Lok Sabha Question No. 3420 (UNSTARRED), answered on 2021-12-17
Subject: Death Cases of Tribal Women and Children
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Anto  Antony

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

## LOK SABHA UNSTARRED QUESTION NO. 3420 TO BE ANSWERED ON 17 TH  DECEMBER, 2021

## DEATH CASES OF TRIBAL WOMEN AND CHILDREN

## 3420. SHRI ANTO ANTONY:

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

- (a) whether the Government is aware regarding several death cases of tribal women and children in the country due to malnutrition and other health related issues;
- (b) if so, the details of such cases reported during the last five years, year-wise and State-wise;
- (c)  whether  the  Government  has  observed  that  number  of  death  cases  of  pregnant  women, children and new born babies are increasing in tribal areas in Attappady, Kerala;
- (d) if so, the details of such cases reported in the state during the last five years, year-wise along with the major reasons for such deaths;
- (e) whether the Government has sought any reports from the State in this regard, if so, the details thereof;
- (f) whether lack of medical facilities is major cause of such deaths and if so, the details thereof; and
- (g) the details of financial assistance extended by the Union Government to provide nutritious food to women, pregnant women and children in Attappady, Kerala during the last five years, year-wise?

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

- (a) & (b): Malnutrition  is  not  a  direct  cause  of  deaths;  however,  it  can  increase morbidity and mortality by reducing resistance to infections.

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 2016-18, Infant Mortality  Rate  (IMR)  has  declined  from  32  in  2018  to  30  and  Under-five  Mortality  Rate  has declined from 37 in 2017 to 36 in 2018. The State/UT wise details of MMR, Under-five MR and IMR are placed at Annexure- I, II & III.

In order to bring down MMR, IMR and Under-five MR, Ministry of Health and Family Welfare (MoHFW)  supports  all  States/UTs  including  Kerala  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 (PIPs) submitted by States/ UTs.

Steps taken by the Government to minimize maternal and child mortality rate are as under:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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).
6. 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.
7. 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 is established for confirmation and management of children screened under RBSK.

8. 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.
9. Intensified  Diarrhoea  Control  Fortnight  (IDCF)  has  been  launched  for  promoting  ORS and Zinc use to reduce child diarrheal deaths.

Under NHM, there is a provision to formulate specific plans and allocate additional resources to tribal areas. The specific scheme such as Birth Waiting Homes (BWH) are established in remote and tribal areas to promote institutional delivery and improve access to healthcare facilities.

(c): As  per  the  information  received  from  the  State  of  Kerala,  the  Government  has  not observed an increase in death cases of pregnant women, children and new born babies in tribal areas in Attappady, Kerala.

(d) to (f): This is not applicable since the State has not observed any increase in death cases of pregnant women, children and new born babies in tribal areas in Attappady, Kerala.

(g): The  Ministry  of  Women  and  Child  Development  (MWCD)  is  implementing  the Anganwadi Services Scheme of which the beneficiaries are the children in the age group of 6 months  to  6  years,  Pregnant  Women  and  Lactating  Mothers.  Funds  are  released  under Supplementary Nutrition Programme of Anganwadi Services Scheme to all the States/UTs which includes the state of Kerala. Details of funds released to States/UTs under POSHAN Abhiyaan and ICDS Scheme from FY 2017-18 to FY 2020-21.

## Amount in lakhs

| Total Central Funds released to States/UTs from FY 2017-18 to FY 2020-21   | Total Central Funds released to States/UTs from FY 2017-18 to FY 2020-21   |
|----------------------------------------------------------------------------|----------------------------------------------------------------------------|
| POSHAN Abhiyaan                                                            | ICDS scheme                                                                |
| 5,31,279.08                                                                | 34,00,721.54                                                               |

Further, information related to the fund allocation to the blocks from the State is not maintained at the central level.

