Infant Mortality Rate

IIT DELHI
Infant Mortality Rate and
Malnourishment
Satna, Madhya Pradesh: A Case
Study
HUC 722
Under the guidance of Prof Kamlesh Singh
Submitted by:
Avinash Singh Bagri
2009MT50541

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Infant mortality rate (IMR) & Malnourishment in Satna
Index
Abstract 3
Introduction 4
o Key Facts 6
o Main Focus 7
Literature Survey 8
o Worldwide Presence 8
o India among the world 12
 Key Facts 12
 Demographics 14
o IMR Case Study Satna 15
 Neo Natal Mortality 16
 IMR and Malnutrition- Broader Aspects 17
Methodology 20
o Participants 20
o Tools 21
o Procedure 22
o Analysis 22
Results and Discussions 24
o Pointing out the malnourishment 24
o Surveys/Methods to figure out IMR and Malnourishment 24
o Reasons behind high IMR and Malnourishment 25
o Suggestive Steps 36
o Directions for future Study 39

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References 41
Annexures 42
o Questionnaire I 42
o Questionnaire II 44

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Abstract
This report briefs about the condition of Infant Mortality Rate and
Malnourishment in Satna (Madhya Pradesh) with the help of
various available data from the government accompanied by media
reports, non-governmental organisations and surveys. Using the
information from well-known organisations like UNICEF, WHO,
World Bank, definitions and key facts were stated to draw a parallel
between the situation in the world and Satna. While infant
mortality rates have dropped across districts over past ten year
period, there still remains a lot of heterogeneity across districts and
hence across the states. One of such cases is Satna. It still has an
IMR above than any other state in India and most of the countries
in the world. The report starts with reviewing the overall status of
IMR and malnourishment across the globe followed by an overview
on Indian condition. Finally the study is confined to Satna by
mentioning stats made available by the Government of MP. Then to
go further down in the matter, two surveys meant for two different
classes of the people namely “WCD (Women and Child
Development) officials” and “non WCD officials” were carried out.
After the surveys the data was summarized and various
factors/reasons are pointed out. Then, the steps are suggested
which could help in curbing this drastic increase in IMR and
malnourishment in the district. It is notable that the views of
officials and public are given considerable weightage in the report.
Finally with the help of inputs I got from the officials I have
formularized how future study in this direction could be directed.

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I. Introduction
Infant Mortality Rate is certainly amongst the most significant
indicators of the general level of health of a given person or may be
a community. It is a measure of the yearly rate of deaths in children
less than one year old. As per the UNICEF, Infant Mortality Rate is
defined as:
“The probability of dying between birth and exactly one year
of age expressed per 1,000 live births.” (UNICEF, para.2)
In the similar terms World Bank term Infant Mortality Rate as:
“The number of infants dying due to any reason before the
age of 1 year, per 1000 live births in a given year. This rate is
often used as an indicator of the level of health in a country.
In general words it is termed as the number of deaths of
babies below one year of age per 1,000 live births.
Therefore, the rate in any given place or region is calculated
by dividing the total number of new-borns dying under one
year of age by the total number of live births during the year,
followed by multiplying with 1,000.” (Mortality rate, WHO,
2011, para. 1)
The infant mortality rate is also known as the infant death rate (per
1,000 live births). It is generally divided into two categories, i.e.
neonatal deaths and post-neonatal deaths. “Infants dying under 28
days of age constitutes to neonatal death whereas post-neonatal
deaths are those deaths occurring in infants older than 28 days but
lesser than one year of life” (Last, 2001).
All the three rates i.e. Infant mortality rate, neonatal death rates
and post-neonatal deaths rates are computed with respect to per
1000 live births within a given period in a particular region.

