Lok Sabha Question No. 654 (UNSTARRED), answered on 2016-02-26
Subject: Child Mortality
Ministry: HEALTH AND FAMILY WELFARE
Asked by: KAMAKHYA PRASAD TASA, KALIKESH NARAYAN SINGH DEO, RAJENDRA AGRAWAL, P. KUMAR

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

## LOK SABHA UNSTARRED QUESTION NO. 654 TO BE ANSWERED ON 26 TH FEBRUARY, 2016

## CHILD MORTALITY

## 654. SHRI KAMAKHYA PRASAD TASA:

SHRI KALIKESH N. SINGH DEO:

SHRI RAJENDRA AGRAWAL:

SHRI P. KUMAR:

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

- (a) whether the incidence of infant, child and maternal mortality rate in the country is high as compared to other developing countries of the world including BRICS and SAARC countries;
- (b)  if  so,  the  details  thereof  along  with the  schemes/programmes/funds  launched/ released  to check high mortality rate during the last three years and the current year, scheme and State/UT -wise;
- (c) whether India has achieved the target set under Millennium Development Goals (MDGs);
- (d) if so, the details thereof and if not, the reasons for slow progress in this regards; and
- (e) whether infant/maternal mortality rate has decreased in the States covered under National Family Health Survey (NFHS), if so, the details thereof?

## ANSWER THE MINISTER OF HEALTH AND FAMILY WELFARE

## (SHRI JAGAT PRAKASH NADDA)

- (a): The incidence of infant, child and maternal mortality rates/ratio in country is h compared  toBRICS  Countries  whereas  among  SAARC  Countries,  Afghanistan  and  Pakistan have higher infant, child and maternal death rates as compared to India.
- (b): The detailed comparison of infant, child and maternal mortality rates/ratio BRICS SAARC Countries are placed in Annexure I .

The Government of India is implementing the following interventions under the Natio Health Mission (NHM) all across the country to reduce child, infant and maternal mortality

- i. Promotion of Institutional deliveries through cash ince ntive under Janani Suraksha Yojana  (JSY)  and  Janani  Shishu  Suraksha  Karyakaram  (JSSK)  which  entitles  all pregnant  women  delivering  in  public  health  institutions  to  absolutely  free  an expense ante - natal check - ups, delivery including Caesarean section, p ost - natal  care and treatment of sick infants till one year of age.

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- ii. Strengthening of delivery points for providing comprehensive and Reproductive,  maternal,  newborn,  Child  and  Adolescent  Health  (RMNCH+A) Services,    ensuring  essential  newborn  care  a t all  delivery  points,  establishment  of Special  Newborn  Care  Units  (SNCU),  Newborn  Stabilization  Units  (NBSU)  and Kangaroo Mother Care (KMC) units for care of sick and small babies.
- iii. Early  initiation  and  exclusive  breastfeeding  for  first  six  months  and appropriate Infant and Young Child Feeding (IYCF) practices are promoted in convergence wit Ministry  of  Women  and  Child  Development.  Village  Health  and  Nutrition  Days (VHNDs)  are  observed  for  provision  of  maternal  and  child  health  services  a creating  aw areness  on  maternal  and  child  care  including  health  and  nutriti education.
- iv. Universal Immunization Programme (UIP) is being supported to provide vaccination to children against many life threatening diseases such as Tuberculosis, Dipht Pertussis,  P olio,  Tetanus,  Hepatitis  B  and  Measles.  Pentavalent  vaccine  has  bee introduced all across the country and 'Mission Indradhanush' has been launched to fully immunize more than 89 lakh children who are either unvaccinated or parti vaccinated;  those  that have  not  been  covered  during  the  rounds  of  routine immunization for various reasons.
- v. Name based tracking of mothers and children till two years of age (Mother and Ch Tracking System) is done to ensure complete antenatal, intranatal, postnatal car complete immunization as per schedule.
- vi. Rashtriya Bal Swasthya Karyakram (RBSK ) for health screening, early detection of birth  defects,  diseases,  deficiencies,  development  delays  including  disabilit early intervention services has been operationalize d to provide comprehensive care to all the children in the age group of 0 - 18 years in the community.
- vii. Some other important interventions are Iron and folic acid (IFA) supplementation for the prevention of anaemia among the vulnerable age groups, annual deworming on National Deworming Day (NDD), home visitation by ASHAs to promote exclusive breast feeding and early detection and referral of sick newborns and promote us ORS and Zinc for management of diarrhoea in children.

