Lok Sabha Question No. 1114 (UNSTARRED), answered on 2015-12-04
Subject: MMR and IMR
Ministry: HEALTH AND FAMILY WELFARE
Asked by: SEETARAM AJMEERA NAIK, RAMESH POKHRIYAL NISHANK, KRISHNAN NARAYANASAMY RAMACHANDRAN, BALKA SUMAN, VASANTHI M., BHAGWANTH KHUBA, TAMRADHWAJ SAHU, J.C. DIVAKAR REDDY

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

## LOK SABHA UNSTARRED QUESTION NO. 1114 TO BE ANSWERED ON 4 TH DECEMBER, 2015

## MMR AND IMR

## 1114. PROF. A.S.R. NAIK:

DR. RAMESH POKHRIYAL "NISHANK":

SHRI K.N. RAMACHANDRAN:

SHRI SUMAN BALKA:

SHRIMATI VASANTHI M.:

SHRI BHAGWANTH KHUBA:

SHRI TAMRADHWAJ SAHU:

SHRI J.C. DIVAKAR REDDY:

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

- (a) the details of the scheme formulated by the Government to reduce the reportedly alarming Maternal Mortality Rate (MMR) and Infant Mortality Rates (IMR) in the Country;
- (b) whether the Government has devised any special measures to bring down the MMR and IMR in the rural areas of various States/UTs including Utta r Pradesh, Jharkhand, Madhya Pradesh and Bihar; and
- (c)  if  so,  the  details  thereof  along  with the  MMR  and  IMR  reported  under  the Millennium Development Goal (MDG) during each of the last three years and the current year across the country, State/UTwise?

