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Government of India
Ministry of Health and Family Welfare
27-February-2015 12:35 IST
Steps Taken to Reduce IMR and MMR

As per Sample Registration System (SRS), 2013 reports published by Registrar General of India the Infant Mortality Rate (IMR) of India is 40 per 1000 live births and as per Sample Registration System (SRS), 2011-13 reports Maternal Mortality Ratio (MMR) is 167 per 1,00,000 live births in the Country.

 

Under the Millennium Development Goal (MDG) 4 target is to reduce Child Mortality by two-third between 1990 and 2015. In case of India, it translates into a goal of reducing Infant mortality rate from 88 per thousand live births in 1990 to 29 in 2015.

 

Under the Millennium Development Goal (MDG) 5, the target is to reduce Maternal Mortality Ratio (MMR) by three quarters between 1990 & 2015. This translates to reducing the MMR from 560 in 1990 to 140 in 2015.

 

State/UT-wise infant mortality rate and maternal mortality ratio is given below:-

 

States/UTs-wise status of infant mortality rate (IMR) and

maternal mortality ratio (MMR) in India

Sr. No

States/UTs

IMR (SRS 2013)

MMR(SRS  2011-13)

1

A & N Islands

24

-

2

Andhra Pradesh

39

92

3

Arunachal Pradesh

32

-

4

Assam

54

300

5

Bihar

42

208

6

Chandigarh

21

-

7

Chhattisgarh

46

221

8

Dadra & Nagar Haveli

31

-

9

Daman & Diu

20

-

10

Delhi

24

-

11

Goa

9

-

12

Gujarat

36

112

13

Haryana

41

127

14

Himachal Pradesh

35

-

15

Jammu & Kashmir

37

-

16

Jharkhand

37

208

17

Karnataka

31

133

18

Kerala

12

61

19

Lakshadweep

24

-

20

Madhya Pradesh

54

221

21

Maharashtra

34

68

22

Manipur

10

-

23

Meghalaya

47

-

24

Mizoram

35

-

25

Nagaland

18

-

26

Odisha

51

222

27

Puducherry

17

-

28

Punjab

26

141

29

Rajasthan

47

244

30

Sikkim

22

-

31

Tamil Nadu

21

79

32

Telangana

39

92

33

Tripura

26

-

34

Uttar Pradesh

50

285

35

Uttarakhand

32

285

36

West Bengal

31

113

India

40

167

Source: Sample registration System (SRS), RGI office, 2013 & 2011-13 reports

 

Under National Health Mission, the following interventions are being implemented to reduce infant mortality rate and maternal mortality ratio in the Country:

 

  1. Promotion of institutional deliveries through JananiSurakshaYojana.
  2. Operationalization of sub-centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services.
  3. Name Based Web enabled Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care.
  4. Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children.
  5. Antenatal, intranatal and postnatal care including Iron and Folic Acid supplementation to pregnant & lactating women for prevention and treatment of anaemia.
  6. Engagement of more than 8.9 lakhs Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community.
  7. Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services.
  8. Adolescent Reproductive Sexual Health Programme (ARSH) – Especially for adolescents to have better access to family planning, prevention of sexually transmitted Infections, Provision of counselling and peer education.
  9. Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption.  

10.  JananiShishuSurakshaKaryakaram (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.  The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home.  Similar entitlements have been put in place for all sick infants accessing public health institutions for treatment.

11.  Universal Immunization Programme (UIP): Vaccination protects children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Infants are thus immunized against seven vaccine preventable diseases every year. The Government of India supports the vaccine programme by supply of vaccines and syringes, cold chain equipment and provision of operational costs.

12.  Strengthening Facility based newborn care: Newborn care corners (NBCC) are being set up at all health facilities where deliveries take place; Special New Born Care Units (SNCUs) and New Born Stabilization Units (NBSUs) are also being set up at appropriate facilities for the care of sick newborn including preterm babies.

13.  Home Based Newborn Care (HBNC):  Home based newborn care through ASHA has been initiated to improve new born practices at the community level and early detection and referral of sick new born babies

14.  Capacity building of health care providers: Various trainings are being conducted under National Health Mission (NHM) to build and upgrade the skills of health care providers in basic and comprehensive obstetric care of mother during pregnancy, delivery and essential newborn care.

15.  Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been established for management of severe acute malnutrition in children.

