The Infant Mortality in the state of Uttarakhand is a cause of concern, as the National Family Health Survey (NFHS-III), has revealed. The survey reports that the Infant Mortality Rate (IMR) of the state has in fact increased from the previous years. It is a matter of serious concern as the new state was expected to improve the health status of the people, but the Infant Mortality Rate which is a sensitive indicator of health status points towards an anesthetic state. Though the government speaks of continuing its effort towards improving the health services in the state, the next NFHS or health survey will only tell if the situation has improved.
Although the world has begun to see significant improvements in child survival, still every year, 8 million infants die, out of which three-quarter deaths happen during the first week, out of which at least 1 million infants die in their first 24 hours.
A number of report shows that 96% of all infant deaths occur in low- and middle-income countries, with two-thirds of those occurring in South-Asia and Africa only. The majority of infants die at home due to the absence of a skilled health provider’s. Complications related to pregnancy, delivery and infections cause about one-third of newborn deaths.
While diarrhoea, pneumonia, measles and malnutrition have direct impact on infant mortality, improper breast-feeding, imbalance and inaccurate complementary feeding also decrease their chances for healthy survival.
In the past two decades, there have been programs, viz. Child Survival and Safe Motherhood Program, Reproductive and Child Health Program and Integrated Management of Neonatal Childhood Illness program to improve the situation. However, irrespective of these developments the situation related to infant’s health remains a major global concern and a daunting challenge.
India is the second largest populated country in the world and one-fourth of its population lives below the poverty line and income of these families is less than Rs 50 per day (UNDP, 2004). Every year more than 27 million children are born in India and 4 million die within one year of their births (WHO, 2005) Seventy percent of children are born at home and more than 50 percent do not receive skilled birth attendants’ services. Besides this, the antenatal and postnatal services coverage is also below 50 percent.
High infant mortality in India also encourages families to have more children, which affects the mother’s health and leads to a high maternal mortality. The early age of marriages and pregnancy, large number of unplanned and unwanted pregnancy and short interval between births are the key intrinsic determinants, which also increases infant mortality in India.
It is proved by empirical studies that two thirds of deaths can be saved by providing better health information and preventative health services to the women and infant. The asphyxia, acute respiratory infection, diarrhea, tetanus, sepsis, injury and congenital defect are major causes for 80 percent of infant deaths of which more than 70 percent are preventative.
According to NFHS – 3, data on Uttrakhand, the Infant Mortality rate (IMR) is 42 per thousand live births, which is slightly higher from the NFHS-2 estimates of 38. There is a significant difference between rural and urban household. Survey shows two thirds of women delivered their child at home, and only 36% of pregnant women used health facilities.
Access to health services is the one of major issue in the state of Uttarakhand. Every year many infant deaths take place in the state, where even simple interventions do not reach the needy.
To improve matters, the first step is to assess the situation and create a policy environment for the survival of infant. The next step is to optimize care of infants within the health system. Scaling up of clinical care is a challenge but it is necessary to have minimum resources to take care of infant and maternal health.
Development of health system is also related to overall development of public amenities and social security system. To quote Amartya Sen, “an adequate engagement with health equity also requires that the considerations of health be integrated with the broader issues of social justice and overall equity, paying adequate attention to the versatility of resources and the diverse reach and impact of different social arrangements.” While we build strong health systems over the time, conscious effort to have a strong social security network for the aam admi is paramount.