## ANSWER

## THE MINISTER OF HEALTH AND FAMILY WELFARE (SHRI JAGAT PRAKASH NADDA)

- (a)  & (b):The key steps to accelerate reduction of Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR) under the National Health Mission (NHM) particularly to rura population throughout the country, with a special focus on States with weak public hea indicators including States of Uttar Pradesh, Jharkhand, Madhya Pradesh and Bihar are as under :
-  Promotion of institutional deliveries through Janani Suraksha Yojana.
-  Ja nani  Shishu  Suraksha  Karyakaram  (JSSK)  has  been  launched  on  1 st June,  2011, which entitles all pregnant women delivering in public health institutions to absolu free and no expense delivery including Caesarean section.  The initiative stipul free d rugs, diagnostics, blood and diet, besides free transport from home to institut between facilities in case of a referral and drop back home.  Similar entitlements been put in place for ante - n tal and post -natal complications during pregnancy and a ll sick infants accessing public health institutions for treatment.
-  Capacity  building  of  MBBS  doctors  in Anesthesia  (LSAS)  and  Obstetric  Care including C - section  (EmOC)  skills  to  overcome  the  shortage  of  specialists  in  these disciplines, particularly in r ural areas.
-  Capacity  buildings  of  SNs  &  ANMs  in  Skilled  Birth  Attendant  (SBA)  and DAKSHATA  programme  to  equip  them  for  managing  normal  deliveries,  identify complications, do basic management and then refer at the earliest to higher faciliti
-  To strengthen the quality of training, a new initiative has been taken for setting Skill Labs with earmarked skill stations for different training programs in the sta which necessary allocation of funds is made under NHM.
-  Operationalization o f adequate number of Primary Health Centres for providing 24 x7 basic emergency obstetric care services.
-  Operationalization of adequate number of FRUs to provide 24 X 7 comprehensive emergency obstetric care services.
-  Establishing Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
-  Name Based Web enabled Tracking of Pregnant Women and New born babies so that provision of regular and complete services to them can be ensured .
-  Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
-  Engagement  of  more  than  9.15  lakhs  Accredited  Social  Health  Activists  (ASHAs)  t generate demand and facilitate accessing of health care services by the community.
-  Village Health and Nutrition Days in rural areas as an outreach activity, for provi of maternal and child health services.
-  Operationalization of Comprehensive Abortion Care Services and Rep roductive Tract Infections and Sexually Transmitted Infections (RTI/STI) at health facilities with a focus on 'Delivery Points'.
-  Over  21,000  ambulances  are  being  supported  under  NHM  to  interalia  transport pregnant women to institution for delivery and als o for referral.
-  Newer operational guidelines have been prepared and disseminated to the States fo Screening for Diagnosis & management of Gestational Diabetes Mellitus, Hypothyroidism  during  pregnancy,  Calcium  supplementation  during  pregnancy  and lactatio n, De - worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis  during  pregnancy,  Guidance  note  on  use  of  Uterotonic  during  labor  and Guidance note on prevention and management of PPH.
-  Facility Based Newborn Care (FBNC) at different level s to reduce child morbidity and mortality by setting up of facilities for care of sick newborn such as Special Born Care Units (SNCUs), Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) at different levels is a thrust area under NHM.
-  Home Based Newborn Care (HBNC) through ASHAs has been initiated to improve new born practices at the community level and early detection and referral of sick born babies.
-  India Newborn Action Plan (INAP) has been launched with an aim to reduce neonatal mortality and stillbirths.
-  Newer  interventions  to  reduce  newborn  mortality - Vitamin  K  injection  at  birth, Antenatal  corticosteroids  for  preterm  labour,  kangaroo  mother  care  and  injectio gentamicin to young infants in cases of suspected sepsis.
-  In tensified Diarrhoea Control Fortnight (IDCF) is being observed to focus on ORS and Zinc distribution for management of diarrhoea and feeding practices.
-  Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest child mo rtality (UP, MP, Bihar and Rajasthan).
-  Nutritional Rehabilitation Centres (NRCs) have been established for management of severe acute malnutrition in children.
-  Appropriate  Infant  and  Young  Child  Feeding  practices  are  being  promoted  in convergence with Min stry of Woman and Child Development.
-  Rashtriya Bal Swasthya Karyakram (RBSK) for health screening and early intervention services has been operationalized to provide comprehensive care to a the children in the age group of 0 - 18 years in the community. The purpose of these services is to improve the overall quality of life of children through early detect birth defects, diseases, deficiencies, development delays including disability.
-  Under National Iron Plus Initiative (NIPI), through life cycle ap proach, age and dose specific IFA supplementation programme is being implemented for the prevention of anaemia  among  the  vulnerable  age  groups  like  under - 5  children,  children  of  6 -10 years  of  age  group,  adolescents,  pregnant  &  lactating  women  and  women  in reproductive age along with treatment of anaemic children and pregnant mothers at health facilities.
-  Various trainings are being conducted under NHM to train doctors, nurses and ANMs for essential newborn care, early diagnosis and case management of common ailments of  children.  These  trainings  are  on  Navjaat  Shishu,  Suraksha  Karyakram  (NSSK), Integrated Management of Neonatal and Childhood Illnesses (IMNCI), Facility Based Newborn Care (FBNC), Infant and Young Child Feeding practices (IYCF), etc.
-  Reproducti ve Maternal Newborn Child Health + Adolescent (RMNCH+A) interventions  for  achieving  improved  maternal  and  child  health  outcomes  through continuum of care across life cycle.
-  Further  to  sharpen  the  focus  on  the  low  performing  districts,  184  High  Priori Districts (HPDs) have been identified. These districts would receive higher per cap funding,  relaxed  norms,  enhanced  monitoring  and  focussed  supportive  supervision, and  encouraged  to  adopt  innovative  approaches  to  address  their  peculiar  healt challenges.

(c): As per the latest report of the Registrar General of India, Sample Registration Sys (RGI- SRS),  Maternal  Mortality  Ratio  (MMR)  of  India  has  shown  a  decline  from  212  per 100,000 live births in the period 2007 - 09 to 178 per 100,000 live births in 2010 - 12 to 167 per 100,000 live births in the period 2011 - 13.State wise MMR is placed at Annexure I .

Infant Mortality Rate (IMR) of India has declined from 44 per 1,000 live births 2011 to 42 per 1,000 live births in 2012 to 40 per 1,000 live births in 201 3 as per the latest report of the Registrar General of India, Sample Registration System. State/UTs wise IMR is placed at Annexure II .

