The J.K Lone Hospital in Kota, Rajasthan is seeing an increasing number of deaths of infants. Amid the outrage caused by the infants’ death, disturbing figures of similar deaths emerged from Jodhpur and Bikaner as well as Rajkot and Ahmedabad in Gujarat. Reports indicate that the cause for these increasing infant deaths is the poor quality of infrastructure in public hospitals. The low-quality public healthcare has a huge impact on the nation’s Infant mortality rate – the indicator of the quality of a country’s healthcare system.
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What is the Infant Mortality Rate (IMR)?
- Infant Mortality Rate is the number of babies below one year dying out of every 1,000 born alive for a given time and a given region.
- It is considered an important indicator of the country’s health system.
What is India’s IMR?
- According to the latest government data released by the Sample Registration System, India’s Infant Mortality Rate (IMR) has reduced by 42% over the 11 years – from 57 per 1,000 live births in 2006 to 33 in 2017.
- Despite the reduction, India’s IMR in 2017 is higher than the global average of 29.4.
- India’s IMR is equivalent to that of the West African nation of Senegal and higher than most of the South Asian nations.
- In 2017, India’s rural India had an IMR of 37 and urban India had IMR of 23. This shows the difference in quality and access to healthcare in the urban and rural areas despite the implementation of National Rural Health Mission, a national programme to bridge this gap, since 2005.
- Also, the data showed that the rural IMR has reduced marginally and the urban IMR remained the same for the whole of India when compared to the previous year.
- There was a marginal increase in the IMR in urban areas of Bihar, Gujarat, Chhattisgarh, Jharkhand, Karnataka, Maharashtra, Punjab and Uttarakhand from 2016, with the highest increase in urban Gujarat and Karnataka – going from 19 to 22 in both the states.
- In the case of urban Gujarat, the IMR for females went from 19 to 23, higher than the increase for the males.
Worst performing states:
- Among the Indian states, Madhya Pradesh saw the most number of deaths of children below one year (IMR 47) in 2017.
- Assam (44) and Arunachal Pradesh (42) followed it.
- Madhya Pradesh’s IMR was equivalent to that of the West African nation, Niger, whose 80% of the land lies in the Sahara Desert and ranked the very last in the UN Human Development Index in 2018.
- Furthermore, the only states that showed an increase in IMR are Manipur and Arunachal Pradesh. Manipur and Arunachal Pradesh’s IMR increased between 2006 and 2017 from 11 to 12 and 40 to 42 respectively.
States that performed well:
- Nagaland recorded the lowest IMR of 7 – equivalent to that of Kuwait and Lebanon.
- It is followed by Goa (9), Kerala (10), Puducherry (11), Sikkim (12) and Manipur (12), all small states with a population less than 10 million (except Puducherry, which is a Union Territory).
States with significant improvement:
- When compared to 2006 SRS figures for IMR among India’s larger states (with a population more than 10 million), New Delhi and Tamil Nadu reduced their IMR by 57% – from 37 in 2006 to 16 in 2017.
- Other states that showed similar improvement were Jammu and Kashmir (-56%), Himachal Pradesh (-56%) and Punjab (-52%).
- Among the smaller states, Nagaland showed the most decline of 65% from 20 in 2006 to 7 in 2017. It is followed by Sikkim (-64%) and the Union Territories, Dadra and Nagar Haveli (-63%) and Puducherry (-61%).
States with slow improvement:
- Uttarakhand (-5%), West Bengal (-15.8%) and Tripura (-19.4%) are the states that showed the slowest decline in IMR between 2006 and 2017.
India and its Neighbours:
- As previously mentioned, India’s IMR is 33.
- This is worse than India’s neighbours Nepal (28), Bangladesh (27), Bhutan (26), Sri Lanka (8) and China (8).
- However, it is better than that of Pakistan (61) and Myanmar (30).
What are the causes of IMR?
Poverty and malnutrition:
- A major factor that is believed to influence the rate of infant mortality is poverty.
- Official estimates place 21.9% of Indians below poverty line (BPL). Other estimates take into account the 67% of the population that benefit from government scheme that provides subsidised wheat and rice to those who cannot afford it.
- This may indicate that a large population is only technically above the poverty line due to the subsidised food expenditure.
- However, the Public Distribution System is mainly dominated by simple carbohydrate-diet leading to the very low nutritional value in an individual’s diet.
- Many experts suggest that that the low birth weight is the main cause for the neonatal death, which drives up the under-five mortality rate.
- The low birth weight is caused by many factors and mostly it is caused by poor nutritional intake during the pregnancy and the lack of access to quality healthcare before and during birth.
- These issues are often more prevalent in rural areas, where access to healthcare is minimal.
- A large number of malnourished individuals is sharply contrasted by the increase in the western-style junk food in the diets of the individuals in the urban area.
- Malnutrition is often applied to those who do not eat enough. However, an obese individual can also suffer from malnutrition.
- While calorie consumption may be high, nutrient intake from junk food is very low. Therefore, the individual may be malnourished in the sense that they lack mineral or vitamin.
- A UNICEF report pointed out that newborn deaths are difficult to address with a single drug or intervention. Therefore, they require a system-wide approach.
- It noted that an increase in the access to quality healthcare is critical to reducing the IMR.
- In India, there are inequalities in the levels of access to healthcare. This is seen between urban and rural regions of the country and between the states at different levels of economic development.
- The lack of access to healthcare both during and after the pregnancy can have severe consequences on the health of the infant. Without regular check-ups, the health of both the mother and the child are at risk and is worsened by the lack of medical assistance during the birth itself. This situation is seen mostly in rural India.