The funds allocated and rel eased during the last three years, State and UT wise for th Reproductive and Child Health programme under the national Health Mission are detailed Annexure-II .

(c) & (d): India has made steady progress in reduction of Under - five mortality Rate (U5MR) from 126/1000 live births in 1990 to 49/1000 live births in 2013 as per the Sample Regis System Report (SRS) issued by the Registrar General of India (RGI). India may come clos achieving MDG- 4 target of Under 5 mortality rate 42/1000 live births , provided the current trend of annual decline of 6.6 percent continues.

MDG 5 target is to reduce Maternal Mortality Ratio (MMR) by three quarters betwee 1990 and 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015. As the off icial report of the Registrar General of India, Sample Registration System (RGI - SRS), Maternal Mortality Ratio (MMR) of India has shown a declined to 167 per 100,000 live birt the  period  2011 -13.  India's  MMR  is  likely  to  reach  141  if  current  rate  of  a nnual  decline continues.

(e ): Reports  are  available  for15  states/UTs  where  National  Family  Health  Survey -4 (NFHS - 4) was carried out and IMR has declined in all these states. The comparison of IMR NFHS -3 and NFHS- 4 is placed at Annexure -III .

National Family Health Survey (NFHS) does not give data on MMR.

| Status of Infant, Child and Maternal Mortality in the BRICSand SAARC Countries (2015)   | Status of Infant, Child and Maternal Mortality in the BRICSand SAARC Countries (2015)   | Status of Infant, Child and Maternal Mortality in the BRICSand SAARC Countries (2015)   | Status of Infant, Child and Maternal Mortality in the BRICSand SAARC Countries (2015)   |
|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|
|                                                                                         | Infant Mortality Rate (IMR)*                                                            | Under 5 Mortality Rate (U5MR)*                                                          | Maternal Mortality Ratio (MMR)**                                                        |
| Afghanistan                                                                             | 70                                                                                      | 97                                                                                      | 396                                                                                     |
| Bangladesh                                                                              | 33                                                                                      | 41                                                                                      | 176                                                                                     |
| Bhutan                                                                                  | 30                                                                                      | 36                                                                                      | 148                                                                                     |
| Brazil                                                                                  | 12                                                                                      | 14                                                                                      | 44                                                                                      |
| China                                                                                   | 11                                                                                      | 13                                                                                      | 27                                                                                      |
| India                                                                                   | 41                                                                                      | 53                                                                                      | 174                                                                                     |
| Maldives                                                                                | 8                                                                                       | 10                                                                                      | 68                                                                                      |
| Nepal                                                                                   | 32                                                                                      | 42                                                                                      | 258                                                                                     |
| Pakistan                                                                                | 69                                                                                      | 86                                                                                      | 178                                                                                     |
| Russian Federation                                                                      | 9                                                                                       | 10                                                                                      | 25                                                                                      |
| South Africa                                                                            | 33                                                                                      | 44                                                                                      | 138                                                                                     |
| SriL anka                                                                               | 8                                                                                       | 10                                                                                      | 30                                                                                      |

*Source: The

State of the World's Children 2015

**Source :Trends in M aternal Mortality: 1990 to 2015

Statement showing the Allocation of funds & utilization under the Programme RCH for the F.Ys 2012 - 13 to 2015-16 ( Rs. In crore )

