Mortality Rate in India: A Comparative Analysis
India has witnessed significant changes in mortality rates since gaining independence in 1947. This article delves into the trends of infant mortality rate (IMR), maternal mortality rate (MMR), and female mortality rate across different decades, highlighting the highest and lowest states, analyzing the reasons behind these rates, and discussing their implications on India’s economy and demographics.
Historical Overview of Mortality Rates
Infant Mortality Rate (IMR)
Infant Mortality Rate (IMR)is a critical indicator of child health and overall development. The IMR in India has shown a declining trend over the decades:
– 1950s: The IMR was approximately 146 per 1,000 live births.
– 1970s: It decreased to about 110 per 1,000 live births.
– 1990s: The IMR further declined to around 70 per 1,000 live births.
– 2010s: By 2019, the IMR had reduced to 30 per 1,000 live births.
Maternal Mortality Rate (MMR)
Maternal Mortality Rate (MMR) reflects the health care system’s effectiveness in managing pregnancy and childbirth. The MMR in India has also seen significant reductions:
– 1990s: The MMR was approximately 556 per 100,000 live births.
– 2000s: This figure dropped to about 374 per 100,000 live births.
– 2010s: By 2018-2020, the MMR stood at 97 per 100,000 live births.
State-wise Comparison of Mortality Rates
Highest and Lowest States for Infant Mortality Rate (IMR)
Highest and Lowest States for Maternal Mortality Rate (MMR)
Female Mortality Rate Analysis
The female mortality rate in India has historically been higher than that of males due to various socio-economic factors. The reasons include:
– Gender Discrimination: Cultural biases lead to neglect of female health.
– Access to Healthcare: Women often face barriers in accessing healthcare services.
– Nutrition: Poor nutritional status among women contributes to higher mortality rates.
Decadal Analysis of Mortality Rates
Trends from the Post-Independence Era
1.1947-1960s: High mortality rates due to inadequate healthcare infrastructure.
2. 1970s-1980s: Introduction of family planning and maternal health programs led to gradual improvements.
3. 1990s: Economic liberalization brought better healthcare access but disparities persisted between states.
4. 2000s-Present: Significant investments in healthcare infrastructure have resulted in a notable decline in both IMR and MMR.
Reasons Behind High Mortality Rates
Several factors contribute to high mortality rates in specific states:
– Socioeconomic Status: Poorer states like Uttar Pradesh and Madhya Pradesh exhibit higher mortality rates due to lower income levels and inadequate healthcare facilities.
– Education Levels: Lower educational attainment among women correlates with higher maternal and infant mortality rates.
– Healthcare Access: Rural areas often lack access to quality healthcare services, leading to preventable deaths during childbirth or infancy.
Consequences on Economy and Demographics
High mortality rates have profound implications for India’s economy and demographics:
– Economic Impact: High maternal and infant mortality can hinder economic productivity as families lose potential earners. Additionally, healthcare costs associated with high mortality can strain public resources.
– Demographic Changes: High infant mortality rates can lead families to have more children than desired, affecting population growth dynamics. This can perpetuate cycles of poverty as families invest heavily in child-rearing without assurance of survival.
Interventions for improving Maternal Mortality Rate (MMR):
- Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme was launched in April 2005 with the objective of reducing Maternal and Infant Mortality by promoting institutional delivery among pregnant women.
- Janani Shishu Suraksha Karyakram (JSSK) aims to eliminate out-of-pocket expenses for pregnant women and sick infants by entitling them to free delivery including caesarean section, free transport, diagnostics, medicines, other consumables, diet and bloodin public health institutions.
- SurakshitMatratvaAshwasan (SUMAN) aims to provide assured, dignified, respectful and quality healthcare at no cost and zero tolerance for denial of services for every woman and newborn visiting the public health facility to end all preventable maternal and newborn deaths.
- Pradhan MantriSurakshitMatritvaAbhiyan (PMSMA) provides pregnant women fixed day, free of cost assured and quality Antenatal Careon the 9thday of every month.
- LaQshya aims to improve the quality of care in labour room and maternity operation theatres to ensure that pregnant women receive respectful and quality care during delivery and immediate post-partum period.
- Comprehensive Abortion Care services are strengthened through trainings of health care providers, supply of drugs, equipment, Information Education and Communication (IEC) etc.