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The infant mortality rate (IMR) indicates the state of child’s health
and overall development in countries. Better sanitation, clean
water, improved nutritional measures and easy access to health
care have contributed heavily in improving infant mortality rates in
those regions which were impoverished, undernourished and
unclean. In developing and under developed nations, IMRs are on
the higher side because these basic requirements for infant survival
are scarce or unequally distributed. Diseases which are
communicable and highly infectious are more common in
developing or under developed countries as well, though proper
nutrition and solid sanitary practices would do a lot to prevent
them.
According The World Health Organization (WHO) 7 out of 10
childhood deaths in developing countries are because of five main
causes. Those are: pneumonia, diarrhoea, measles, malaria, and
malnutrition—the latter has been greatly affecting the rest.
Malnutrition or Malnourishment has been associated with a
decrease or reduction in immune function of the body. A paralyzed
or weak immune function often gives birth to an increased
susceptibility to various sorts of infections. It is a well-established
fact that infections, no matter how mild, have adverse effects on
nutritional status. Conversely, almost any nutritional deficiency will
diminish resistance to disease. Despite the United States spending
more per capita on health care than any other country, 33 nations
have better IMRs. Some countries have IMRs that are less than half
the US rate: Singapore, Sweden, and Japan are below 2.80.
According to the Centres for Disease Control and Prevention (CDC)
(Miniño, 2010), “The relative position of the United States in
comparison to countries with the lowest infant mortality rates
appears to be worsening.”
There are several factors that affect the IMR of any given region or
country, for example; preterm births, immunization. Every year, an
estimated 15 million babies are born preterm (before 37 completed
weeks of gestation), and this number is rising. An estimated 1.1

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million babies die annually from preterm birth complications.
Preterm birth is the leading cause of new-born deaths (babies in the
first four weeks of life) and the second leading cause of death after
pneumonia in children under five years. Three-quarters of them
could be saved with current, cost-effective interventions, even
without intensive care facilities. Across 184 countries, the rate of
preterm birth ranges from 5% to 18% of babies born. Preterm
babies have a higher risk of complications that could lead to death
within the first year of life. Apart from this nations differ in their
immunization requirements for infants younger than 1 year. In
2009, five of the 34 nations with the best IMRs required 12 vaccine
doses, the least amount, while the United States required 26
vaccine doses, the most of any nation.
Key facts
As per the official figures available released by WHO (2011):
According to 2010 figures every year around 7.6 million children
under the age of five die.
Most these early child deaths are because of conditions those
could be avoided or cured or may be prevented with access to
simple, affordable interventions.
Leading causes of death in under-five children are pneumonia,
preterm birth complications, diarrhoea, birth asphyxia and
malaria. About one third of all child deaths are linked to
malnutrition.
Children in low-income countries are about 18 times more likely
to die before the age of five than children in high-income
countries.
Nearly 10 million children under five died worldwide in 2006,
according to a new report. That is a daily rate of 26,000 deaths.

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The United Nations Children’s Fund (UNICEF) has used the latest
data available (2006) on the under-five mortality rate for every
country in the world. The rate is expressed as the number of
children dying before their fifth birthday per 1,000 live births.
Main Focus
As per the data available on the webpages on different sections, of
WHO, it’s clear that infants belonging to following classes are more
endangered than the rest.
Geographic
Out of all the deaths across the globe most of them occur in regions
of Africa and South-East Asia i.e almost 70 % of it. Within the
countries, it is noted that infant mortality is higher in rural areas,
especially the poorer families.
Neonates
More than three million babies die every year in their first month of
life and a similar number are stillborn. Within the first month, one
quarter to one half of all deaths happens within the first 24 hours of
life, and 75% occur in the first week. The 48 hours immediately
following birth is the most crucial period for new-born survival. This
is when the mother and child should receive follow-up care to
prevent and treat illness.