| Sl.   |                           | 2012- 13                            | 2012- 13     | 2013- 14                            | 2013- 14     | 2014- 15                            | 2014- 15     | 2015- 16                            | 2015- 16     |
|-------|---------------------------|-------------------------------------|--------------|-------------------------------------|--------------|-------------------------------------|--------------|-------------------------------------|--------------|
| N o.  | Activity                  | Allocati on (Approv al as per SPIP) | Utilizati on | Allocati on (Approv al as per SPIP) | Utilizati on | Allocati on (Approv al as per SPIP) | Utilizati on | Allocati on (Approv al as per SPIP) | Utilizati on |
| 1     | Bihar                     | 876.84                              | 614.78       | 1103.79                             | 729.30       | 971.58                              | 706.31       | 956.79                              | 446.60       |
| 2     | Ch hattisgarh             | 270.87                              | 167.00       | 330.68                              | 175.47       | 269.05                              | 185.19       | 297.22                              | 134.31       |
| 3     | Himachal Pradesh          | 66.28                               | 38.27        | 49.95                               | 63.78        | 68.45                               | 60.92        | 81.74                               | 33.20        |
| 4     | Jammu & Kashmir           | 145.90                              | 112.89       | 251.16                              | 151.89       | 221.48                              | 147.27       | 252.74                              | 131.42       |
| 5     | Jharkhand                 | 327.03                              | 166.32       | 534.92                              | 215.52       | 370.74                              | 230.90       | 425.26                              | 179.66       |
| 6     | Madhya Pradesh            | 560.49                              | 466.07       | 729.07                              | 600.37       | 740.97                              | 675.61       | 906.63                              | 487.11       |
| 7     | Orissa                    | 325.92                              | 260.03       | 365.31                              | 283.88       | 375.32                              | 296.42       | 413.33                              | 221.54       |
| 8     | Rajasthan                 | 622.20                              | 441.66       | 687.74                              | 460.25       | 661.98                              | 524.52       | 718.71                              | 330.26       |
| 9     | Uttar Pradesh             | 1204.16                             | 674.71       | 1352.42                             | 956.34       | 1410.28                             | 1011.02      | 1464.76                             | 553.39       |
| 10    | Uttarakhand               | 88.12                               | 71.20        | 108.01                              | 84.07        | 117.72                              | 101.95       | 124.14                              | 92.69        |
| 11    | Arunachal Pradesh         | 22.08                               | 16.47        | 30.98                               | 25.26        | 38.02                               | 21.00        | 51.66                               | 23.19        |
| 12    | Assam                     | 488.95                              | 446.70       | 543.44                              | 436.39       | 674.20                              | 461.07       | 591.51                              | 334.92       |
| 13    | Manipur                   | 27.42                               | 15.01        | 29.00                               | 24.57        | 42.80                               | 25.45        | 46.72                               | 21.00        |
| 14    | Meghalaya                 | 44.09                               | 20.50        | 41.67                               | 14.95        | 56.04                               | 26.55        | 66.95                               | 18.39        |
| 15    | Mizoram                   | 28.22                               | 22.37        | 29.49                               | 24.44        | 38.94                               | 17.17        | 47.65                               | 23.82        |
| 16    | Nagaland                  | 43.80                               | 33.54        | 49.94                               | 33.89        | 43.76                               | 24.13        | 43.96                               | 22.24        |
| 17    | Sikkim                    | 12.79                               | 9.04         | 14.52                               | 11.46        | 16.12                               | 12.12        | 16.61                               | 7.82         |
| 18    | Tripura                   | 37.45                               | 21.23        | 30.70                               | 23.49        | 39.94                               | 26.66        | 41.42                               | 18.47        |
| 19    | Andhra Pradesh            | 539.65                              | 325.51       | 584.99                              | 319.42       | 328.58                              | 259.86       | 321.33                              | 150.00       |
| 20    | Goa                       | 9.16                                | 4.79         | 10.88                               | 5.85         | 248.45                              | 144.70       | 12.82                               | 4.44         |
| 21    | Gujarat                   | 312.87                              | 221.49       | 360.53                              | 212.61       | 13.16                               | 6.73         | 340.78                              | 175.23       |
| 22    | Haryana                   | 152.92                              | 116.19       | 173.23                              | 154.74       | 330.23                              | 236.38       | 163.64                              | 102.67       |
| 23    | Karnataka                 | 265.52                              | 205.41       | 275.29                              | 218.81       | 185.53                              | 162.13       | 385.74                              | 173.07       |
| 24    | Kerala                    | 161.55                              | 160.43       | 134.25                              | 150.71       | 363.63                              | 229.23       | 161.81                              | 82.09        |
| 25    | Maharashtra               | 453.37                              | 384.10       | 577.18                              | 485.92       | 157.98                              | 130.34       | 620.75                              | 291.63       |
| 26    | Punjab                    | 134.28                              | 93.21        | 119.35                              | 100.78       | 679.69                              | 477.44       | 178.77                              | 104.32       |
| 27    | Tamil Nadu                | 463.93                              | 228.56       | 419.18                              | 365.83       | 176.24                              | 124.85       | 477.69                              | 221.68       |
| 28    | Telangana                 | -                                   | -            | -                                   | -            | 503.24                              | 467.92       | 246.20                              | 103.07       |
| 29    | West Bengal               | 514.35                              | 337.70       | 563.00                              | 384.03       | 669.17                              | 494.75       | 563.07                              | 365.82       |
| 30    | Andaman & Nicobar Islands | 11.38                               | 6.80         | 7.16                                | 8.57         | 11.37                               | 8.14         | 12.07                               | 4.48         |
| 31    | Chandigarh                | 10.24                               | 4.79         | 7.16                                | 8.52         | 12.63                               | 9.95         | 11.44                               | 3.95         |
| 32    | Dadra & Nagar Haveli      | 5.48                                | 3.08         | 3.65                                | 4.71         | 9.66                                | 4.95         | 10.92                               | 3.49         |
| 33    | Daman & Diu               | 5.38                                | 2.86         | 5.85                                | 4.18         | 6.60                                | 3.71         | 7.05                                | 4.08         |
| 34    | Delhi                     | 139.13                              | 56.31        | 68.94                               | 63.22        | 66.60                               | 49.63        | 59.96                               | 23.90        |
| 35    | Lakshadweep               | 4.04                                | 2.36         | 2.11                                | 0.53         | 4.39                                | 0.72         | 4.30                                | 0.28         |
| 36    | Puducherry                | 10.13                               | 6.42         | 12.40                               | 8.52         | 11.95                               | 8.50         | 9.51                                | 4.84         |
|       | Total                     | 8386.0                              | 5757.8       | 9607.93                             | 6812.3       | 9936.5                              | 7374.2       | 10135. 7                            | 4,899.0      |

