Vital Statics Of Birth And Death

                 Health Status of the country


  • The  health  of  a  nation  is  an  essential  component  of  development,  vital  to  the  

nation‟s economic growth and internal stability. Assuming the minimum level of health

  • care to the population  is  a  critical  constituent  of  the  development  process.
  • First,  India  has  to  complete  its  unfinished  agenda  of  reducing  maternal  and

infant  mortality as  well as communicable diseases such as TB, Vector-borne disease  of

 malaria,  Kala-azar  and  Filaria,  water  borne  diseases  such  as

cholera,  diarrhoeal  diseases,  leptospirosis,  and  vaccine-preventable  measles

and tetanus.

  • Second,  India  has to contend with the rising epidemic of non communicable

diseases  including  cancers,  diabetes,  cardiovascular  diseases,  chronic

obstructive pulmonary diseases and injuries.

  • Third,  developing  systems  to  cope  with  the  new  and  re-emerging  infectious

diseases like HIV, Avian influenza, SARS and very recent H1N1 influenza.

Since independence, India has built up a vast health infrastructure and health personnel

and considerable achievements have been made over the last six decades to improve  key

health  indicators  such  as  life  expectancy,  child  mortality  and  infant  mortality  and

maternal mortality.

In  2005, India  launched  in  a  big  way  the  National  Health  Mission  (NRHM),  an  

extraordinary effort to strengthen the rural health care delivery systems. However, coverage

of priority interventions  remains  insufficient,  and  the  content  and  the  quality  of  existing

interventions are sub optimum.


 India in the International Scenario in terms of key health indicators

The  comparative  picture  with  regard  to  key  health  indicators  such  as  Life  Expectancy,

Maternal  Mortality  Rate,  Infant  Mortality  Rate  and  Total  Fertility  Rate  points  that

countries placed  in almost same situations such as Indonesia, Sri  Lanka and China have

performed much better than India.

Life expectancy in India has more than  doubled in  years  the last sixty years. It increased

from  around  30  years  at  the  time  of  independence  to  over  63.5  years  in  2002-2006.

India‟s life expectancy is lower than the global average of 67.5 years and the average of

most of countries that won their independence from colonial rule at about the same time

like China, Vietnam, Srilanka and so on.

India‟s Infant Mortality Rate too has shown a steady decline from 129 deaths per 1000

live births in 1971 t o  47  in 2010. The rate of decline has been slowing  from 9

points in the 1970s to 16 points in the current decade. Currently,  the urban IMR is  31  as

compared  to  the  rural  IMR  of  51.

India  is  not  in  an  appreciable  situation  when compared with the countries of the same

region.The problem of estimating MMR has been the fixing of a reliable denominator due to

 the comparative  rarity  of  the  event,  necessitating  a  large  sample  size.  However,  given

  this constraint, data suggests that India had a MMR of 400  in 1997-98  to 301 in 2001-03

 declining to 254 deaths per 100000 live births in 2004-2006 and 212 in 2007-09.

On the maternal mortality front,  South Asian nations except Sri  Lanka do worse than India,

and  South  Asia  as  a  region  has  poor  record  of  maternal  mortality  in  the  world,  very

significantly affecting the global effect to achieve the MDG set for 2015.

The  population stabilization  is indicated through  TFR, which is the average number of

children that a woman would bear over her lifetime if she were to experience the current

age-specific  fertility  rates.  Total  Fertility  Rate  has  reduced  from  5.2  in  1971  to  2.6  in

2008. India‟s record compares poorly  with that of Japan, China and United States which

have TFR of 1.3, 1.7 and 2.1 respectively.