## 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                                                  |

## Annexure II

| States           |   2014 | 2015 43   | 2016 39   | 2017 37   |   2018 |
|------------------|--------|-----------|-----------|-----------|--------|
| India            |     45 | 2015 43   | 2016 39   | 2017 37   |     36 |
| Andhra Pradesh   |     40 | 39        | 37        | 35        |     33 |
| Assam            |     66 | 62        | 52        | 48        |     47 |
| Bihar            |     53 | 48        | 43        | 41        |     37 |
| Chhattisgarh     |     49 | 48        | 49        | 47        |     45 |
| Delhi            |     21 | 20        | 22        | 21        |     19 |
| Gujarat          |     41 | 39        | 33        | 33        |     31 |
| Haryana          |     40 | 43        | 37        | 35        |     36 |
| Himachal Pradesh |     36 | 33        | 27        | 25        |     23 |
| Jammu &Kashmir   |     35 | 28        | 26        | 24        |     23 |
| Jharkhand        |     44 | 39        | 33        | 34        |     34 |
| Karnataka        |     31 | 31        | 29        | 28        |     28 |
| Kerala           |     13 | 13        | 11        | 12        |     10 |
| Madhya Pradesh   |     65 | 62        | 55        | 55        |     56 |
| Maharashtra      |     23 | 24        | 21        | 21        |     22 |
| Orissa           |     60 | 56        | 50        | 47        |     44 |
| Punjab           |     27 | 27        | 24        | 24        |     23 |
| Rajasthan        |     51 | 50        | 45        | 43        |     40 |
| Tamil Nadu       |     21 | 20        | 19        | 19        |     17 |
| Telangana        |     37 | 34        | 34        | 32        |     30 |
| Uttar Pradesh    |     57 | 51        | 47        | 46        |     47 |
| Uttarakhand      |     36 | 38        | 41        | 35        |     33 |
| West Bengal      |     30 | 30        | 27        | 26        |     26 |

## Annexure III

| States            |   2014 |   2015 |   2016 |   2017 |   2018 |   2019 |
|-------------------|--------|--------|--------|--------|--------|--------|
| ALL INDIA         |     39 |     37 |     34 |     33 |     32 |     30 |
| Andhra Pradesh    |     39 |     37 |     34 |     32 |     29 |     25 |
| A&N Islands       |     22 |     20 |     16 |     14 |      9 |      7 |
| Arunachal Pradesh |     30 |     30 |     36 |     42 |     37 |     29 |
| Assam             |     49 |     47 |     44 |     44 |     41 |     40 |
| Bihar             |     42 |     42 |     38 |     35 |     32 |     29 |
| Chandigarh        |     23 |     21 |     14 |     14 |     13 |     13 |
| Chhattisgarh      |     43 |     41 |     39 |     38 |     41 |     40 |
| D&N Haveli        |     26 |     21 |     17 |     13 |     13 |     11 |
| Daman &Diu        |     18 |     18 |     19 |     17 |     16 |     17 |
| Delhi             |     20 |     18 |     18 |     16 |     13 |     11 |
| Goa               |     10 |      9 |      8 |      9 |      7 |      8 |
| Gujarat           |     35 |     33 |     30 |     30 |     28 |     25 |
| Haryana           |     36 |     36 |     33 |     30 |     30 |     27 |
| Himachal Pradesh  |     32 |     28 |     25 |     22 |     19 |     19 |
| J&K               |     34 |     26 |     24 |     23 |     22 |     20 |
| Jharkhand         |     34 |     32 |     29 |     29 |     30 |     27 |
| Karnataka         |     29 |     28 |     24 |     25 |     23 |     21 |
| Kerala            |     12 |     12 |     10 |     10 |      7 |      6 |
| Lakshadweep       |     20 |     20 |     19 |     20 |     14 |      8 |
| Madhya Pradesh    |     52 |     50 |     47 |     47 |     48 |     46 |
| Maharashtra       |     22 |     21 |     19 |     19 |     19 |     17 |
| Manipur           |     11 |      9 |     11 |     12 |     11 |     10 |
| Meghalaya         |     46 |     42 |     39 |     39 |     33 |     33 |
| Mizoram           |     32 |     32 |     27 |     15 |      5 |      3 |
| Nagaland          |     14 |     12 |     12 |      7 |      4 |      3 |
| Odisha            |     49 |     46 |     44 |     41 |     40 |     38 |
| Puducherry        |     14 |     11 |     10 |     11 |     11 |      9 |
| Punjab            |     24 |     23 |     21 |     21 |     20 |     19 |
| Rajasthan         |     46 |     43 |     41 |     38 |     37 |     35 |
| Sikkim            |     19 |     18 |     16 |     12 |      7 |      5 |
| Tamil Nadu        |     20 |     19 |     17 |     16 |     15 |     15 |
| Telangana         |     35 |     34 |     31 |     29 |     27 |     23 |
| Tripura           |     21 |     20 |     24 |     29 |     27 |     21 |
| Uttar Pradesh     |     48 |     46 |     43 |     41 |     43 |     41 |
| Uttarakhand       |     33 |     34 |     38 |     32 |     31 |     27 |
| W. Bengal         |     28 |     26 |     25 |     24 |     22 |     20 |