## Note:

1. SPIP stands for State Program implementation Plan
2. Utilization is inclusive of previous years unspent balance.
3. Expenditure includes expenditure against Central Release, State share & unspent balances at the beginning year.

## Comparison of Infant Mortality Rate between NFHS - 3 (2005 - 06)and NFHS - 4 (2015 - 16)

| Infant Mortality Rate ( NFHS -3,2005-06 and NFHS -4, 2015 -16)   | Infant Mortality Rate ( NFHS -3,2005-06 and NFHS -4, 2015 -16)   | Infant Mortality Rate ( NFHS -3,2005-06 and NFHS -4, 2015 -16)   | Infant Mortality Rate ( NFHS -3,2005-06 and NFHS -4, 2015 -16)   |
|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|------------------------------------------------------------------|
| S. No.                                                           | Name of States/ UTs                                              | NFHS -3 (2005- 06)                                               | NFHS -4 (2015 -16)                                               |
| 1                                                                | Andaman & Nicobar Island                                         | -                                                                | 10                                                               |
| 2                                                                | Andhra Pradesh*                                                  | 54                                                               | 35                                                               |
| 3                                                                | Bihar                                                            | 62                                                               | 48                                                               |
| 4                                                                | Goa                                                              | 15                                                               | 13                                                               |
| 5                                                                | Haryana                                                          | 42                                                               | 33                                                               |
| 6                                                                | Karnataka                                                        | 43                                                               | 28                                                               |
| 7                                                                | Madhya Pradesh                                                   | 70                                                               | 51                                                               |
| 8                                                                | Meghalaya                                                        | 45                                                               | 30                                                               |
| 9                                                                | Puducherry                                                       | -                                                                | 16                                                               |
| 10                                                               | Sikkim                                                           | 34                                                               | 29                                                               |
| 11                                                               | Tamilnadu                                                        | 30                                                               | 21                                                               |
| 12                                                               | Telangana*                                                       | 54                                                               | 28                                                               |
| 13                                                               | Tripura                                                          | 52                                                               | 27                                                               |
| 14                                                               | Uttarakhand                                                      | 42                                                               | 40                                                               |
| 15                                                               | West Bengal                                                      | 48                                                               | 27                                                               |

* Data is for undivided State of Andhra Pradesh