Variation of health indicators across the states

The  special  concern  and  challenge  is  the  wide  variance  in  health  indication  across  the

states.  Life  expectancy  is  74  years  in  Kerala  whereas  the  life  expectancy  of  states  like

Assam, Bihar, Madhya Pradesh, Orissa,  Rajasthan  and Uttar Pradesh is in the range of

58-62 years, a level achieved during the period of 190-75 in Kerala. Similarly, Kerala and

Tamil  Nadu  reporting  an  MMR  of  95  and  111  respectively  lower  than  Assam  (480),

Bihar/Jharkhand (312), Madhya Pradesh/ Chattisgarh (335), Orissa (303), Rajastan (388)

and Uttar Pradesh/Uttar khand (440).

 Further,  TFR  of  Uttar  Pradesh,  Bihar,  Jharkhand,  Rajasthan,  Madhya  Pradesh,  and

Chhattisgarh that account for over 40% of India‟ population and have a TFR in the range

of 3.0 to 3.9 – a level that Kerala and Tamil Nadu had in the early 1970s.

The  nine  states  Assam,  Bihar/  Jharkhand,  Madhya  Pradesh  /  Chhattisgarh,  Orissa,

Rajasthan, Uttar Pradesh /  Uttar khand  account for 47% of India‟s population represent the

  core  of  our  poor  performance  on  all  four  indicators  that  is  Life  expectancy,  IMR,

MMR and TFR.


Maternal Health – Antenatal Care

Maternal  care  involves  three  stages  antenatal  care  (period  of  pregnancy),  delivery  care

and  post  natal  care  (care  after  the  delivery  of  the  baby)  Even  though  every  stage  is

significant for the health of mother as well as child, antenatal care takes more emphasis

as it assures a safe delivery, less chances of neonatal deaths / infant deaths or maternal

deaths. Ante natal care involves timely appropriate checkups,  taking Iron and Folic Acid

supplements  and Tetanus  toxin  vaccines and delivery at  hospital.

According  to NFHS-3,  less  than  half  of  the  women  received  antenatal  care  during  the

first  trimester  of pregnancy,  22%  had  their  first  visit  during  the  fourth  or  fifth  month

of  pregnancy  and 51% of mothers had three or more antenatal visits. Rural women are less

likely to receive three or more visits than urban women.  65% of the mothers received IFA

supplements, but  only  23%  consumed  them  for  the  recommended  90  days  or  more.

Three  in  Four mothers have received the prescribe dose of TT vaccination.


Delivery Care

Delivery  at  health  facility  in  the  presence  of  health  professionals  with  the  required

medical  facility  is  recommended  for  safe  delivery.  Three  out  of  every  five  delivery  in

India  take  place  at  home.  Only  two  births  out  of  five  takes  place  in  a  Health  facility.

However, the percentage of birth in health facility has increased steadily since NHFS-1.

According  to  NHFS-3,  Deliveries  at  home  are  more  common  in  among  women  who

received  no  antenatal checkups, older women, women with no education, women in the

lowest quintile and women with more than three previous births.


Postnatal Care

Early  postnatal  care  for  a  mother  helps  safeguard  her  health  and  can  reduce  maternal

mortality.  Only  37%  of  mothers  had  a  postnatal  checkup  within  2  days  of  birth,  as  is

recommended. Most women receive no postnatal care at all. Postnatal care is common

following  births  in  a  medical  facility,  however,  about  one  in  five  births  in  medical

facilities  were  not  followed  by  a  postnatal  checkup  of  the  mother.  Only  15%  of  home

deliveries were followed by a postnatal checkup.


Maternal Mortality Rate

Maternal death is  an important indicator of the reach of effective clinical health services

to  the  poor,  and  is  regarded  as  one  of  the  composite  measure  to  assess  the  country‟s

progress. Reliable estimation of levels and trends of maternal mortality is thus extremely

essential.  Deaths  due  to  pregnancy  and  child  birth  are  common  among  women  in  the

reproductive  age  groups.  Reduction  of  mortality  of  women  has  thus  been  an  area  of

concern and governments across the globe have set time bound targets to achieve it. The

Millennium Development Goals (MDG) have  set the target of achieving 109  per lakh of

live births by 2015.

  • The MMR during 2001–03 has been 301 per 100000 live births.