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II. Literature Survey
Worldwide Presence
Over the years countries suffering with high infant mortality rate
have had major success against it, but mostly they are the
developed countries. Under developed or developing countries of
Africa and Indian sub-continent continue to suffer with the tragic
high numbers of Infant Mortality Rate.
As per the literature and data I have collected so far it can be seen
that India is not the only country suffering from it but there are
many other countries which are severely affected. Rather
surprisingly India rank lower than what is being expected after
having read the reports of various NGO’s and non-governmental
health organisation and human right groups. But while looking
around we find that among all those countries placed above India
are highly under developed then India. Moreover, it is notable that
more or less they are African countries and South-East Asian
countries neighbouring India mostly. This figure does present an
alarming situation in front of us.
We can observe them in the following table:
Country name 2007 2008 2009 2010
Sierra Leone 121 119 117 114
Congo, Dem. Rep. 115 114 113 112
Somalia 108 108 108 108
Central African Republic 109 108 107 106
Afghanistan 104 103 103 103
Mali 103 102 101 99
Comoros 67 66 64 63

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Country name 2007 2008 2009 2010
Rwanda 71 66 63 59
Malawi 69 65 61 58
Swaziland 63 59 57 55
Kenya 59 57 56 55
Gabon 57 56 55 54
Sao Tome and Principe 54 54 54 53
Tajikistan 58 56 54 52
Zimbabwe 56 54 52 51
Myanmar 54 53 52 50
Ghana 54 53 51 50
Senegal 53 52 51 50
India 52 51 50 48
Papua New Guinea 49 49 48 47
Bolivia 47 45 43 42
Nepal 47 45 43 41
South Africa 47 45 43 41
Singapore 2 2 2 2
Luxembourg 3 2 2 2
Liechtenstein 2 2 2 2
San Marino 2 2 2 2
Iceland 2 2 2 2
*courtesy: World Bank Indicators

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Above table contains only few countries i.e. the countries with
highest and lowest infant mortality rates. I have skipped the
countries lying in middle for now and will cover it later. The above
list is in decreasing number of death rate of infants in the respective
countries. It allows us to monitor the impact and spread of the
phenomenon across the globe and also gives us the glimpse which
countries have managed to reduce it over the years. Like in every
field the name of US comes up here as well. As from 1850 having a
death rate of 217 among 1000 whites and 300+ among 1000 blacks
to a meagre 7 is laudable.
Following figure depicts the Infant Mortality Rate among the
developed countries:
*courtesy: Howard Steven Friedman

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Variation around the globe can be viewed in the picture shown
below:
*courtesy: Global Health Facts
It is evident from the picture that that almost whole of Africa has a
serious number of Infant Mortality Rate along with Indian sub-
continent led by India and Bangladesh and also a few countries
from the Middle East.

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India among the World
Confining our study on India I would like to quote recent decline in
figures along with the Infant Mortality Rates of various states
which beat most of the countries in the world. According to an NGO
“Save the Children” indulged in saving the children, every 15
seconds one infant dies in the country which amounts to more than
4 lakh infants’ deaths in the first 24 hours of their life. As per the
report, 90 per cent of deaths are because of deadly yet curable
diseases like pneumonia and diarrhoea. Moreover
malnourishment/malnutrition is also cited as one of the major
reasons which contribute heavily in increasing the Infant Mortality
Rate.
Key Facts
The UNICEF (2012) in their Indian homepage points out:
Averting neonatal deaths is pivotal to reducing child mortality.
The New-born period is the period starting from birth and
continues throughout 28 days of life.
Neonatal mortality rate (mortality in the new-born period)
stands at 35/1000 lives births, and contributes to 65 per cent of
all deaths in the first year of life.
Between 2004-2008, neonatal mortality has moved from
37/1000 live births to 35/1000 only.
56 per cent of all new-born deaths occur in five states: UP,
Rajasthan, Orissa, MP and Andhra Pradesh.
Three major causes contribute to about 60 per cent of all deaths
in the new-born period: pre-maturity and low birth weight, birth
asphyxia and infections.

