New Delhi: The death of 18 newborn babies within a span of three days reported at Ahmedabad Civil Hospital last week has caused massive outrage in Gujarat, forcing the state health department to order a probe. Given the image of Gujarat as a dynamic and affluent state, the incident may look like an aberration.
However, closer scrutiny shows that the state has done poorly in reducing its infant mortality rate (IMR), neonatal mortality rate (NMR) and maternal mortality rate (MMR) in recent years. Gujarat’s IMR, at 33 in 2015, still remains high when compared to other affluent states like Maharashtra (21) and Punjab (23).
The IMR is defined as the number of deaths per 1,000 live births of children under one year of age. The rate for a given region is the number of children dying under one year of age, divided by the number of live births during the year and multiplied by 1,000.
Not just prosperous states, even those inthe ‘special category’ and financially constrained, such as Himachal Pradesh (28), Jammu and Kashmir (26), Sikkim (18), Nagaland (12) and Tripura (20), have lower IMRs than Gujarat.
The only consolation for Gujarat is that its achievement in IMR reduction has been better than the national average during the given period.
Over the ten-year period between 2006 2015, Gujarat has lagged behind these states in reducing the IMR. Gujarat achieved just 37.7% reduction in IMR in these years, compared to Punjab’s 48% and Maharashtra’s 40%. Even Jammu and Kashmir, Sikkim and Himachal have reduced their IMRs at a much faster rate than Gujarat. For example, Jammu and Kashmir halved its IMR to 26 in this period, while Sikkim and Himachal brought it down by 45% and 44% respectively.
Tripura and Nagaland too have brought down their IMRs by 44% and 40% respectively. In 2014, the female IMR (37) in Gujarat was higher than male IMR (34) and rural IMR (43) was much higher than urban IMR (23). Gujarat ranked at 25 among state and union territories on this front. While Gujarat has progressively reduced its IMR in recent years, its maternal mortality rate (MMR) has risen between 2014 and 2016, according to the comptroller and auditor general (CAG).
The MMR, defined as female deaths per 1,00,000 live births, rose from 72 in 2013-14 to 80 in 2014-15 and further to 85 in 2015-16, as per the CAG audit report on Gujarat titled ‘General and Social Sector for the year ended March 2016’.
The CAG observed that at this pace, it would be difficult for Gujarat to achieve the MMR target of 67 (per 1,00,000 live births) by March 2017 set under the National Rural Health Mission (NRHM).
“Considering the pace and direction of achievement of the goals, it would be difficult for the state to achieve the target of 67 by March 2017,” it said, while observing that implementation of Janani Shishu Suraksha Karyakram (JSSK) did not help the state in achieving the MMR reduction goals.
The JSSK was launched by the Centre in June 2011 to provide free health facilities to pregnant women and sick newborns. The main objective of the JSSK was to reduce the MMR, NMR and IMR in the state. The CAG found that MMR was higher than state average in the districts of Valsad (94), Dahod (93) and Surat (89).
During 2004-13, the national MMR declined from 254 to 167, showing 34% reduction. During the same period, the MMR in Gujarat came down from 160 to 112, registering a decline of 30%. In terms of percentage reduction in maternal death, Gujarat ranked at 11 among 15 major states during the period.
The NMR in Gujarat was 24 in 2014. The rural NMR at 30 was much higher than urban NMR of 16. Further, 69% of infant mortality was from neonatal death which was higher than the national average of 67.60%. Gujarat ranked at nine among 22 major states in NMR.
The CAG report has also found that Gujarat’s primary healthcare service remains dysfunctional. As per operational guidelines, the Gujarat government should have operationalised 50% of primary health centres as 24×7 health centres by 2010. The objective was to provide 24-hour delivery and newborn care. These PHCs should have been equipped with the facility to provide delivery and emergency obstetric and child health services close to a patient’s home.
But as of August 2016, the state had operationalised only 323 out of 1,334 PHCs, or 24%, as 24×7 health centres. It had also failed to equip 344 PHCs as 24X7 PHCs even six years after the given deadline, found the CAG audit.