Date of Release: December 1st, 2014
Published in: Times of India
A decade after India committed to a national health policy to provide improved access to healthcare, there is growing inequality in infant health across the country. States like Tamil Nadu, Delhi and Maharashtra have improved on their already superior health outcomes rapidly while poorer performing states like Uttar Pradesh, Assam and Madhya Pradesh have slid, a study has found.
Lowering of infant mortality rate (IMR) or the rate at which children under the age of one die is a critical priority of the National Rural Health Mission (NRHM) and part of the UN millennium development goals that India has committed to. In India, IMR has declined from 57 per 1,000 live births in 2006 to 42 per 1,000 live births in 2012.
Think tank Swaniti Initiative’s analysis of state-level IMR data from 2006-2012 suggests that despite huge infusion of funds in NRHM, there is growing national disparity in infant health. None of the poorly performing states were able to achieve a rate of decline in infant mortality close to what the best performing states have achieved. In other words, the interstate inequity grew between 2006 and 2012, despite the fact that NRHM provides additional funding to states with poorer outcomes.
The contrast between these two groups becomes starker when looking at the progress states with the lowest IMR in 2006 achieved in the past six years. Out of the seven states with the lowest IMR in 2006, four achieved a decrease of 29% or more. None of the seven states with the highest IMR in 2006 were able to achieve a decrease this rapid. The data itself is grim: the current infant mortality rate in Assam is over two times as high as the rate in Delhi, Tamil Nadu, Maharashtra and Kerala.
Assam continues to lag far behind the other six states with the highest IMR in 2006 and the smallest decrease, of 18% between 2006 and 2012. Every other state decreased its IMR between 23%-28% over the six-year period.
Swaniti attributes the disparity to multiple causes. “Infant mortality is impacted by a host of factors, including access to nutritional food, sanitation or good housing. In other words, simply improving healthcare is insufficient to address the structural causes of high infant mortality. Presumably, in 2006, high performing states were already better at addressing the structural causes of infant mortality and continued to improve over these six years. In contrast, poorly performing states received insubstantial support under NRHM to tackle structural causes of infant mortality. Moreover, the institutional causes of poor health outcomes in the states with high IMR — such as poorly run district-level health facilities or a shortage of qualified doctors — likely persisted under NRHM,” the analysis said.