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The high mortality rate also reflects the position of India in “public
health spending” as it ranks 171 out of 175 countries in the world.
What is worse, it's the state in which the child is born that decides
how long he would survive.
Following figure shows state-wise distribution of Infant Mortality
Rate in India:
*courtesy: MapsofIndia
From the figure we can see the cluster in Northern-Central part
having the worst IMR as compared to others. Uttar Pradesh leads
the charts by having rate of 96 deaths in 1,000 births, closely

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followed by Madhya Pradesh at 94, Orissa at 91 and 85 in
Rajasthan. It is notable that these parts of India have significant
number of tribals and economically undeveloped population.
Demographics
*courtesy: Indexmundi
In the figure above we can see the changes in IMR in last decade. As
we can see in 2008-09 India touched its lowest at 30 but again in
2010-11 it rose to 47.57 again.
While looking for apparent reasons for this variance I went through
several papers and found an interesting piece. In which
Arulampalam and Bahlotra (2006) argue that:

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“Although socio-economic reasons have big role to play in
the varying IMR across the country but we can’t actually
attribute it to them only. They support it by mentioning
varying GDP across the states but the ratios of IMR were not
proportionate. Similarly, talking about the social conditions
there were not very consistency in apparent reasons except
son-preference. Apart from them demographics covariates
have the major role to play in varying IMR among the states”
(P 31).
In order to improve health standards and get the IMR under a
proper check NRHM has laid down various blue prints. The NRHM
has set its aim to reduce the infant mortality from 50 to 30 per
1,000 births by 2012 and the ICDS programme focuses on providing
nutrition supplement to children under the age of five.
Shireen Miller, Policy Head, Save the Children, states that:
“Highest rate of malnutrition are in four of five states in
India. Clearly the National Rural Health Mission (NRHM) and
Integrated Child Development Services (ICDS) have failed to
reach those for whom it has been designed” (Marya
Shakil, CNN-IBN, 2009, para. 4).
IMR Case Study Satna
According to first time released Annual Health survey 2010-11,
Infant mortality rate in Madhya Pradesh is 67, which is worse than
Bangladesh (41), Ghana (47), Zimbabwe (56), Myanmar (57),
Botswana (43), and other Saharan countries, and it is equal to
Ethiopia.
Panna ranks highest among all districts with 93 deaths per thousand
live births. First five districts having highest IMR are Panna (93),
Satna (90), Damoh (80), Guna & Ashoknagar (79) and Raisen (78).

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Mandla and Sidhi (37) have lowest among all the districts of
Madhya Pradesh.
The main reason for highest IMR of Satna may be because it’s
geographical location. It shares its boundaries with UP on north and
Panna (Bundelkhand) on its east. It’s pertinent to mention that
these regions are among the most backward regions and also these
borders are Dacoit marred areas. Many villages in Satna still are
predominantly feudal, have high levels of caste and gender
discrimination, and also prone to drought. It has been an upper
caste dominated, Dacoit-infested region where girl-child is very
much neglected, at times to the extent of infanticide. This region
has been in need for larger socio-political-economic intervention for
improving the status of child health indicators and malnutrition.
Distress migration due to consecutive drought in the region in last
10 years has become a regular phenomenon in the life of Satna.
Satna has an IMR of 90 which more than the IMR of almost 3/4th
countries of the world. Among them, males have an IMR of 87,
whereas the females have higher IMR with 94.
Neo Natal Mortality
According to Annual Health survey 2010-11, Neonatal mortality rate
of Madhya Pradesh is 44 which is worse than Bhutan (33), Angola
(42), Bangladesh (30), Burundi (42) and Ethiopia (36) and almost
equal to Chad and Chile (45).
As per the Annual Health Survey report (2011), Panna again ranks
highest among all districts with 66 NMR closely followed by Satna
and Damoh with 63 and 61 respectively. With comparison to other
countries Panna, Satna and Damoh ranks highest with 66, 63 and 61
NMR respectively in all over world. In rural areas the Neonatal
mortality rate is 49 where as in urban area it is 32. Out of every 10
infant deaths 6 -7 pertains to Neo Natal Deaths. Rural NMR in
districts is significantly higher than the urban.

