e) and (f) Government of India has undertaken consistent efforts and effective implementation of law to check the Sex Ratio at Birth (SRB) and gender differential in U5MR.

1. The Pre-conception  and  Pre-natal  Diagnostic  Techniques  (PC&PNDT)  Act was enacted  to  check  female  foeticide,  in  1994  and  was  brought  into  operation  from  1st January,  1996.  The  Act  was  amended  further  in  2003  to  make  it  more  stringent  and comprehensive. PC&PNDT, Act, 1994 is implemented in all the States & UTs.
2. Ultrasound equipment notified in 2020, as drug under Drugs and Cosmetic Act, 1945. The licenses from Drug Controller of India made mandatory for selling / importing/ R&D of Ultrasound Machines
3. Monitoring/ reviewing of the implementation of the PC&PNDT Act
- a. Regular  monitoring  through  National  Inspection  and  Monitoring  Committee (NIMC) and State Inspection and Monitoring Committees (SIMC)
- b. Regular meetings of State Supervisory Board and sending report to the Central Supervisory Board.
- c. State/UT level Review meetings conducted regularly to evaluate the progress of implementation at the district level.
- d. Notification of State/ District Appropriate Authority and Advisory Committees
4. Directions  provided  to  States  to  develop online  mechanism  for  registrations ,  record maintenance  under  the  PC&PNDT  Act  to  ensure  accountability,  transparency  and effective monitoring.
5. Monitoring  of  online  sex-selection  advertisements by  the  Nodal  Agency  under MoHFW
6. Capacity Building and Sensitization through workshops, Standard Operational Guidelines, sensitization for Judicial Officers and Public Prosecutors conducted through National  and  State  Judicial  Academy,  incorporation  of  PC&PNDT  Act  in  the  training curriculum of Lal Bahadur Shastri National Academy of Administration (LBSNAA) etc.
7. Financial support provided to strengthen implementation structures under National Health  Mission  (NHM): Dedicated  PNDT  Cells,  Capacity  Building,  Monitoring, Advocacy Campaigns etc.
8. IEC activities undertaken for the awareness of provision of PC&PNDT Act

## Following achievements have been recorded:

1. Under 5 Child Mortality (U5MR) has declined significantly from 69 in 2008 to 36 in 2018 thus showing a 33 points decline since 2008 with compound annual decline rate of 5.6% as per the SRS.
2. Gender differential in U5MR: At National level there is 1 point gap between male and female Under 5 Mortality Rate (Male-36, Female-37) in 2018 which has shrunk from 5 points in 2015.
3. As per NFHS, Sex Ratio at birth has increased from 919 (NFHS-4; 2015-16) to 929 (NFHS-5; 2019-20).

## Annexure: 1

| Maternal Mortality Rate as per latest SRS reports   | Maternal Mortality Rate as per latest SRS reports   | Maternal Mortality Rate as per latest SRS reports   |
|-----------------------------------------------------|-----------------------------------------------------|-----------------------------------------------------|
| India/States                                        | SRS (2015-17)                                       | SRS (2016-18)                                       |
| India                                               | 122                                                 | 113                                                 |
| Andhra Pradesh                                      | 74                                                  | 65                                                  |
| Assam                                               | 229                                                 | 215                                                 |
| Bihar                                               | 165                                                 | 149                                                 |
| Jharkhand                                           | 76                                                  | 71                                                  |
| Gujarat                                             | 87                                                  | 75                                                  |
| Haryana                                             | 98                                                  | 91                                                  |
| Karnataka                                           | 97                                                  | 92                                                  |
| Kerala                                              | 42                                                  | 43                                                  |
| Madhya Pradesh                                      | 188                                                 | 173                                                 |
| Chhattisgarh                                        | -                                                   | 159                                                 |
| Maharashtra                                         | 55                                                  | 46                                                  |
| Odisha                                              | 168                                                 | 150                                                 |
| Punjab                                              | 122                                                 | 129                                                 |
| Rajasthan                                           | 186                                                 | 164                                                 |
| Tamil Nadu                                          | 63                                                  | 60                                                  |
| Telangana                                           | 76                                                  | 63                                                  |
| Uttar Pradesh                                       | 216                                                 | 197                                                 |
| Uttarakhand                                         | 89                                                  | 99                                                  |
| West Bengal                                         | 94                                                  | 98                                                  |

| Infant Mortality Rate at National/ State/ UT level in 2018 and 2019   | Infant Mortality Rate at National/ State/ UT level in 2018 and 2019   | Infant Mortality Rate at National/ State/ UT level in 2018 and 2019   |
|-----------------------------------------------------------------------|-----------------------------------------------------------------------|-----------------------------------------------------------------------|
| India/States                                                          | SRS (2018)                                                            | SRS (2019)                                                            |
| India                                                                 | 32                                                                    | 30                                                                    |
| Andhra Pradesh                                                        | 29                                                                    | 25                                                                    |
| Assam                                                                 | 41                                                                    | 40                                                                    |
| Bihar                                                                 | 32                                                                    | 29                                                                    |
| Chhattisgarh                                                          | 41                                                                    | 40                                                                    |
| Delhi                                                                 | 13                                                                    | 11                                                                    |