Maternal Mortality Ratio: India and State wise

| Major State    |   MMR(SRS) (2007-09) |   MMR(SRS) (2010-12) |   MMR(SRS) (2011-13) |
|----------------|----------------------|----------------------|----------------------|
| India Total *  |                  212 |                  178 |                  167 |
| Assam          |                  390 |                  328 |                  300 |
| Bihar          |                  261 |                  219 |                  208 |
| Jharkhand      |                  261 |                  219 |                  208 |
| MP             |                  269 |                  230 |                  221 |
| Chhattisgarh   |                  269 |                  230 |                  221 |
| Orissa         |                  258 |                  235 |                  222 |
| Rajasthan      |                  318 |                  255 |                  244 |
| Uttar Pradesh  |                  359 |                  292 |                  285 |
| Uttaranchal    |                  359 |                  292 |                  285 |
| Andhra Pradesh |                  134 |                  110 |                   92 |
| Karnataka      |                  178 |                  144 |                  133 |
| Kerala         |                   81 |                   66 |                   61 |
| Tamil Nadu     |                   97 |                   90 |                   79 |
| Gujarat        |                  148 |                  122 |                  112 |
| Haryana        |                  153 |                  146 |                  127 |
| Maharashtra    |                  104 |                   87 |                   68 |
| Punjab         |                  172 |                  155 |                  141 |
| West Bengal    |                  145 |                  117 |                  113 |
| *Others        |                  160 |                  136 |                  126 |

(Source: RGI (SRS) 2007-09, 2010-12, 2011-13)

*: Includes Others

## ANNEXURE - II

## Infant Mortality Rate: India and State/UTs wise (Source: RGI (SRS) 2011, 2012, 2013)

| Sr. No   | State/UTs         |   2011 |   2012 |   2013 |
|----------|-------------------|--------|--------|--------|
| India    | India             |     44 |     42 |     40 |
| 1        | Bihar             |     44 |     43 |     42 |
| 2        | Chhattisgarh      |     48 |     47 |     46 |
| 3        | Himachal Pradesh  |     38 |     36 |     35 |
| 4        | Jammu & Kashmir   |     41 |     39 |     37 |
| 5        | Jharkhand         |     39 |     38 |     37 |
| 6        | Madhya Pradesh    |     59 |     56 |     54 |
| 7        | Odisha            |     57 |     53 |     51 |
| 8        | Rajasthan         |     52 |     49 |     47 |
| 9        | Uttar Pradesh     |     57 |     53 |     50 |
| 10       | Uttarakhand       |     36 |     34 |     32 |
| 11       | Arunachal Pradesh |     32 |     33 |     32 |
| 12       | Assam             |     55 |     55 |     54 |
| 13       | Manipur           |     11 |     10 |     10 |
| 14       | Meghalaya         |     52 |     49 |     47 |
| 15       | Mizoram           |     34 |     35 |     35 |
| 16       | Nagaland          |     21 |     18 |     18 |
| 17       | Sikkim            |     26 |     24 |     22 |
| 18       | Tripura           |     29 |     28 |     26 |
| 19       | Andhra Pradesh    |     43 |     41 |     39 |
| 20       | Goa               |     11 |     10 |      9 |
| 21       | Gujarat           |     41 |     38 |     36 |
| 22       | Haryana           |     44 |     42 |     41 |
| 23       | Karnataka         |     35 |     32 |     31 |
| 24       | Kerala            |     12 |     12 |     12 |
| 25       | Maharashtra       |     25 |     25 |     24 |
| 26       | Punjab            |     30 |     28 |     26 |
| 27       | Tamil Nadu        |     22 |     21 |     21 |
| 28       | West Bengal       |     32 |     32 |     31 |
| 29       | A & N Islands     |     23 |     24 |     24 |
| 30       | Chandigarh        |     20 |     20 |     21 |
| 31       | D & N Haveli      |     35 |     33 |     31 |
| 32       | Daman & Diu       |     22 |     22 |     20 |
| 33       | Delhi             |     28 |     25 |     24 |
| 34       | Lakshadweep       |     24 |     24 |     24 |
| 35       | Pondicherry       |     19 |     17 |     17 |