The Hindu : National : India among "slow progressing'' nations in child, maternal care

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Friday, Apr 08, 2005

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India among "slow progressing'' nations in child, maternal care

By Aarti Dhar

NEW DELHI, APRIL 7. Hundreds of millions of women and children have no access to potentially life-saving care and it is no surprise then that 10.6 million children die before the age of five and half a million women globally die at child birth, according to the World Health Report, 2005 released here today. The report points out that these deaths could be sharply reduced through wider use of key interventions and a "continuum of care'' approach for mother and child that began before pregnancy.

The report puts India in the list of 51 "slow progressing'' countries as far as infant and child mortality and maternal mortality is concerned with an estimated 1,36,000 maternal and one million newborn deaths, and newborns suffering from pregnancy birth-related mortality and where morbidity continued to take a toll on the lives of Indian women and their newborns.

Globally about 5,30,000 women die annually in pregnancy or childbirth, more than three million babies are stillborn, more than four million newborns die within the first days of weeks of life, and altogether 10.6 million die before their fifth birthday, according to the World Health Organisation (WHO) report. In "The World Heath Report 2005 — Make Every Mother and Child Count'', WHO estimates that out of a total of 136 million births every year worldwide, less than two-thirds of women in less developed countries and only one-third in the least developed countries have their babies delivered by a skilled attendant.

The report was launched in India to draw the attention of the Indian Government towards this issue. "Maternal and child health is a human rights issue of women and children. It is politically important to care for maternal and child health and the present situation is unacceptable,'' Joy Phumaphi, assistant Director-General, Family and Community Health, WHO said.

Trends in perinatal and infant mortality show a slow but steady decline in infant mortality rates in India but steady decline in infant mortality rates (IMR), less for neonatal mortality (NMR) and almost no change for rate of stillbirths. Each year 27 million infants are born in India, of which 10 per cent do not survive for five years. In absolute terms, India contributes to 25 per cent of the over 10 million under-five deaths occurring worldwide every year.

Nearly, half of under-five deaths occur in neonatal period.

Infant mortality

Over the decades there had been a declining trend in infant mortality rate, neonatal mortality rate and stillbirth rate.

However, the decline for NMR shows signs of slowing and stagnation -- only 15 per cent decline in NMR during the 1990s, compared to a 25 percent decline during the 1980s. The decline has become even less during 1995-2000, a meagre 4 points (48 to 44 per 1,000 live births).

According to the report, one in every three world's malnourished children lives in India and about 50 per cent of all childhood deaths in India are attributable to malnutrition.

The proportion of low birth weight babies remains high at one-third of all births. Describing human resources for the health sector as a major challenge, the report however, points out that a number of innovations were underway to increase the capacities in the health workers, both in numbers and skills.

There are regions in the country with health profile comparable to developed countries and there are others that lag well behind. Regional disparities in maternal and neonatal mortality are wide. Maternal mortality is so low in Kerala and Punjab that indirect estimates for these States could not be attempted. In contrast, in as many as 10 of the 15 major States (Assam, Bihar, Gujarat, Haryana, Karnataka, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and West Bengal) where maternal mortality ratios (MMRs) exceed 400 per 100,000 live births and three states (Assam, Madhya Pradesh and Uttar Pradesh ) where MMRs are as high as 700 or more.

The health care expenditure in India currently stands at 6.1 per cent of the Gross Domestic Product (GDP) and is increasing.

The total government expenditure on family welfare has shown an increasing trend from Rs. 4.9 billion in the Fifth Plan (1974-79) to Rs. 271.25 billion in the Tenth Plan (2002-07). A sum of Rs. 63.59 billion (23 per cent) of the Tenth Five Year Plan outlay has been allocated to the Reproductive and Child Health (RCH) programme.

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