16.  India Newborn Action Plan (INAP) has been launched to reduce neonatal mortality and stillbirths.

17.  Newer interventions to reduce newborn mortality- Vitamin K injection at birth, Antenatal corticosteroids for preterm labour, kangaroo mother care and injection gentamicin for possible serious bacillary infection.

18.  Intensified Diarrhoea Control Fortnight was observed in August 2014 focusing on ORS and Zinc distribution for management of diarrhoea and feeding practices.

19.  Integrated Action Plan for Pneumonia and Diarrhoea (IAPPD) launched in four states with highest infant mortality (UP, MP, Bihar and Rajasthan).

 

State/UT-wise allocation of funds and expenditure during each of the last three years and current year is given below:-

 


States/UTs-wise SPIP Approval and Expenditure under Maternal Health for F.Y. 2011-12 to 2014-15

Rs. In Lakhs

S. No.

States / UTs

2011-12

2012-13

2013-14

2014-15

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure up to  31.12.2014

1

Bihar

25,851.86

24,628.25

33,648.05

34,929.70

57,799.07

43,236.25

53,586.41

8,075.53

2

Chhattisgarh

8,302.14

6,100.49

9,935.17

5,842.64

11,644.17

6,520.47

8,455.42

1,232.60

3

Himachal Pradesh

751.28

503.34

2,442.60

1,129.22

1,004.33

2,140.70

1,850.45

746.19

4

J&K

2,406.76

2,675.47

4,115.40

4,040.05

4,263.02

5,478.60

5,710.79

1,560.33

5

Jharkhand

10,047.41

5,955.63

15,825.94

7,930.82

14,095.90

10,354.26

15,052.81

3,459.32

6

Madhya Pradesh

25,709.57

21,096.32

26,474.90

25,428.96

32,087.44

29,800.56

26,859.37

4,366.54

7

Orissa

12,288.67

12,341.45

18,029.81

13,478.66

16,596.26

14,723.62

13,953.96

5,204.89

8

Rajasthan

18,514.77

18,806.25

32,377.91

25,739.42

34,505.46

27,084.38

33,700.11

10,565.29

9

Uttar Pradesh

71,620.85

43,364.99

72,223.89

49,447.79

70,227.81

60,350.43

71,388.65

19,512.02

10

Uttarakhand

1,787.90

2,241.40

3,171.99

3,085.61

3,377.79

3,467.17

3,943.30

1,668.87

11

Arunachal Pradesh

172.90

138.06

283.09

180.83

451.95

301.20

572.63

35.63

12

Assam

11,561.35

9,452.87

14,374.31

13,581.92

16,621.84

13,642.00

22,028.59

4,450.53

13

Manipur

293.59

184.49

644.43

225.06

713.71

486.83

913.25

292.59

14

Meghalaya

175.47

132.95

822.86

243.66

685.89

111.24

1,084.11

302.16

15

Mizoram

319.39

134.70

480.22

207.07

427.59

347.83

447.14

44.97

16

Nagaland

333.24

203.49

620.79

364.40

704.33

514.70

736.71

24.90

17

Sikkim

89.29

69.57

183.57

80.55

187.33

165.26

146.88

50.95

18

Tripura

1,226.47

689.01

1,433.98

929.64

1,245.37

1,055.02

1,681.23

137.78

 19

 Andhra Pradesh

3,434.51

2,373.74

8,811.45

5,519.20

13,830.58

4,945.64

8,240.16

2,526.45

 20

Telangana

0.00

0.00

0.00

0.00

0.00

0.00

7,963.19

586.00

 21

 Goa

151.55

73.88

202.55

170.61

198.96

126.69

258.18

10.79

 22

 Gujarat

5,171.09

3,749.80

9,023.68

5,710.45

6,423.77

6,124.60

7,464.73

2,674.26

 23

 Haryana

1,085.97

1,096.03

2,983.48

1,960.02

3,096.08

2,899.59

3,269.47

785.71

 24

Karnataka

4,937.48

4,582.69

7,867.50

6,953.84

11,221.25

8,678.38

11,560.00

1,304.69

 25

 Kerala

1,730.66

943.35

3,875.86

4,226.18

3,780.85

4,985.39

3,740.99

1,692.95

 26

 Maharashtra

6,423.25

4,664.68

11,016.12

9,518.80

18,178.50

11,593.83

18,695.29

4,210.61

 27

 Punjab

1,336.38

1,542.68

3,723.22

2,057.55

3,723.68

2,922.97

3,683.13

1,236.04

 28

 Tamilnadu

4,034.13

3,056.75

14,772.87

9,485.98

16,095.73

12,767.13

17,249.17

3,146.61

 29

 West Bengal

8,474.51

9,866.23

20,343.20

14,461.61

23,752.26

15,278.77

26,298.38

7,284.68

 30

 Andaman & Nicobar Island

8.09

29.85

116.90

8.20

107.10

61.49

45.03

1.22

 31

 Chandigarh

8.30

5.31

109.23

6.33

5.66

5.97

6.72

1.98

 32

Dadar& Nagar Haveli

45.70

22.18

57.34

25.24

42.06

46.77

136.10

11.61

 33

 Daman & Diu

17.44

1.59

42.15

7.46

16.29

16.04

19.69

9.60

 34

 Delhi

1,300.67

147.02

1,933.76

232.22

810.55

336.43

1,001.90

218.24

 35

 Lakshadweep

16.96

12.53

19.48

10.58

20.42

10.87

23.33

11.82

 36

 Puducherry

67.13

66.75

399.80

112.19

568.92

282.70

390.46

111.51

 India Total

2,29,696.73

1,80,953.80

3,22,387.50

2,47,332.47

3,68,511.92

2,90,863.78

3,72,157.74

87,555.86

 

SPIP- State Programme Implementation Plan

 

States/UTs-wise SPIP Approval and Expenditure under Child Health for F.Y. 2011-12 to 2014-15

