Under the Millennium Development Goals (MDGs), the MDG 5 target is to reduce maternal mortality ratio (MMR) by three quarters between 1990 and 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015. India is likely to reach an MMR of 140 if the current compound rate of annual decline continues.

 

MDG 4 target is for reduction of child mortality by two-third between 1990 and 2015. In terms of Infant Mortality Rate (IMR), this translates into IMR of 29/1000 live births to be achieved by 2015.  As per the latest, Sample Registration System (SRS) Report published by the Registrar General of India(RGI) in 2013, the IMR in India is 40/1000 live births.  As per SRS 2013, 15 States/UTs have already achieved MDG 4 (IMR ≤ 29) namely Kerala, Tamil Nadu, Goa, Andaman & Nicobar Islands, Chandigarh, Daman & Diu, Delhi, Lakshadweep, Puducherry, Manipur, Maharashtra, Nagaland, Tripura, Sikkim, Punjab.

 

No targets have been set under MDG for Total Fertility Rate (TFR). The progress however for TFR as per SRS in 2011 and 2012 was 2.4 and has declined to 2.3 in 2013. 24 States and UTs having already achieved the replacement level of fertility of 2.1.

 

The achievement during the last 3 years for MMR, IMR and TFR state/UTs-wise is given below:-

 

Maternal Mortality Ratio: India and State wise

 

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

 

 

*: Includes Others

 

Infant Mortality Rate, State and UT wise as per the SRS Reports 2010-2013

 

State/UTs	2010	2011	2012	2013
India	47	44	42	40
Bihar	48	44	43	42
Chhattisgarh	51	48	47	46
Himachal Pradesh	40	38	36	35
Jammu & Kashmir	43	41	39	37
Jharkhand	42	39	38	37
Madhya Pradesh	62	59	56	54
Odisha	61	57	53	51
Rajasthan	55	52	49	47
Uttar Pradesh	61	57	53	50
Uttarakhand	38	36	34	32
Arunachal Pradesh	31	32	33	32
Assam	58	55	55	54
Manipur	14	11	10	10
Meghalaya	55	52	49	47
Mizoram	37	34	35	35
Nagaland	23	21	18	18
Sikkim	30	26	24	22
Tripura	27	29	28	26
Andhra Pradesh	46	43	41	39
Goa	10	11	10	9
Gujarat	44	41	38	36
Haryana	48	44	42	41
Karnataka	38	35	32	31
Kerala	13	12	12	12
Maharashtra	28	25	25	24
Punjab	34	30	28	26
Tamil Nadu	24	22	21	21
West Bengal	31	32	32	31
A and N Islands	25	23	24	24
Chandigarh	22	20	20	21
Dadra and Nagar Haveli	38	35	33	31
Daman and Diu	23	22	22	20
Delhi	30	28	25	24
Lakshadweep	25	24	24	24
Pondicherry	22	19	17	17

 

State wise Total Fertility Rate as per Sample Registration System

 

India & Bigger States	TFR
	2011	2012	2013
India	2.4	2.4	2.3
Andhra Pradesh	1.8	1.8	1.8
Assam	2.4	2.4	2.3
Bihar	3.6	3.5	3.4
Chhattisgarh	2.7	2.7	2.6
Delhi	1.8	1.8	1.7
Gujarat	2.4	2.3	2.3
Haryana	2.3	2.3	2.2
Himachal Pradesh	1.8	1.7	1.7
Jammu and Kashmir	1.9	1.9	1.9
Jharkhand	2.9	2.8	2.7
Karnataka	1.9	1.9	1.9
Kerala	1.8	1.8	1.8
Madhya Pradesh	3.1	2.9	2.9
Maharashtra	1.8	1.8	1.8
Odisha	2.2	2.1	2.1
Punjab	1.8	1.7	1.7
Rajasthan	3.0	2.9	2.8
Tamil Nadu	1.7	1.7	1.7
Uttar Pradesh	3.4	3.3	3.1
West Bengal	1.7	1.7	1.6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The key steps taken to accelerate the pace of reduction for Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate(TFR)  under the National Health Mission (NHM) for achieving MDG goals are:

 

·      Promotion of institutional deliveries through Janani Suraksha Yojana (JSY).

·      Janani Shishu Suraksha Karyakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery, including caesarean section. Similar entitlements have been put in place for all sick infants accessing public health 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 Child Development to monitor service delivery for mothers and children.

·     Mother and Child Tracking System 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 their timely management

·      Operationalization of Safe Abortion Services 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 facilities and in the community. The purpose is to take corrective action at appropriate levels and 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 dose specific IFA supplementation programme is being implemented.

·        To tackle the problem of anaemia due to malaria particularly in pregnant women and children, Long Lasting Insecticide Nets (LLINs) and Insecticide Treated Bed Nets (ITBNs) are being distributed in endemic areas.

·        Capacity building of health care providers in basic and comprehensive obstetric care, Integrated Management of Neo-natal and 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 programs to 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 ASHAs/ANMs for high home delivery districts.

·        Emphasis on facility based newborn care i.e. Special New Born Care Units (SNCUs), Newborn Stabilization Units (NBSUs) and Newborn Care Corners (NBCCs) at different levels to reduce child morbidity and mortality:

·        Launch of India Newborn Action Plan (INAP) with an aim to reduce neonatal mortality and stillbirths to single digit by 2030.

·        Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo 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 General Surgeons for performing  Caesarean Section, Calcium supplementation during pregnancy and lactation, De-worming during pregnancy, Maternal Near Miss Review, Screening for Syphilis during pregnancy  and  Dakshata guidelines for strengthening intra-partum 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 with highest infant mortality (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 Ministry of Woman and Child Development.

·        Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.

·        Universal Immunization Programme (UIP): Vaccination protects children against  seven vaccine preventable diseases.

·        Mission Indradhanush has been launched in 201 high focus districts to fully immunise more than 89 lakh children who are either unvaccinated or partially vaccinated; those that have not been covered during the rounds of routine immunisation for various reasons.

·      Rashtriya Bal Swasthya Karyakram (RBSK) for health screening and early intervention services has been launched to provide comprehensive care to all the children in the age group of 0-18 years in the community.

·      Expansion of Family Planning Choices through introduction of new device- Cu IUCD 375 (effective for five years) introduced in program in 2012-13 and introduction of new method  Post partum IUCD in 2010-11 has provided post partum women an effective spacing option

·        Influencing the demand through ASHA Schemes for Family Planning through Scheme of Home Delivery of Contraceptives by ASHAs,  Scheme of Ensuring Spacing at Birth and  Pregnancy Testing Kits (PTK) scheme

·        Promoting quality sterilization services through enhanced compensation scheme, ensuring drop back services to sterilization clients and dedicated Mobile teams for FP services.

·        Promoting quality IUCD services by introducing PPIUCD incentive scheme, development of online beneficiary based software to track IUCD removals/complications and increasing provider’s base for providing IUCD services through Task shifting.

 

The Health Minister, Shri J P Nadda stated this in a written reply in the Lok Sabha here today.

 

                                                       *****

MV/BK