Declining Mortality Rates | Gist of Rajya Sabha TV / RSTV (now Sansad TV) - UPSC PDF Download

Introduction

As per the Sample Registration System (SRS) Statistical Report 2020 that was released recently, India’s under 5 mortality rate has declined from 45 per 1000 live births in 2014 to 35 per 1000 live births in 2019 and further down to 32 per 1000 live births in 2020. Infant Mortality Rate has also registered a 2-point decline to 28 per 1000 live births in 2020 from 30 per 1000 live births in 2019. While Neonatal Mortality Rate has dipped 2 points from 22 per 1000 live births in 2019 to 20 per 1000 live births in 2020. Total Fertility Rate (TFR) for the country has also come down to 2.0 in 2020 from 2.1 in 2019. The Crude Birth Rate at the national level during 2020 stands at 19.5, exhibiting a decline of 0.2 points over 2019. From 2015 to 2020, there’s been a decline of 1.3 points in the Crude Birth Rate for the country. The targets under the National Health Mission to be achieved by 2025 is to reduce Infant Mortality Rate to 23, Under 5 Mortality Rate to 23 and sustain Total Fertility Rate to 2.1.

SRS

• The SRS is a demographic survey for providing reliable annual estimates of infant mortality rate, birth rate, death rate and other fertility and mortality indicators at the national and sub-national levels.
• Initiated on a pilot basis by the Registrar General of Indiain a few states in 1964-65, it became fully operational during 1969-70.
• The field investigation consists of continuous enumeration of births and deaths in selected sample units by resident part-time enumerators, generally anganwadi workers and teachers; and an independent retrospective survey every six months by SRS supervisors. The data obtained by these two independent functionaries are matched.

2020 report

• In a significant milestone, India has achieved landmark achievement in further reduction of child mortality rates.
• Following a steady downward trend, IMR, U5MR and NMR have further declined:
• Under 5 Mortality Rate (U5MR)for the country has shown significant decline of 3 points (Annual Decline Rate: 8.6%) from 2019 (32 per 1000 live births in 2020 against 35 per 1000 live births in 2019). It varies from 36 in rural areas to 21 in urban areas.
• U5MR for Female is higher (33) than male (31). There has been a decline of 4 points in male U5MR and 3 points in female U5MR during the corresponding period.
• Highest decline of U5MR is observed in the State of Uttar Pradesh (5 points) and Karnataka (5 points)
• Infant Mortality Rate (IMR) has also registered 2-point decline to 28 per 1000 live births in 2020 from 30 per 1000 live births in 2019 (Annual Decline Rate: 7%).
• The Rural-Urban difference has narrowed to 12 points (Urban 19, Rural-31).
• No gender differential has observed in 2020 (Male -28, Female – 28).
• Neonatal Mortality Rate has also declined by 2 points from 22 per 1000 live births in 2019 to 20 per 1000 live births in 2020 (Annual Decline Rate: 1%). It ranges from 12 in urban areas to 23 in rural areas.

Why India is not able to reduce new born mortality rate as other developed countries 

• Premature birth. Premature births counts for over 80% of newborn deaths.
• Complications like asphyxia during delivery.  Due to lack of institutionalisation of births and lack of health infrastructure in rural areas.
• Female literacy rates are less leading to less awareness regarding nutrition needed.
• Shortage of properly trained health workers and midwives:-
• Babies born to the poorest families are 40 per cent more likely to die than those who are born to the least poor
• The absence of steps to propagate basic healthy practices relating to breast feeding and immunisation.
• Part of the reason is that in the last two decades, efforts to tackle the problem were not as well funded as HIV and AIDS prevention.

India’s Per capita spending on health:

• Per capita spending on healthin the Budget in India is Rs.458 (Rs.61,398 crore/ 134 crore, which is the population).
• A comparison between two large democracies is telling the U.S.’s health expenditure is 18% of GDP, while India’s is still under 1.2%.
• US Budget spending per capita on healthin the U.S. is therefore $3,150 ($1.04 trillion/ 330 million, the population). Adjusting for purchasing power parity, this is about $30, one-hundredth of the U.S.
• Yet, the $4,000-$5,000 per capita spending in other OECD countriesis not comparable with India’s dismal per capita health expenditure.
• The rate of growth in U.S. expenditure has slowed in the last decade, in line with other comparable nations.

Solutions

• Paying attention to the mother’s health during pregnancy and ensuring she delivers in a hospital attended by trained doctors or midwives.
• Each State will have to identify a specific goal to meet the target.These could be enhanced coverage of health and nutrition, water, sanitation and hygiene which can prevent pneumonia and diarrhoea.
• It is also equally important to forge interlinkages and package different interventions at various levels like linking child survival to reproductive health, family planning, and maternal health
• Universalisation of maternal health and child services, which includes special newborn care, skilled delivery, immunisation and management of diarrhoea, need to be effectively implemented if India is to achieve the high goals of reducing child deaths.
• More than 80 per cent of newborn deaths can be saved with:
• Provide clean water, disinfectants
• Breastfeeding within the first hour
• Good nutrition

Conclusion

• The Central and State governments have introduced several innovationsin the healthcare sector in recent times, in line with India’s relentless pursuit of reforms.
• However, while the government’s goalis to increase public health spending to 2.5% of GDP, health spending is only 1.15-1.5% of GDP.
• Since a major innovation in universal healthcare, Ayushman Bharat, is being rolled out, it must be matched with a quantum leap in funding.
• To reach its target, the government should increase funding for health by 20-25% every year for the next five years or more.