Sansad TV Perspective: Declining Mortality Rates

In the series Sansad TV Perspective, we bring you an analysis of the discussion featured on the insightful programme ‘Perspective’ on Sansad TV, on various important topics affecting India and also the world. This analysis will help you immensely for the IAS exam, especially the mains exam, where a well-rounded understanding of topics is a prerequisite for writing answers that fetch good marks.

In this article, we feature the discussion on the topic: Declining Mortality Rates.

Anchor: Teena Jha

Guests:

1. Urvashi Prasad, Director, Development Monitoring and Evaluation Office, NITI Aayog
2. Dr. Usha Ram, Professor & Head, Department of Bio-Statistics and Epidemiology, IIPS, Mumbai
3. Dr. Suneela Garg, Chair, Programme Advisory Committee, National Institute of Health and Family Welfare

Context: As per the Sample Registration survey, there is a decline in mortality rates.

Highlights of the discussion:

• Introduction.
• Details.
• Interventions adopted.
• Associated Challenges.
• Way Ahead

Introduction:

• A significant milestone was achieved by India in reducing the Child Mortality rates. 
• As per the Sample Registration System (SRS) Statistical Report 2020, India’s Under 5 mortality rate(U5MR) has declined from 45 per 1000 live births in 2014 to 35 per 1000 live births in 2019 and further down to 32 per 1000 live births in 2020. 
• Infant Mortality Rate(IMR) has also registered a 2-point decline to 28 per 1000 live births in 2020 from 30 per 1000 live births in 2019. The Neonatal Mortality Rate(NMR) has dipped 2 points from 22 per 1000 live births in 2019 to 20 per 1000 live births in 2020. 
• The Total Fertility Rate (TFR) for the country has also come down to 2.0 in 2020 from 2.1 in 2019. 
• The Crude Birth Rate at the national level during 2020 stands at 19.5, exhibiting a decline of 0.2 points over 2019. From 2015 to 2020, there’s been a decline of 1.3 points in the Crude Birth Rate for the country. 
• The target under the National Health Mission to be achieved by 2025 is to 
  • Reduce Infant Mortality Rate to 23
  • Reduce Under 5 Mortality Rate to 23 
  • Sustain Total Fertility Rate to 2.1

For more information on IMR and TFR, read here: Infant Mortality | Replacement Rate in Fertility Rate [UPSC Notes]

Details:

• It is important to note that in some states the mortality rate has reached a lower level to such an extent that baseline mortality levels are already at the bottom and significant decline cannot be observed. For example Kerala, Karnataka, etc.
• On the other hand there are states where more distance needs to be covered in reducing the mortality rate. For instance, Chhattisgarh, Bihar, Uttar Pradesh, etc.
• India is moving in the direction of attaining the Sustainable Development Goals and Eleven states have already achieved the target of U5MR to less than or equal to 25(the target year was 2030). Similarly, six states have achieved the target of Infant Mortality Rate.

For more information on Child health indicators, read here: Child Health Programs in India – Child Health Indicators & Governmental Interventions

Interventions that helped in reducing Mortality Rates:

• For the last 10 to 15 years, National Rural Health Mission, now called as National Health Mission has been a game changer in reducing mortality rates(IMR, NMR, U5MR) including Maternal Mortality Rates. Specific interventions that were covered under it are:
  • Ante-natal care coverage with both content and quality.
  • Institutional deliveries.
  • Post-natal care.
• There are significant advancements in terms of health service delivery, which were made accessible to the lowest wealth groups. It is observed that health inequalities can be reduced between the rich and the poor if the health care services reach the marginalized sections of society.
• The center-state coordination has also helped in reducing the mortality rates.
• There has been a considerable transformation in healthcare system, which is also attributed to the dedication of the healthcare workers. ASHA workers and Anganwadi workers were also involved in providing supplementary nutrition. This has been acknowledged by the United Nations. The participation of Auxilary Nurse Midwives(ANM), Nurses, and Community Health workers are also appreciable.
• A large number of Health and Wellness Centers have been established. There are approximately 1,50,000 centers and out of these 1,00,000 have 12 task forces for RMNCHA services.
• Another aspect that has made a substantial difference is the focus on quality rather than quantity. The various programmes that have focused on quality are the Labor Room Quality Standard initiative(LaQshya), SUMAN, Mothers Absolute Affection(MAA), etc.
• The initiatives like Sarva Shiksha Abhiyan have also empowered women through education. Similarly, Midday Meal Scheme has also indirectly contributed in the direction of reducing mortality and addressing the nutritional demands of mothers and Children.
• Universal Immunization Program has also considerably prevented communicable and non-communicable diseases in children, thus reducing mortality.
• The involvement of private sector at various points has also helped in attaining the targets. One such instance is the involvement of the private sector in dealing with Tuberculosis cases.
• The use of technology like telemedicine has also contributed to the direction. But it is still at a nascent stage and a lot needs to be done in this regard.

Challenges that persists in India:

• Under Five mortality rate shows a gender disparity. The U5MR stands at 33 in females as compared to 31 in males.
• According to a study in 2013, out of 640 districts in the country, 304 districts had female U5MR 25 percent more than the male U5MR. Moreover, these districts are spread across the entire country including the developed states of Kerala and Tamil Nadu.
• There are eight states where the female U5MR is higher than the males.
• The neonatal mortality within the Infant mortality rate is about 80 to 85 percent. One in every 35 infants dies before one year at the national level.
• Post-natal care is at the lower level in the majority of states. Moreover, delayed breastfeeding also contribute to higher infant mortality.
• Another challenge in this regard is the lack of district-level data.
• The issue of gender-based violence, gender inequity, and inequality are still major concerns in India

Future Course of Action:

• A life cycle approach is required beginning with adolescence to good ante-natal, intra-natal, and post-natal care including the care of infants, Under five and mothers.
• Rural-Urban disparities should be addressed through focused interventions. A data-driven approach should be used to identify the differences not only between rural and urban areas but also between different districts of the state. A localized and targeted approach is required.
• Apart from health interventions, steps are required to be taken in education, nutrition, poverty alleviation, housing and infrastructure development, etc.
• It is also important to work towards maternal anemia and nutrition components.
• Child survival cannot be addressed in isolation and thus it should be holistic alongwith the maternal health.
• Efforts are required to be made in spreading awareness and creating an enabling environment at the family level. Mothers and families should be sensitized about the various aspects like contraception, breastfeeding, the importance of monitoring growth and development.
• Timely immunization of children and all associated facilities should be adequately provided.
• Societal transformation and evolution are also required to address the concerns.
• Quality healthcare should be provided in rural, urban, peri-urban, and tribal areas.
• The efforts should go beyond awareness to community engagement. It has to be a partnership approach moving from community mobilization to community participation.
• Community leaders, the private sector, and civil society should also be involved in the whole-of-society approach.
• Human resource aspects should also be considered. It should be made available at all levels, even reaching the block level.
• Area-specific approach needs to be at the heart of all interventions.

Conclusion:

The larger implication of the health of a country has its direct bearing on the nation’s well-being. To improve the National Wellness parameter, it is essential to have a healthy infant, child, and young population. This is paramount in achieving the desired goals and the status of a developed Nation.

Read all the previous Sansad TV Perspective articles in the link.

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