Rs. In Lakhs

 S. No.

 States / UTs

 2011-12

 2012-13

 2013-14

 2014-15

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure

 SPIP Approval

 Expenditure up to  31.12.2014

 1

 Bihar

    2,238.37

            559.10

      7,994.21

         1,377.22

            5,393.69

           2,929.51

          1,240.69

            731.27

 2

 Chhattisgarh

       764.20

            306.85

      1,403.11

            543.47

            1,053.40

              612.30

          1,170.49

            437.51

 3

 Himachal Pradesh

                  -  

              20.45

         182.79

            153.04

               117.62

              729.44

             723.84

         1,006.17

 4

 J&K

    3,698.75

            379.76

         271.47

            134.99

            1,192.95

              468.29

             647.76

            312.80

 5

 Jharkhand

       646.43

            286.44

      1,040.57

            296.56

            1,905.04

              883.34

          1,851.56

            519.78

 6

 Madhya Pradesh

   1,612.30

         1,682.59

      3,086.54

         2,672.08

            4,244.62

           3,974.20

          3,408.46

         2,017.80

 7

 Orissa

       443.69

            145.62

      1,233.57

            788.94

            1,114.75

              622.06

          1,562.70

            351.55

 8

 Rajasthan

       270.70

            340.15

      3,416.94

            808.22

            2,187.88

           1,114.49

          2,440.05

            541.26

 9

 Uttar Pradesh

    1,799.07

            130.36

      1,516.15

            558.10

            1,234.83

              445.58

          1,790.09

            299.93

 10

Uttarakhand

       110.75

            250.49

         233.33

            249.54

               150.50

              201.89

             215.41

              87.46

 11

 Arunachal Pradesh

                  -  

                0.40

         212.70

              61.87

               137.83

                64.80

             126.49

              10.94

 12

 Assam

       410.04

            414.15

      1,474.33

            776.09

            2,575.66

           1,568.67

          3,003.88

            990.86

 13

 Manipur

         26.20

              15.24

           93.76

              11.80

                 38.13

                74.84

             177.08

            134.02

 14

 Meghalaya

         12.12

              13.49

         283.01

              34.91

               178.22

                12.90

             364.50

              38.45

 15

 Mizoram

         23.81

                1.18

           62.50

              17.34

               140.10

                78.16

               86.45

                6.77

 16

 Nagaland

         33.86

              38.11

         199.34

              63.84

               178.90

                46.39

             128.97

                9.11

 17

 Sikkim

         25.43

                5.27

           62.50

              15.36

                 49.01

                50.54

               64.91

              30.56

 18

 Tripura

       200.48

              68.41

         221.21

              56.63

                 58.07

                88.35

             255.55

              99.23

 19

 Andhra Pradesh

    1,604.14

              88.36

      4,656.98

            866.21

            2,144.84

              604.91

          1,234.37

            427.91

 20

Telangana

                 -  

                    -  

                 -  

                    -  

                      -  

                      -  

             755.59

              72.58

 21

 Goa

        10.28

            191.02

           43.28

              32.46

                 45.80

                14.69

               69.58

                8.35

 22

 Gujarat

    1,178.55

         1,595.02

      4,616.99

         2,521.96

            2,799.58

           1,658.45

          2,110.41

            797.91

 23

 Haryana

       742.61

            426.85

         484.79

            180.92

               568.26

              560.96

             573.59

            295.75

 24

 Karnataka

       587.73

