Tackling Infant Mortality

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General studies 2

• Issues relating to development and management of Social Sector/Services relating to Health

In News: 

• The death toll of infants at the JK Lon Hospital in Rajasthan’s Kota has reached 110 in the past 36 days. In Gujarat the State run civil hospitals in Rajkot and Ahmedabad witnessed death of 134 and 85 infants respectively in the month of December, 2019. 
• While Rajasthan’s Infant Mortality Rate in 2017 stood at 38 which is higher than the national average of 33, this figure for Gujarat was below the national average in 2017 at 30.

Infant Mortality Rate:Death of children under the age of 1 is measured by Infant Mortality Rate which is the number of deaths per 1000 live births. 

How high are the mortality numbers?

India has an annual birth cohort of approximately 26 million. The infant mortality rate (IMR) in the country currently stands at 33 per 1,000 live births. This means babies numbering in the region of 8,50,000 die every year in India, or an average daily toll to 2,350. 

Gujarat has an annual birth cohort of 1.2 million. In 2017, the infant mortality rate in the state was 30 per 1,000 live births. This means the state sees about 36,000 deaths a year, or an average 98 a day.

In Rajasthan, an estimated 1.65 million births take place every year. The infant mortality rate is 38 per 1000 live births which implies an estimated 62,843 deaths annually, or an average 172 every day.

Do Gujarat and Rajasthan have the highest infant mortality?

Between 2014 and 2017, India’s IMR has declined by 15.4%. 

• At a decline rate of 17.4%, Rajasthan has been ahead of the national average in reducing IMR while Gujarat has a decline rate of 14.3%. The IMR in Rajasthan dropped from 46 per 1,000 live births in 2014 to 38, and in Gujarat from 35 to 30. 
• In 2017, states such as Arunachal Pradesh (42), Madhya Pradesh (47), Assam (44), Uttar Pradesh (41), Meghalaya (39), Odisha (41) and Chhattisgarh (38) had a higher IMR than Gujarat and Rajasthan.
• Arunachal, Tripura and Manipur have recorded a negative reduction rate between 2014 and 2017, which means child death rates there have gone up. In Arunachal it went up from 30 to 42, in Tripura from 21 to 29 and in Manipur from 11 to 12.

Why do so many infants die in India every year?

• Lack of education in the mother
• Malnutrition (more than half of Indian women are anaemic)
• Age of the mother at the time of birth, spacing, and whether the child is born at home or in a facility (infection risks in a non-institutional birth)
• Pneumonia, Prematurity, low birth weight, Diarrhoeal diseases, Neonatal infections, Birth asphyxia
• Low vaccine compliance level

According to a UNICEF factsheet on child mortality in India, “… Children born to mothers with at least 8 years of schooling have 32% lesser chances of dying in neonatal period and 52% lesser chances in the post-neonatal period, as compared to the illiterate mothers.” It also notes that infant and under-five mortality rates are highest among mothers under age 20. The rates are lowest among children born to mothers between the ages of 20-24, remain low up to 25-34, and increase again after that age.

..and then there is structural violence

The deaths in Kota, Muzaffarpur and Gorakhpur should draw our attention to a conglomeration of factors that govern child health in India. Most of the children who died in Gorakhpur, Muzaffarpur and Kota belong to the lowest strata of the society – therefore, they were victims of structural violence. In India, this structural violence is unleashed through a multitude of social, political and economic factors — 

• Apathy of healthcare professionals, 
• Poor health services/infrastructure in rural hinterlands, 
• Low rates of female literacy, 
• Economic inequality, 
• The rigid caste system, 
• Social apartheid, 
• Lack of political will and patriarchy

What measures are in place for sick newborns?

Special newborn care units (SNCUs) have been established at district hospitals and sub-district hospitals with an annual delivery load more than 3,000 to provide care for sick newborns: that is, all type of neonatal care except assisted ventilation and major surgeries. It is a separate unit in close proximity to the labour room with 12 or more beds, and managed by adequately trained doctors, staff nurses and support staff to provide 24×7 services.

India Newborn Action Plan (INAP) was launched in 2014 to make concerted efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Still birth Rate,”

Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK) was started to promote institutional deliveries so as to reduce IMR

The Way Forward

The death of children due to largely-preventable illnesses is a matter of serious concern and calls for urgent introspection. Unfortunately, we have failed to learn from past experiences.

What is urgently required is not the involvement of private players but a sincere engagement by the state in matters concerning peoples’ health. Reports have shown that most of the babies in Kota died due to suffocation at birth; low birth-weight and infections were the other significant causes of death. These are highly-preventable reasons. The role of the state in delivering health to its people cannot be overemphasised. We need to question the government’s priorities in a country where nearly a million children die every year.

Connecting the Dots:

1. The deaths in Kota bare the light on a healthcare system founded on apathy towards the poor. Discuss.
2. Kota happened because we slept after Muzaffarpur and the tragedy in Bihar happened because we were complacent after Gorakhpur. Comment.
3. Do you think profit and private involvement in healthcare leads to an erosion of trust? Examine.
4. Does it make more sense for the government to lay more emphasis on women and child development to ensure overall socio-economic transformation. Do you agree? Substantiate.  
5. Essay Topic: The idea that some lives matter less is the root of all that is wrong with the world.