India’s IMR indicates a step towards ‘gender equality’

In a significant development, the female Infant mortality rate (IMR) has registered a decline in India. The identical IMR of boys, and girls a step towards gender equality.

Highlights of the Report:

• Sample Registration System Statistical Report 2020, has highlighted a decline in Infant Mortality Rate (IMR).
• No gender difference has been observed in 2020 (Male -28, Female - 28).
• The IMR has remained higher for female babies than males but the gap had reduced since 2011.
• A drop in the Neonatal Mortality Rate from 22 per 1000 live births in 2019 to 20 per 1000 live births in 2020.
• India will soon achieve the Sustainable Development Goals (SDG) targets by 2030.

Infant Mortality Rate:

• Infant mortality is the death of an infant before his or her first birthday.
• The infant mortality rate is the number of infant deaths for every 1,000 live births.
• In addition to giving us key information about maternal and infant health, the infant mortality rate is an important marker of the overall health of a society.

IMR has 2 components:

1. IMR: infants dying within 1 year of birth
2. Neonatal Mortality Rate (NMR): It is defined as the ‘number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period’

• Abysmal Doctor-to-Patient Ratio: There is a problem of understaff in Medical sciences in India
• Availability of Life-saving Equipment: We have low availability of life-saving equipment like ventilators, life support systems, radiant warmers, blood-pressure monitoring systems, etc.
• Pre-admission Causes: These include, underweight babies who are more prone to infections within the first 48 hours of their birth.
• Insufficient Resources: The current GDP allocation for the health sector is just 2.1 % of the total GDP. In other countries, this rate varies from 3.5-5%.
• Malnutrition: According to National Family Health Survey-5: At least 67 percent of children (6-59 months) have anemia and 57.0 percent of women (15-49 years) are anemic.

Introducing Behavioral Change:

• Several schemes have been launched by the respective governments but the one that stands out is BetiBachao, BetiPadhao, and National Girl Child Day.
• It came into existence when the country was observing a consistent decline in the Child Sex Ratio (CSR). The decline from 945 in 1991 to 927 in 2001 and further to 918 in 2011 is alarming.

BetiBachao, BetiPadhao:

• The Scheme was launched in 2015.
• This is a joint initiative of the Ministry of Women and Child Development, the Ministry of Health and Family Welfare, and the Ministry of Human Resource Development.
• The Overall Goal of the BetiBachaoBetiPadhao (BBBP) Scheme is to celebrate the girl child and enable her education.
• Other objectives:
  • Prevention of gender-biased sex-selective elimination
  • Ensuring survival & protection of the girl child
  • Ensuring education and participation of the girl child

A Positive Change:

• Encouraging Trend: The data suggests that the girl child is receiving better care and attention from parents as well as the health staff.
• Reduced Gender Discrimination: It also indicates that gender discrimination is largely absent when it comes to addressing the causes of infant mortality:
  • Preterm birth
  • Low birth weight
  • Pregnancy-related complications

Interventions for improving Infant Mortality Rate (IMR):

• Promotion of Institutional Delivery through Janani Suraksha Yojana (JSY): Promoting Institutional delivery by the skilled birth attendant is key to reducing both maternal and neonatal mortality.
• Emphasis on facility-based new-born care at different levels to reduce Child Mortality: Setting up of facilities for the care of sick new-borns such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs) and New Born Care Corners (NBCCs).
• Capacity building of health care providers: Various pieces of training are being conducted under NHM to train doctors, and nurses for early diagnosis and case management of common ailments of children and care of the mother during pregnancy and delivery.
• Management of Malnutrition: Nutritional Rehabilitation Centres (NRCs) have been established for the management of severe acute malnutrition.
• Appropriate Infant and Young Child Feeding (IYCF) practices are being promoted in convergence with the Ministry of Woman and Child Development.
• Universal Immunization Programme (UIP): Vaccination protects children against many life-threatening diseases. The Government of India supports the vaccine programme by the supply of vaccines and syringes, Cold chain equipment, and provision of operational costs.
• Janani Shishu Suraksha Karyakaram (JSSK): entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section.
• Home-based new born care (HBNC): Home-based new-born care through ASHAs has been initiated. The purpose of Home Based New Born Care is to improve new born practices at the community level and early detection and referral of sick new born babies.
• Mother and Child Tracking System (MCTS): A name-based Mother and Child Tracking System have been put in place which is web-based to ensure registration and tracking of all pregnant women and new born babies.
• Anaemia Mukt Bharat: In 2018, the Government of India launched the Anaemia Mukt Bharat (AMB) strategy with the target to reduce anaemia in vulnerable age groups.

Definitive Role of Governance:

• Increased Institutional Deliver: Percentage of live births in hospitals shot up from 35% in 2006 to 67% in 2011 to 82% in 2020.
• Improved Healthcare services: The percentage of deaths with medical attention received at hospitals has risen from 28% in 2006 to 34% in 2011 and 49% in 2020.
• Increased Expenditure on health: Economic growth has boosted spending in social sectors. Public health focus. Combined government expenditure on health had increased from Rs 2.73 lakh crore in 2019-20 to Rs 4.72 lakh crore in 2021-22, a 73% increase.
• Improvement in Social Indicators: As per the latest National Family Health Survey (NFHS)-5, social indicators such as sex ratio and health outcome indicators, viz., infant mortality rate, under-five mortality rate, and institutional birth rates have improved over years.

Suggestive measures:

• Bringing Behavioural Change: Increasing female education and economic prosperity help to improve the ratio.
• Sensitizing Youth: There is an urgent need to reach young people for reproductive health education and services as well as to cultivate gender equity norms.
• Stringent Enforcement of Law: India must implement the Pre-Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 more stringently and dedicate more resources to fighting the preference for boys.