- Madhya Pradesh, which saw the highest IMR lacks healthcare infrastructure.
- In Madhya Pradesh, around 24 million people – roughly a third of the population – live below the poverty line. 21% of the population is tribal and 17% are part of the scheduled caste.
- A report stated that if all newborns in India experienced the same survival rates as the newborns from the richest Indian families, nearly 360,000 more babies would survive annually.
What causes the increased deaths of infants in J.K Lone Hospital in Kota, Rajasthan?
- According to the data of the hospital administration, 100 infants lost their lives in December 2019 and 101 in November 2019.
- This is higher than December and November 2018 when the hospital saw the deaths of 77 and 76 infants respectively.
- By the end of the first week of 2020, a dozen more children had lost their lives due to health complications.
- The J.K. Lone Hospital had ordered the investigation into the children’s deaths.
- The hospital’s neonatal ICU ranking, issued by the National Health Mission every month by the services’ quality has shown a low infant mortality rate.
- However, many blame poor infrastructure quality and the negligence of the staff for the increase in the death toll.
- The negligence of the staff and the doctors cannot be the only factor that led to the situation.
- K. Lon Hospital is the biggest hospital in the region and is a tertiary care medical facility.
- The many infants with the terminal stage of illness are referred to this hospital by the private hospitals.
- Also, many children develop hypothermia, hypoglycaemia and hypoxia during the transit.
- The shortage of staff is also to blame for the current situation.
- An internal study by the hospital has found that it needs at least 300 additional beds.
- A major shortcoming in the hospital is the absence of a centralised oxygen system, as oxygen cylinders are supplied by carts.
- Many of the hospital’s equipment is of either low quality or defunct.
What are the measures taken by the Indian government?
National Health Mission (NHM):
The Indian government addressed India’s high IMR through the National Health Mission (NHM) that included the following interventions:
- The Janani Suraksha Yojana (JSY) aims to reduce the maternal and neonatal mortality by promoting institutional delivery among the poor pregnant women. It provides financial assistance for delivery and post-delivery care.
- Janani Shishu Suraksha Karyakaran (JSSK) entitles all pregnant women delivering in public health institutions to absolutely free antenatal check-ups, delivery, including Caesarean section, post-natal care and treatment of sick infants till one year of age.
- Strengthening of delivery points through Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy.
- The government also ensured that the essential newborn care is provided at all delivery points by the establishment of Special Newborn Care Units (SNCU), Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for the care of sick and small babies.
- Early initiation and exclusive breastfeeding for the first 6 months and appropriate Infant and Young Child Feeding (IYCF) are promoted.
- Village Health and Nutrition Days are organised creating awareness on maternal and child health and nutritional care.
- Universal Immunisation Programme (UIP) promotes vaccination to children against many deadly diseases like Tuberculosis, Diptheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Mission Indrahanush was launched for the immunisation of the children across the country.
- Mother and Children Tracking System, a name-based tracking of mothers and children until two years of age is ensuring the complete antenatal, intranatal, postnatal care and complete immunisation per schedule.
- Rashtriya Bal Swasthya Karyakram (RBSK) is an initiative that aims to undertake early identification and early intervention for all children from birth to 18 years to cover defects at birth, deficiency, diseases, development delays including disability.
- Training has been given under the NHM to build and upgrade the skills of healthcare providers to help them provide comprehensive care for mothers during pregnancy, delivery and essential newborn care.
India Newborn Action Plan (IANP)
- It was launched in 2014 to make concerted efforts towards the attainment of the following goals by 2030:
- Single Digit Neonatal Mortality Rate
- Single Digit Stillbirth Rate
Mothers’ Absolute Affection Programme:
- It aims to spread awareness about the best breastfeeding practices (initial breastfeeding within an hour, exclusive breastfeeding up to 6 months and compulsory breastfeeding for up to two years).
- This is done through mass media and the capacity building of healthcare providers and communities.
- It is undertaken by the state governments for the children from 9 months to 15 years of age to eliminate Measles by 2020.
What can be the way forward?
- The incident of poor public healthcare in Kota is not an isolated incident.
- Unless the maternal health services, child health services and primary healthcare are strengthened, the lives cannot be saved through treatment at the tertiary level.
- Also, infant mortality is the consequence of poor budgetary allocation and unspent capital funds for the public healthcare system.
- Rajasthan’s budget allocation for health and family welfare increased by an abysmal 1.76% between 2018-19 and 2019-2020, against a 9.61% increase in the total budget.
- The health budget of the state hovers at about 6% of the total budget.
- Increasing the budget for healthcare can exponentially reduce the infant mortality rate as it would mean improving the infrastructure of healthcare as well as increased access to affordable quality healthcare.
- Maternal education can also help improve the country’s performance in the IMR. It is found that educated women show better health outcomes for children.
- Start-ups can be encouraged to improve affordable healthcare for all. For instance, a start-up based in Madurai, Tamil Nadu has created a kit called SaveMom that can monitor several vital health parameters of the pregnant women in remote rural areas, all the while sending the data back as a live feed to the relevant health professionals. Such start-ups can an invaluable asset for reducing infant mortality.
The current instances of increased IMR are indicating India’s failing public healthcare system. Due to low quality public healthcare institutes, many are preferring private healthcare. However, private healthcare is always costly and is mostly confined within urban India. Thus, low quality public healthcare and unaffordability and inaccessibility to private hospitals are increasing the health risk of the mothers and infants. Therefore, the government should focus on improving affordable public healthcare to all to address this situation.
Critically analyse the reasons behind India’s high Infant Mortality Rate. What are the measures that can be taken to reduce IMR? (250 Words)