Bengal Is Attacked For Infant Deaths, But Statistics Tell A Different Story

Some 300 infant or crib deaths were reported from different hospitals in West Bengal since January 2012. West Bengal Chief Minister Mamata Banerjee came under considerable flak at the time.

Ms Banerjee went on to blame the previous Left Front Government for the deaths saying they were in power for 34 years during which crib deaths averaged more than 40,000 every year. Blaming the media for sensationalism, she claimed instead that her Government (in power since May 2011) had brought down the rate of crib deaths by 2%. Moreover, she claimed she would bring down the death rate by 25%.

IndiaSpend’s Sourjya Bhowmick contrasts Ms Banerjee’s claims against data from other states in India and also delves deeper into the country’s infant mortality track record, particularly against the United Nation’s Millennium Development Goals.

Infant Mortality Indicators

The most stark data point is that West Bengal ranks among the top 5 performing states when it comes to Child Mortality. Here’s how:

1. West Bengal scores high on the RCH (Reproductive and Child Health) programme of the National Rural Health Mission (NRHM), which sets an Infant Mortality Rate (IMR) target of less than 30 by 2012. Bengal has an IMR of 33, based on the Sample Registration System bulletin, 2009.
2. Moreover, since 2007, Bengal’s IMR has been reducing at the rate of 2 points per year. Therefore it is highly possible that at present, West Bengal’s IMR is 30, or less.
3. Bengal scores 19 for Early Neo Natal Mortality Rate (infant deaths within 1 week of birth, expressed per 1,000) while the national average is 27. Bengal again features in the top 5 performing state. Kerala is the best performer (13), while Chhattisgarh and Madhya Pradesh is the worst performer (45), as on 2009.
4. A NRHM 2009 document also shows that 76% of Bengal’s children between 12-23 months had received full immunization as compared to the national average at 54%.

Not Enough Health Centres

So, what are Bengal’s problem areas? A NRHM review, done towards the end of 2007 said the state had established state-of-the-art State New Born Units (SNCU) at district and sub district hospitals. Activists were chosen from women of the community, trained and then started to assist the 4 Medical Officers and 6 staff nurses in such units.

However, while the target was to set up 40 SNCU’s by 2012, only 6 were established. The incremental target in 2010-2011 was reduced to 24 but till March 2011, only 1 was established. In all, 6 Nutritional Rehabilitation Centres (NRC) were set up by 2012, but the target was 26.

Only 105 of the 671 New Born Care Corners (NBCC) were set up in Sub Centres, Primary Health Centre and District hospitals. The Integrated Management of Neo Natal and Childhood Illness (IMNCI), is running in only 6 of 19 districts. Though, children seeking medical care for Acute Respiratory Infection have come down from 82% to 77%.

Infant Mortality In India

Now, let’s look at the overall landscape for infant mortality in India.

1. Every year about 1.5 million children below the age of 5 years have died, while the world average is 9.2 million. This is also known as the Under 5 Mortality Rate (U5MR). This is the highest for any country.
2. Nearly 26 million infants are born each year, out of these nearly 1 million die before they complete 4 weeks.
3. Every 6^th death in the country pertains to an infant.

Under 5 Mortality Rate (U5MR) is defined as children dying under the age of 5 per thousand live births. In 1988-92, it was 125. In 1998-2002, U5MR decreased to 98. It was 74 per 1,000 live births in 2005-2006.

Presently, as per the State Registration System, 2009 for India, U5MR is 64 per 1000 live births, varying from 71 in rural areas to 41 in urban areas. U5MR reduced 5 percentage points in the last year as compared to a drop of 5 percentage points in the preceding three years.

IMR (Infant Mortality Rate) which is the number of children dying per 100 thousand live births, declined by 33 points in the last 20 years with an average decline of 1.65 points. However, it declined by 6 points between 2008 and 2010 with the IMR being 47 in 2010. Our Infant Mortality Rate is worse than that of various African countries as well as our neighbours like Bhutan, Nepal. Even our BRIC counterparts are in a better condition. Brazil has an IMR of 21.17, Russia 10.08, China 16.06.

Child Mortality Rates In India

The figures for U5MR vary across states. The table below showcases the top 5 states and the worst 5 states. Madhya Pradesh has the worst U5MR and Kerala has the lowest U5MR of 14. The National Average U5MR is 64.

Source: Central Statistical Organisation.

The average Infant Mortality Rate (IMR) in India is 50. The table below has the top 5 states and the 5 states with the worst IMR.

Source: Family Welfare Statistics, Ministry of Family and Health Welfare, 2011.

Kerala once again has the lowest figures with an IMR of 12 while Madhya Pradesh is the worst performer with an IMR of 67.

Missing The MDGs?

It’s useful to contrast what has been achieved in India with the United Nations’ flagship programme Millennium Development Goals.

The Millennium Development Goals lay considerable importance to Under 5 Infant Mortality rates (U5MR) and features it as an important part of its Goal Number 4 (also includes children immunisation against measles). UN’s target for U5MR is 42 and for IMR is 26 by 2015.

The Central Statistical Organisation, which monitors MDG’s statistics, declares in its Country Report, 2011 that as many as 20 out of 29 States and UT’s are going to miss their MDG targets by 2015.

If the present trend continues, India will have a U5MR of 54 by the end of 2015, which is 12 points short of the prescribed target of 42. India’s IMR will most likely be 44 by the end of 2015, which is far away from the MDG target of 26.67 by 2015.

However, from the table it is clear that many states have already achieved the U5MR. They include Kerala, Tamil Nadu, Maharashtra, West Bengal and Delhi. As per CSO estimates, the state of Jammu and Kashmir and Sikkim may join these achievers by 2015. At the same time states which are surely going to miss the target for 20 or more percentage points are Arunachal Pradesh, Assam, Madhya Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Orissa, Rajasthan, UP.

When it comes to IMR, Kerala has already achieved the target. Tamil Nadu, Delhi, Maharashtra, Punjab and West Bengal are close.

India's health track record overall is weak. Funds earmarked for schemes like the NRHM itself have disappeared thanks to widespread corruption, notably in states like Uttar Pradesh where a Rs 10,000 crore scam is being investigated.

Bengal's performance (clearly better than other states) and the spotlight on child deaths in hospitals should serve to highlight the larger problems in healthcare infrastructure rather than one state's problems.