            229.01

         897.08

            553.49

               478.10

              302.37

          1,024.33

            113.37

 25

 Kerala

         46.13

              18.97

      1,231.82

         1,046.48

               401.69

              310.24

             198.13

            104.29

 26

 Maharashtra

    2,931.06

         2,639.75

      2,602.04

         2,204.45

            1,773.38

           2,656.63

          2,408.12

            623.93

 27

 Punjab

       287.00

            132.67

         742.00

            394.24

               295.35

                47.73

             784.41

            431.84

 28

 Tamil Nadu

         17.21

                    -  

      5,946.94

              20.15

               561.50

           1,062.79

             656.00

            662.67

 29

 West Bengal

    1,286.83

            409.61

      3,593.78

            919.29

            1,441.89

           1,119.11

          3,245.09

         1,225.84

 30

 Andaman & Nicobar Island

        -  

                    -  

           55.45

                    -  

5.98

                      -  

               29.20

                    -  

 31

 Chandigarh

         14.58

                    -  

           14.03

                0.02

0.40

                  0.18

                 3.08

                0.25

 32

 Dadra & Nagar Haveli

     7.21

                0.64

           21.01

                3.42

10.20

                  3.82

               23.60

                0.33

 33

 Daman & Diu

          2.50

                0.17

             6.60

                0.33

0.00

                      -  

                 0.46

                0.32

 34

 Delhi

        61.47

                3.05

         409.20

              24.40

86.70

                19.12

             152.60

              14.17

 35

 Lakshadweep

           0.20

                    -  

           47.00

                    -  

4.52

                      -  

               15.20

                0.27

 36

 Puducherry

         13.30

                9.29

             3.20

                3.50

14.96

                  5.71

               15.60

                0.05

 

 Grand Total

21,107.00

10,402.47

48,360.22

17,391.32

  32,584.35

 22,332.48

32,558.24

     12,405.30

 

SPIP- State Programme Implementation Plan

 

Based on the UN Inter–Agency Expert Group’s MMR estimates in the publication “Trends in Maternal Mortality: 1990 to 2013", the target for MMR is estimated to be 140 per 1,00,000 live births by the year 2015  taking a baseline of 560 per 100,000 live births in 1990. If the MMR declines at the same pace, India will achieve an MMR of 140 per 100,000 live births by 2015 and achieve the MDG target.

 

As per the information provided in the same report, 52 countries have MMR higher than that of India. Details are given below:-

 

International comparison of Maternal Mortality Ratio (MMR)

 

Sl. No.

Country

MMR per 1,00,000 live births

1

Sierra Leone

1100

2

Chad                      

980

3

Central African Republic                 

880

4

Somalia

850

5

Burundi

740

6

Democratic Republic of the Congo

730

7

South Sudan

730

8

Côte d’Ivoire          

720

9

Guinea

650

10

Liberia

640

11

Niger

630

12

Cameroon            

590

13

Guinea-Bissau

560

14

Nigeria

560

15

Mali

550

16

Malawi

510

17

Lesotho

490

18

Mozambique

480

19

Zimbabwe

470

20

Angola

460

21

Togo

450

22

Madagascar

440

23

Gambia

430

24

Ethiopia

420

25

Congo                     

410

26

United Republic of Tanzania

410

27

Afghanistan

400

28

Burkina Faso

400

29

Kenya

400

30

Eritrea

380

31

Ghana

380

32

Haiti

380

33

Sudan

360

34

Uganda

360

35

Comoros                 

350

36

Benin

340

37

Mauritania

320

38

Rwanda

320

39

Senegal

320

40

Swaziland

310

41

Equatorial Guinea

290

42

Zambia

280

43

Timor-Leste

270

44

Yemen

270

45

Guyana

250

46

Gabon

240

47

Dijibouti

230

48

Lao People’s Democratic Republic

220

49

Papua New                                                                                                                                         making Guinea                 

