Infant mortality: TS fares better than AP

According to the National Family Health Survey (NFHS-4) 2015-16 data, Telangana has improved Infant Mortality Rate (IMR) levels compared to Andhra Pradesh. In fact, Telangana has managed to outperform Andhra Pradesh in the IMR, which is the mortality rate of infants for every 1,000 live births.

According to the NFHS-4, the IMR for Telangana State (both urban has rural) is at 28 for every 1,000 live births. At the same time, average IMR (urban and rural) for AP is at 35. In urban Telangana, the IMR is at 20 while in rural areas, it is a bit higher at 35. In urban AP, IMR was at 20, while in rural areas, it is 40.

According to data, both Telangana and AP have very high under-five mortality rate (U5MR) per every 1,000 live births. The average U5MR in Telangana is 32 while for AP it is at 41. Senior paediatricians pointed out that the high level of under-five mortality rates highlight the need to strengthen long-term care for infants soon after they are born. Compared to other States and even developed countries, the IMR rates in Telangana and AP are very high.

In this direction, the recently launched Telangana Newborn Action Plan, (TNAP), which is a part of the India Newborn Action Plan (INAP) launched by Government of India (GOI), could go a long way in improving things. Essentially, the TNAP and the INAP outline ‘a targeted strategy for accelerating the reduction of preventable newborn deaths and stillbirths in the State and elsewhere in the country.

Till recently, the IMR level in TS was between 33 and 35. Earlier, surveys in Telangana had indicated that IMR was around 35. When this is compared to NFHS-4 survey, it shows the IMR is now 28, it is definitely heartening. However, the overall picture shows that Telangana is still way behind States like Kerala or even Karnataka. In the end, Telangana aims to bring down the IMR to a single digit by allocating Rs 1,553 crore in the budget of 2016-17 through women and child welfare department to mitigate the maternal and infant mortality rates in the state.

At present, the state government has succeeded in reducing the maternal mortality rate (MMR) to 92 per every one lakh pregnant women in the state, while the national average of MMR is 167 mother deaths for every one lakh women in the country. Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. India continues to contribute a quarter of all global maternal deaths. WHO defines maternal mortality as the death of a woman during pregnancy or in the first 42 days after the birth of the child due to causes directly or indirectly linked with pregnancy.

Young married women in the age group of 15-19 years (66.6% girls) are more likely to experience delivery complications compared to 30-34 year old women (59.7%) and neonatal, infant and child mortality rates are much higher for younger girls. Nearly half (43%) of women aged 20 to 24 are married before the age of 18 in India. Andhra Pradesh has one of the highest incidences of child marriage (51.9%) in the country, according to UNCICEF.

A large number of maternal deaths are preventable through safe deliveries and adequate maternal care. Skilled attendance at all births, backed by emergency obstetric care when needed, also reduces risks of maternal deaths due to complications during delivery. On a positive note, the percentage of women in Telangana and Andhra Pradesh who had institutional delivery are 94 per cent. However, only 37 per cent pregnant women in Andhra Pradesh and 45 per cent in Telangana received antenatal care.

Through allocation of Rs 1,553 crore, the TS government aims to bring both the IMR and the MMR on a par with the national average. Its target is to reach IMR below 10 and MMR below 40 by end of this year. Under the Integrated Child Development Scheme (ICDS), the state government is spending a major chunk of allocated funds for providing healthcare needs such as vaccination and medicines to children below 5 years. Apart from this, to ensure proper nourishment of the children and to reduce the neonatal and malnutrition deaths, the state government is providing eggs and ‘balamrutam’ nutritional food to about 10.06 lakh children in the state.

For reducing the MMR, the state government has earmarked Rs 508 crore to be spent for providing iron tablets, nutritious food and other medication for the pregnant women. About 4.38 lakh pregnant women have been benefiting under the ‘Arogya Laxmi’ healthcare scheme for the women in the state. Overall, the government is providing healthcare and nutritional services to small children below 5 years and pregnant women through 35,700 anganwadi centers in the state.

However, despite all these efforts and continuous spending of about Rs 1,500 crore every year for the last 3 years, there are still a lot of problems. The major problem is proper implementation of ICDS scheme in rural areas. To ensure transparency and avoid rampant corruption,
the state government has embarked on employing a tracking and monitoring system, wherein the Anganwadi centers need to update the beneficiaries’ names every month on the website.

In States like Kerala, Tamil Nadu and even for that matter Karnataka, the neonatal mortality rate hovers between 10 and 18 infants for every 1,000 live births. Telangana has started taking care of would-be mothers’ right from conceiving stage till delivery and later after the birth, in order to reduce MMR rate.

By Gudipati Rajendera Kumar