Lok Sabha Question No. 2284 (UNSTARRED), answered on 2016-05-06
Subject: Maternal and Child Mortality Rate
Ministry: HEALTH AND FAMILY WELFARE
Asked by: JYOTIRADITYA MADHAVRAO SCINDIA, RAMESH POKHRIYAL NISHANK, NITYANAND RAI

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

LOK SABHA UNSTARRED QUESTION NO. 2284 TO BE ANSWERED ON 6 TH MAY, 2016

## MATERNAL AND CHILD M ORTALITY RATE

## 2284. SHRI JYOTIRADITYA M. SCINDIA: DR. RAMESH POKHRIYAL NISHANK: SHRI NITYANAND RAI:

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

- (a)  whether  the  Government  has  made any  assessment  regarding  the  causes  of maternal  and infant mortality prevalent in the country, if so, the detai ls thereof;
- (b) whether the Government has noted a sharp decline in maternal and child morta ity rate as per the National Family Health Survey (NFHS - 4) 2015 - 16;
- (c) if so, the details thereof along with the reasons therefor;
- (d) whether despite remarkableimprovements, some States including  Bihar, Madhya Pradesh and Meghalaya have performed poorly in the area of MMR and IMR; and
- (e) if so, the details thereof and the steps taken by the Government to improve the MMR and IMR across the country?

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

- (a): The  Registrar  General  of  India,  Sample  Registration  System  (RGI - SRS)  provides  a nation - wide  disaggregated  data  on  the  different  causes  of  maternal  and  infant  mortali diffe rent intervals.

The major causes of maternal deaths as per RGI -SRS(2001- 03) are :

- Haemorrhage: 38% occur mainly because of post -partum Haemorrhage.
- Sepsis: 11%, because of any infection during pregnancy, labor and in post - partum period.
- Abortion: 8%, bec ause of unsafe abortions.
- Hypertensive disorders: 5%, because of High Blood pressure during pregnancy.
- Obstructed labor :5%
- Other causes: 34% -includes anaemia and various other causes.

The major causes of Infant mortality as per RGI -SRS (2010- 13), are: Prematurity & low birth weight (35.9%), Pneumonia (16.9%), Birth asphyxia & birth trauma (9.9%), other n -communicable  diseases  (7.9%),  diarrhoeal  diseases  (6.7%),  ill - defined  (4.6%),    co ngenital anomalies  (4.6%),  infections  (4.2%),  injuries  (2.1%),  fever  of  unknown  origin  (1.7%), causes (5.4%).

(b)& (c) : Data on Maternal Mortality rate is not being captured under NFHS - 4.  However the data on infant mortality rate and Child mortality rate is captured in NFHS - 4. The report of the NFHS - 4 is available for 15 States/UTs currently.

The comparison of Infant Mortality Rate and Child Mortality rate and the point de between  two  surveys  as  recorded  in  15  States  /UTs  is  provided  at Annexure - 1.  All  the States/UTs, except Tripura have shown a decline in IMR between NFHS - 3 and NFHS- 4.

(d): All the three states namely Bihar, M.P. and Meghalaya have shown a decline of 13, and 14 points respectively in Infant mortality rate.

(e): The details of the steps taken to reduce MMR and IMR are place at Annex II.

Annexure I Comparison of NFHS-4 and NFHS-3 data for IMR and U5MR

|                           | Infant mortality rate (IMR)   | Infant mortality rate (IMR)   | Infant mortality rate (IMR)     | Under - five mortality rate (U5MR)   | Under - five mortality rate (U5MR)   | Under - five mortality rate (U5MR)   |
|---------------------------|-------------------------------|-------------------------------|---------------------------------|--------------------------------------|--------------------------------------|--------------------------------------|
|                           | NFHS - 4                      | NFHS - 3                      | Points Decline (NFHS - 3 and 4) | NFHS - 4                             | NFHS - 3                             | Points Decline (NFHS - 3 and 4)      |
| Bihar                     | 48                            | 61                            | 13                              | 58                                   | 84                                   | 26                                   |
| Goa                       | 13                            | 15                            | 2                               | 13                                   | 20                                   | 7                                    |
| Haryana                   | 33                            | 41                            | 8                               | 41                                   | 52                                   | 11                                   |
| Karnataka                 | 28                            | 43                            | 15                              | 32                                   | 54                                   | 22                                   |
| Meghalaya                 | 30                            | 44                            | 14                              | 40                                   | 70                                   | 30                                   |
| Madhya Pradesh            | 51                            | 69                            | 18                              | 65                                   | 93                                   | 28                                   |
| Sikkim                    | 29                            | 34                            | 5                               | 32                                   | 40                                   | 8                                    |
| Tamil Nadu                | 21                            | 30                            | 9                               | 27                                   | 35                                   | 8                                    |
| Tripura                   | 31                            | 27                            | - 4                             | 36                                   | 33                                   | - 3                                  |
| Uttarakhand               | 40                            | 42                            | 2                               | 47                                   | 56                                   | 9                                    |
| West Bengal               | 27                            | 48                            | 21                              | 32                                   | 59                                   | 27                                   |
| Andhra Pradesh*           | 35                            | 54                            | 19                              | 41                                   | 63                                   | 22                                   |
| Telangana*                | 28                            | 54                            | 26                              | 32                                   | 63                                   | 31                                   |
| Puducherry                | 16                            | NA                            | -                               | 16                                   | NA                                   | -                                    |
| Andaman & Nicobar Islands | 16                            | NA                            | -                               | 22                                   | NA                                   | -                                    |