| Gujarat             |   28 |   25 |
|---------------------|------|------|
| Haryana             |   30 |   27 |
| J&K                 |   22 |   20 |
| Jharkhand           |   30 |   27 |
| Karnataka           |   23 |   21 |
| Kerala              |    7 |    6 |
| Madhya Pradesh      |   48 |   46 |
| Maharashtra         |   19 |   17 |
| Odisha              |   40 |   38 |
| Punjab              |   20 |   19 |
| Rajasthan           |   37 |   35 |
| Tamil Nadu          |   15 |   15 |
| Telangana           |   27 |   23 |
| Uttar Pradesh       |   43 |   41 |
| Uttarakhand         |   31 |   27 |
| West Bengal         |   22 |   20 |
| Arunachal Pradesh   |   37 |   29 |
| Goa                 |    7 |    8 |
| Himachal Pradesh    |   19 |   19 |
| Manipur             |   11 |   10 |
| Meghalaya           |   33 |   33 |
| Mizoram             |    5 |    3 |
| Nagaland            |    4 |    3 |
| Sikkim              |    7 |    5 |
| Tripura             |   27 |   21 |
| A&N                 |    9 |    7 |
| Chandigarh          |   13 |   13 |
| Dadra &Nagar Haveli |   13 |   11 |
| Daman &Diu          |   16 |   17 |
| Lakshadweep         |   14 |    8 |
| Puducherry          |   11 |    9 |

## Statement showing Central Release & Expenditure under RCH Flexible Pool (including RI, PPI and NIDDCP) under NHM for the F.Y. 2019-20 and 2020-21

Rs. In crore

| Sl.   |                          | 2019-20         | 2019-20     | 2020-21         | 2020-21     |
|-------|--------------------------|-----------------|-------------|-----------------|-------------|
| No.   | States                   | Central Release | Expenditure | Central Release | Expenditure |
| 1     | Andaman &Nicobar Islands | 3.57            | 2.73        | 5.08            | 4.76        |
| 2     | Andhra Pradesh           | 200.81          | 238.18      | 184.81          | 311.01      |
| 3     | Arunachal Pradesh        | 37.85           | 36.81       | 23.50           | 42.14       |
| 4     | Assam                    | 392.07          | 350.46      | 435.18          | 356.68      |
| 5     | Bihar                    | 474.87          | 1,091.81    | 628.43          | 1,151.50    |
| 6     | Chandigarh               | 6.16            | 2.68        | 4.73            | 1.68        |
| 7     | Chhattisgarh             | 158.05          | 269.51      | 160.88          | 248.34      |
| 8     | Dadra &Nagar Haveli      | 5.68            | 3.05        |                 |             |
| 9     | Daman &Diu               | 4.13            | 1.64        | 7.01            | 6.14        |
| 10    | Delhi                    | 20.23           | 32.56       | 19.18           | 36.51       |
| 11    | Goa                      | 4.98            | 6.90        | 4.69            | 9.11        |
| 12    | Gujarat                  | 219.18          | 410.78      | 219.32          | 423.67      |
| 13    | Haryana                  | 113.89          | 158.02      | 110.96          | 159.40      |
| 14    | Himachal Pradesh         | 58.74           | 66.03       | 68.39           | 67.36       |
| 15    | Jammu &Kashmir           | 120.24          | 105.19      | 140.41          | 95.77       |
| 16    | Jharkhand                | 167.87          | 284.37      | 163.88          | 286.16      |
| 17    | Karnataka                | 214.85          | 305.18      | 220.44          | 298.85      |
| 18    | Kerala                   | 88.48           | 128.32      | 101.22          | 176.79      |
| 19    | Lakshadweep              | 0.87            | 1.26        | 0.99            | 1.13        |
| 20    | Madhya Pradesh           | 396.40          | 915.37      | 456.70          | 897.64      |
| 21    | Maharashtra              | 381.34          | 490.57      | 520.86          | 585.68      |
| 22    | Manipur                  |                 |             |                 |             |

|    |               | 37.38   | 33.76    | 29.55    | 23.30    |
|----|---------------|---------|----------|----------|----------|
| 23 | Meghalaya     | 33.66   | 43.90    | 61.17    | 52.75    |
| 24 | Mizoram       | 20.36   | 17.01    | 28.28    | 18.40    |
| 25 | Nagaland      | 23.58   | 18.62    | 38.20    | 23.47    |
| 26 | Odisha        | 211.53  | 421.48   | 206.43   | 466.49   |
| 27 | Puducherry    | 6.12    | 4.11     | 3.89     | 3.97     |
| 28 | Punjab        | 86.21   | 126.43   | 90.05    | 115.27   |
| 29 | Rajasthan     | 369.06  | 634.47   | 504.58   | 784.22   |
| 30 | Sikkim        | 7.35    | 4.80     | 13.16    | 4.66     |
| 31 | Tamil Nadu    | 242.36  | 283.99   | 256.34   | 264.31   |
| 32 | Tripura       | 44.56   | 43.45    | 43.37    | 42.91    |
| 33 | Uttar Pradesh | 992.01  | 1,649.14 | 1,021.68 | 1,601.08 |
| 34 | Uttarakhand   | 82.91   | 103.17   | 86.25    | 78.69    |
| 35 | West Bengal   | 273.38  | 515.21   | 300.05   | 427.51   |
| 36 | Telangana     | 123.22  | 175.67   | 154.14   | 195.48   |
| 37 | Ladakh        | -       | -        | 19.72    | 6.24     |

## Note:

1. The above releases relate to Central Govt. Grants & do not include State share contribution.
2. Expenditure includes expenditure against Central Release, State release & unspent balances at the beginning of  the year. Expenditure is as per the available Financial Management Report (FMR) submitted by States/UTs.
3. The above data comprises of releases under Reproductive Child Health, Routine Immunisation (cash+kind grants), Pulse Polio Immunisation (cash+kind grants) and NIDDCP.