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Satna has an NNMR of 67. If we distinguish between male and
female, it becomes 47 and 63 respectively.
Here we have to note that the rate for death of female infants is
way higher than male infants. It again put the socio-economic
situation of the district under scrutiny.
IMR and Malnutrition- Broader Aspects
In 2008 April, when Satna came in limelight for such severe cases
for infant death and heavy malnutrition, several probes were set
up. According to Right to Food campaign report
“There were at least 163 children died of severe malnutrition
in four months in four districts of Madhya Pradesh – Satna
(69), Khandwa (47), Shivpuri (32) and Sheopur (15). All the
children belonged to tribal/indigenous communities – Kol,
Mawasi, Saheriya and Korku. It was stated that MP has spent
only 0.86 per cent of its total budget through the ICDS for
children aging below six and only 1.51 per cent of the State’s
budget is allocated for the Department of Women and Child
Development. In money terms, the allocation is Rs.590 crore,
up from Rs.190 crore last year. But only Rs.222 crore has
been allocated for the implementation of the ICDS in 2008-
09 against the need of Rs.799 crore” (Mahaprashasta, The
Hindu, 2009, para.8 & 20)
All the 1.078 crore children under six years of age in the State
should be covered through universalisation of the ICDS, the
Supreme Court had ruled in PUCL vs. Union of India and others. For
this purpose, only 67,000 anganbadi centres are functional,
whereas, according to informed sources, the actual need is for 1.26
lakh centres.

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The Seventh Report of the Commissioners of the Supreme Court
states that as per Census 2001 as many as 6.6 million children are
enrolled in anganbadis run under the ICDS in Madhya Pradesh, but
only 3.89 million, or 35.9 per cent, get supplementary nutrition
from the State through anganbadis.
Satna district, where the deaths of infants were first highlighted,
presents a darker picture. Even the Women and Child Development
Department’s figure for Grade 3 and Grade 4 malnutritioned
children in 28 villages in the district is more than 4,000, but from
January to August 2008 only 435 children were brought to nutrition
rehabilitation centres (NRCs).
In the 11th edition of the six-monthly report published by
Department of WCD under the Bal Sanjeevani Abhiyan, the
government committed a blunder. The report (2007) says that:
“3,18,371 children were weighed and only 2,941 of them
were found to be malnourished. It says that the severely
malnourished in Satna district form 0.92 per cent, which
would be 2,557 children” (page 29).

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III. Methodology
In order to collect variety of data concerning the Infant Mortality
Rate, the poll was conducted on variety of crowd. It had people
from almost all parts of the society ranging from a Doctor, a
government officer to a farmer residing from backward village. I
also happened to get hold of a few reporters from local newspapers
and also members of NGO working on this very cause. I was lucky
enough to be a part of a workshop held in District Panchayat
headquarters on 25th
of October which covered all the following
issues. In the workshop my topics were raised and discussed with
zeal and due seriousness. In order to complete the survey I took a
sample of 50 persons but from different field, so that I get variety in
data depending upon thinking of almost all sections of society.
There were two questionnaires addressed for different variety of
people. Questionnaire 1 was directed towards the officials of
district administration at different levels. The questionnaire was
meant to have a policy-wise view on the problem. The questions
were framed in a way which could enable us to understand the
working of the administration in this very direction. It was intended
to know the possible reasons of high IMR according to them which
could pass our thoughts without having been looked upon.
Other questionnaire was prepared for the women and children
development officers of the district Satna and seven blocks. With
the help of the questionnaire, I intended to get the idea of how the
local factors have affected Infant Mortality Rate and the impact of
Malnourishment/Malnutrition in the region. As I had mentioned
earlier that there are some specific local reasons varying from
socio-economic causes to the geographical location of the region
which have impacted the rate immensely.
Through these short surveys I intended to get the stand of
government as well as the view of common man. After collecting