And 254 in 2006, 212  in 2009 .  Levels of maternal  mortality vary greatly across the

regions due to variation in access to emergency obstetric care (EmOC), prenatal care, and

anemia rates among women, education level of women, and other factors. There has been

a substantial decline during the seven year period of 1997–2003. However, the pace of

decline is insufficient. At the present rate of decline, it will be difficult to achieve the goal

of 109  by 2015.  The major causes of these deaths have been identified as  Hemorrhage

(both  ante  and  post  partum)  (37%),  toxemia  (hypertension  during  pregnancy)  (5%),

obstructed labour  (5%), puerperal sepsis (infections after delivery and unsafe condition)

(11%), abortions (8%), anemia and other conditions (34%).

  • It is very clear that delivery care  remains an  important determinant of maternal health

outcomes.  This reinforces that rapid  expansion  of  skilled  birth  attendance  and  EmOC  is  

needed  to  further  reduce maternal  mortality  in  India.  The  trend  for  undertaking  an

  institutional  delivery  is  on increase as desired in India but differentials exist in different



Infant Mortality Rate

One  of  the  most  sensitive  indicators  of  the  health  status  of  a  population  is  Infant

Mortality Rate. The IMR in India is steadily decreasing,  which is 50  per 1000 live births.

It is  34  in  urban areas far lower than 55  of the rural area  during 2009.

Further,  it  also varies across states with Kerala has the lowest IMR with 12 and the highest is

in Madhya Pradesh with IMR of 67.

  • It  is  observed  from  the  National  Family  Household  Survey-3  and  District  Level

Household  Survey  -3  that  the  higher  rates  of  antenatal,  institutional  deliveries  and

postnatal  are  associated  with  lower  IMR.

  • Infant  mortality  in  rural  areas  is  50% higher than in the urban areas. Children

 whose mothers have no education are more than twice  as  likely  to  die  before  their  first  

birthday as  children  whose  mothers  have completed  at  least  10  years  of  school.  In  

addition, children  from  scheduled  castes  and scheduled tribes are at greater risk of dying

than other children.

Maternal and Child Health Programmes in India

  • India has a long history of  Maternal and Child Health Programmes  since independence, which have undergone significant shifts in their emphasis over time. The 5-year phase of  RCH II was launched in 2005 with a vision to bring about outcomes  as  envisioned  in  the  MDGs,  the  National  Population  Policy  2000,  the  National  Health  Policy  2002  and  The  Tenth  Five  Year  Plan,  minimizing  the  regional  variations  in  the areas  of RCH and  population stabilization through  an integrated, focused, participatory programmes  meeting  the  provisions  of  assured,  equitable,  responsive  quality  services.


Major initiatives in Child Health under RCH II:

  • The  strategy  for  child  health  care  aim  to  reduce  under  5  child  mortality  through

interventions at every level of service delivery and through improved child care practices

and child nutrition. One major component of the strategy was training to the AWWs and

ANMs for early diagnosis and referral to facilities. It  focuses  on  preventive,  promotive,  a  curative  service  i.e.  it  gives  a holistic outlook to the programme. Major components of the strategy are:

(a)  Strengthening the skills of the health care workers

(b)  Strengthening the health care infrastructure

(c)  Involvement of the community

The first two components are facility based IMNCI and the third one is community based

IMNCI. The major features of the IMNCI  are:

  • Focus  on  the  newborn  care  and  young  infant-  since  a  significant  proportion  of child mortality is centered in the first few months of life
  •  Development of protocol and algorithm for home visits by field functionaries like ANMs and AWWs for all newborns in the first week of life.
  • Ensuring  harmonization  between  existing  health  interventions  and  programmes like ICDS and anti Malaria programmes implemented by agencies other than the Department of Family Welfare that impact child health.

CGPCS Notes brings Prelims and Mains programs for CGPCS Prelims and CGPCS Mains Exam preparation. Various Programs initiated by CGPCS Notes are as follows:-

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