*The NFHS-3 data is for the undivided State of Andhra Pradesh

Under National Health Mission, the key steps taken by Government of India to addr the issue of maternal deaths and to accelerate the pace of reduction of MMR across all st as below:

- Promotion of institutional deliveries through Janani Suraksha Yojana (JSY).
- Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in pub health institutions to absolutely free and no expense delivery, including caesarean n. Similar  entitlements  have  been  put  in  place  for  all  sick  infants  accessing  public institutions for treatment.
- Operationalization of Sub - Centers, Primary Health Centers, Community Health Centers and District  Hospitals  for  providing  24x7  basic  and comprehensive  obstetric  care,  neonatal, infant and child care services.
- Mother and Child Protection Card in collaboration with the Ministry of Women and Chi Development to monitor service delivery for mothers and children.
- Mother and Child Tracking Syste m is being implemented to ensure antenatal, intranatal and postnatal care along - with immunization services.
- Identifying the severely anaemic cases of pregnant women  at sub centres and PHCs for timely management
- Operationalization  of  Safe  Abortion  Se rvices  and  Reproductive  Tract  Infections  and Sexually  Transmitted  Infections  (RTI/STI)  at  health  facilities  with  a  focus  on  'Delivery Points'.
- Maternal Death Review (MDR) is being implemented across the country both at facilit and in the community. The purpose is to take corrective action at appropriate levels a improve the quality of obstetric care.
- Establishing Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
- Under  National  Iron  Plus  Initiative  (NIPI),  through  life  cycle  approach,  age  and specific IFA supplementation programme is being implemented.
- To  tackle  the  problem  of  anaemia  due  to  malaria  particularly  in  pregnant  women  a children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITB are being distributed in endemic areas.
- Capacity  building  of  health  care  providers in  basic  and  comprehensive  obstetric  care, Integrated  Management  of  Neo - natal  a nd  Childhood  Illness  (IMNCI), Navjaat  Shishu Suraksha  Karyakaram  (NSSK), Facility  Based  Newborn  Care  (FBNC)  and Infant  and Young Child Feeding practices (IYCF) etc.
- Setting  up of  Skill  Labs  with  earmarked  skill  stations  for  different  training  progra enhance the quality of training in the states.
- A  new  initiative  of  'Prevention  of  Post - Partum  Hemorrhage  (PPH)  through  Community based  advance  distribution  of  Misoprostol'  by  AS HAs/ANMs  for  high  home  delivery districts.
- Emphasis on facility based newborn care i.e. Special New Born Care Units (SNCUs), New -born Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) at different level to reduce child morbidity and mortality:
- Launch of India Newborn Action Plan (INAP) with an aim to reduce neonatal mortality a stillbirths to single digit by 2030.
- Newer interventions to reduce new - born mortality -Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kang aroo mother care and injection gentamicin to young infants in cases of suspected sepsis.
- Newer interventions to reduce maternal mortality and morbidity -Diagnosis & management of Gestational Diabetes Mellitus, Hypothyroidism during pregnancy, Training of G eneral Surgeons for performing  Caesarean Section, Calcium supplementation during pregnanc and lactation, De - worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis during pregnancy  and  Dakshata guidelines for strengthening intra - par tum care
- Home  based  newborn  care  through  ASHAs  to  improve  new  born  practices  at  the community level and early detection and referral of sick new born babies.
- Intensified  Diarrhoea  Control  Fortnight  (IDCF)  to  be  observed  in  July - August  2015 focusing on ORS and Zinc distribution for management of diarrhoea and feeding practices
- Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states w highest infant mortality (UP, MP, Bihar and Rajasthan).
- Nutritional Rehabilitation Centres (NR Cs) have been established for management of severe acute malnutrition in children.
- Appropriate Infant and Young Child Feeding practices are being promoted in convergen with Ministry of Woman and Child Development.
- Village Health and Nutrition Days in r ural a eas as an outreach activity, for provision o maternal and child health services .
- Universal  Immunization  Programme  (UIP):  Vaccination  protects  children  against  seve vaccine preventable diseases.
- Mission Indradhanush has been launched in 201 high fo cus districts to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated; those th not been covered during the rounds of routine immunisation for various reasons.
- Rashtriya  Bal  Swasthya  Karyakram  (RBSK)  for  hea lth screening and early intervention services has been launched to provide comprehensive care to all the children in t group of 0 - 18 years in the community.