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)
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
|
Madhya
Pradesh
|
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
|
*: 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