- Midwifery programmeis launched to create a cadre for Nurse Practitioners in Midwifery who are skilled in accordance to International Confederation of Midwives (ICM) competencies and capable of providing compassionate women-centred, reproductive, maternal and new-born health care services.
- Delivery Points-Over 25,000 ‘Delivery Points’ across the country are strengthened in terms of infrastructure, equipment, and trained manpower for provision of comprehensive RMNCAH+N services.
- Functionalization of First Referral Units (FRUs)by ensuring manpower, blood storage units, referral linkages etc.
- Setting up of Maternal and Child Health (MCH) Wings at high caseload facilities to improve the quality of care provided to mothers and children.
- Operationalization of Obstetric ICU/HDU at high case load tertiary care facilities across country to handle complicated pregnancies.
- Capacity building is undertaken for MBBS doctors in Anesthesia (LSAS) and Obstetric Care including C-section (EmOC) skills to overcome the shortage of specialists in these disciplines, particularly in rural areas.
- Maternal Death Surveillance Review (MDSR) is implemented both at facilities and at the community level. The purpose is to take corrective action at appropriate levels and improve the quality of obstetric care.
- Monthly Village Health, Sanitation and Nutrition Day (VHSND) is an outreach activity for provision of maternal and child care including nutrition.
- Regular IEC/BCC activities are conducted for early registration of ANC, regular ANC, institutional delivery, nutrition, and care during pregnancy etc.
- MCP Card and Safe Motherhood Booklet are distributed to the pregnant women for educating them on diet, rest, danger signs of pregnancy, benefit schemes and institutional deliveries.
Interventions for improving Infant Mortality Rate (IMR):
- Facility Based New-born Care:Sick New-born Care Units (SNCUs) are established at District Hospital and Medical College level, New-born Stabilization Units (NBSUs) are established at First Referral Units (FRUs)/ Community Health Centres (CHCs) for care of sick and small babies.
- Community Based care of New-born and Young Children:Under Home Based New-born Care (HBNC) and Home-Based Care of Young Children (HBYC) program, home visits are performed by ASHAs to improve child rearing practices and to identify sick new-born and young children in the community.
- Mothers’ Absolute Affection (MAA):Early initiation and exclusive breastfeeding for first six months and appropriate Infant and Young Child Feeding (IYCF) practices are promoted under Mothers’ Absolute Affection (MAA).
- Social Awareness and Actions to Neutralize Pneumonia Successfully (SAANS) initiative implemented since 2019 for reduction of Childhood morbidity and mortality due to Pneumonia.
- Universal Immunization Programme (UIP) is implemented to provide vaccination to children against life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B, Measles, Rubella, Pneumonia and Meningitis caused by Haemophilus Influenzae B. The Rotavirus vaccination has also been rolled out in the country for prevention of Rota-viral diarrhoea. Pneumococcal Conjugate Vaccine (PCV) has been introduced in all the States and UTs.
- Rashtriya Bal Swasthya Karyakaram (RBSK): Children from 0 to 18 years of age are screened for 30 health conditions (i.e. Diseases, Deficiencies, Defects and Developmental delay) under Rashtriya Bal SwasthyaKaryakaram (RBSK) to improve child survival. District Early Intervention Centres (DEICs) at district health facility level are established for confirmation and management of children screened under RBSK.
- Nutrition Rehabilitation Centres (NRCs)are set up at public health facilities to treat and manage the children with Severe Acute Malnutrition (SAM) admitted with medical complications.
- Intensified Diarrhoea Control Fortnight / Defeat Diarrhoea (D2) initiative implemented for promoting ORS and Zinc use and for reducing diarrhoeal deaths.
- Anaemia Mukt Bharat (AMB) strategy as a part of POSHANAbhiyan aims to strengthen the existing mechanisms and foster newer strategies to tackle anaemia which include testing & treatment of anaemia in school going adolescents & pregnant women, addressing non nutritional causes of anaemia and a comprehensive communication strategy.
- Capacity Building: Several capacity building programs of health care providers are taken up for improving maternal and child survival and health outcomes.
India’s journey post-independence reflects significant progress in reducing mortality rates; however, challenges remain. Disparities among states highlight the need for targeted interventions focusing on education, healthcare access, and socio-economic development. Continued efforts are essential for achieving sustainable improvements in maternal and infant health outcomes across the nation.
By addressing these issues comprehensively, India can pave the way towards better health outcomes that not only enhance individual lives but also contribute positively to national development goals.
India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.