220

50

Sao Tome and Principe

210

51

Bolivia (Plurinational)

200

52

Myanmar

200

53

India

190

54

Indonesia

190

55

Nepal

190

56

Bangladesh

170

57

Botswana

170

58

Cambodia             

170

59

Pakistan

170

60

Guatemala

140

61

South Africa

140

62

Kiribati

130

63

Namibia

130

64

Solomon Islands

130

65

Suriname

130

66

Bhutan

120

67

Honduras

120

68

Morocco

120

69

Philippines

120

70

Tonga

120

71

Paraguay

110

72

Venezuela (Bolivarian Republic of )

110

73

Dominican Republic

100

74

Nicaragua

100

75

Micronesia (Federated States of )

96

76

Algeria

89

77

Peru

89

78

Democratic People’s Republic of Korea

87

79

Ecuador

87

80

Vanuatu

86

81

Panama

85

82

Trinidad and Tobago

84

83

Colombia                

83

84

Cuba                          

80

85

Jamaica

80

86

Kyrgyzstan

75

87

Mauritius

73

88

Argentina

69

89

Brazil

69

90

El Salvador

69

91

Mongolia

68

92

Iraq

67

93

Turkmenistan

61

94

Fiji

59

95

Samoa

58

96

Cabo Verde             

53

97

Barbados

52

98

Jordan

50

99

Mexico

49

100

Syrian Arab Republic

49

101

Viet Nam

49

102

Occupied Palestinian Territory

47

103

Tunisia

46

104

Belize

45

105

Egypt

45

106

Saint Vincent and the Grenadines

45

107

Tajikistan

44

108

Georgia

41

109

Costa Rica              

38

110

Bahamas

37

111

Uzbekistan

36

112

Saint Lucia

34

113

Romania

33

114

China                        

32

115

Maldives

31

116

Armenia

29

117

Malaysia

29

118

Sri Lanka

29

119

United States of America

28

120

Brunei Darussalam

27

121

Republic of Korea

27

122

Azerbaijan

26

123

Kazakhstan

26

124

Thailand

26

125

Russian Federation

24

126

Grenada

23

127

Iran (Islamic Republic of)             

23

128

Ukraine

23

129

Bahrain

22

130

Chile                        

22

131

Albania

21

132

Republic of Moldova

21

133

Puerto Rico

20

134

Turkey

20

135

Lebanon

16

136

Saudi Arabia

16

137

Serbia

16

138

Libya

15

139

Hungary

14

140

Kuwait

14

141

Uruguay

14

142

Croatia                      

13

143

Latvia

13

144

Canada                                       

11

145

Estonia

11

146

Lithuania

11

147

Luxembourg

11

148

Oman

11

149

Cyprus                     

10

150

France

9

151

Ireland

9

152

Malta

9

153

Bosnia and Herzegovina               

8

154

New Zealand

8

155

Portugal

8

156

United Arab Emirates

8

157

United Kingdom

8

158

Germany

7

159

Montenegro

7

160

Slovakia

7

161

Slovenia

7

162

The former Yugoslav Republic of Macedonia

7

163

Australia

6

164

Belgium

6

165

Japan

6

166

Netherlands

6

167

Qatar

6

168

Singapore

6

169

Switzerland

6

170

Bulgaria

5

171

Czech Republic      

5

172

Denmark                  

5

173

Greece

5

174

Austria

4

175

Finland

4

176

Iceland

4

177

Italy

4

178

Norway

4

179

Spain

4

180

Sweden

4

181

Poland

3

182

Israel

2

183

Belarus

1

 

Source: UN Inter–Agency “Trends in Maternal Mortality: 1990 to 2013".

 

The Government of India has not undertaken any study to assess the ongoing programme/schemes to reduce the IMR and MMR. However, regular supportive supervision visits and Common Review Mission (CRM) have been conducted to assess the progress of ongoing interventions for improvement of infant and maternal health outcomes annually in the States/UTs.

 

Based on these assessments, States/UTs are guided to prepare Annual Program Implementation Plan (PIP) to focus on priority interventions to improve infant and maternal health outcomes in each State/UT.   

 

To sharpen the focus on the low performing districts, 184 High Priority Districts (HPDs) have been identified for implementation of Reproductive Maternal Newborn Child Health+ Adolescent (RMNCH+A) interventions for achieving improved maternal and child health outcomes.

 

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

 

                                                       *****

MV/BK