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the data from both surveys the findings are listed below. I have
tried to draw a parallel between the two different views.
Participants
There were two types of questionnaires aimed towards different
class of people. For the 1st
questionnaire I surveyed 15 persons but
they all were members of Public Health Committee Satna. Out of
which there were only 2 women and 13 men. Standard deviation of
the age of the participants in the survey was 50-55 years. Few
important names, who play important role in policy and decision
making of the district, were District President of BJP, President of
committee on WCD, Health and PHE, District Council, District WCD
officer, Chief Medical and Health officer etc. All of them took an
interactive part in the survey. Opinion of the 4th
pole of democracy
i.e. media was also sought. Editor of the daily “Nav-Swadesh” also
took part in survey.
Talking of the 2nd
questionnaire, it was meant for the general public
belonging mostly to various fields. The survey was conducted over a
sample of 50 persons only. Out of 50 participants 15 were women.
Most of them were housewives coming from different socio-
economic backgrounds. There were few exceptions as well, 4
women were playing active role in public life in different capacity
viz. Chairperson Zila Parishad, Project Officer Zila Parishad, Director
of NGO Vasundhara Mahila Mandal, etc. Most of the male
participants were graduates however women were mostly 12th
passed.
Given the socio-economic profile of the district around 70% of the
participants have a connection with the rural profile of the district.
Most of them were active in public life in different roles of vital
importance. Standard deviation of the age of the participants in the
survey was 53-55 years.
Almost 90% of the participants came from middle class background.

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Tools
Data and figures were mostly collected from internet, Economic
Survey 2012, India Year Book 2012, HUNGaMA report, few media
reports, RTI in office of Zila Panchayat and office of Women and
Child Development.
Opinions and responses were sought in form of a questionnaire.
Questionnaire comprises objective and subjective questions both.
Participants were supposed to fill the questionnaire on their own.
Few discussions with few other eminent people of the district were
also done.
During the survey, I went through minutes of meeting of committee
on WCD, Health and PHE, District Council and also attended a
workshop organized by an NGO in District Council office only. Trip
to the Nagod Block of the district which is the bordering region of
Bundelkhand region of the state was also made. Few important
public representatives of the district belonged to this Block only.
Procedure
Questionnaire was handed over to the participants. No help was
provided by the surveyor in answering the queries. No constraint
was put in answering the questions. Two types of surveys were
prepared, one for government officials i.e. those who were
expected to focus upon current official status and efforts being
made to address the problems. The other survey was meant for
people who were not a part of the government or state machinery,
for e.g. media persons, NGOs, social workers, politicians, etc.
Most of the male and female participants didn’t need any sort of
help in filling up the questionnaire however few participants
(mostly women) needed a little help in understanding the spirit of
the questions.

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The prime motive of the questionnaire was if the victims of the
problem are aware of the problem at all. And if yes, then what do
they perceive as the root cause of the issue. Was they are general
agreement on the root cause. What was the role of local factors in
aggravating a global problem? What was the role of traditional
factor like culture and norms in the problem? What was the role of
modern factors like poverty in the problem, etc? What was the level
of penetration of government run programs and schemes and their
impact?
Analysis
The data collected after the survey was analysed thoroughly and is
represented graphically. Since there were two types of questions so
the way of analysis was different as well. For example the
questionnaire 1 comprises completely of subjective and open-
ended questions, so they are analysed in more detailed and
comprehensive manner. The inputs given by the people have been
discussed and mentioned under various columns later in the paper.
Moreover, the paper tried to look into the details of the cause and
also the possible prevention which also comes later. Apart from this
there were objective questions meant to give a direction to my
study which have been analysed slightly differently. Such questions
were asked by the general public in the 2nd
questionnaire. I went
through the answers thoroughly and compiled the perceptions in
graphical way. Depending upon the type of questions, the stats are
demonstrated either through bar graphs or pie charts. Moreover,
they are followed by little descriptions as well, wherever required.
The enthusiastic participation and general perception in the surveys
indicated that the questions asked in the survey were very much
close to the actual thinking of the public especially belonging to the
rural section and also the officials. As the survey was mostly
concerned about seeking the pattern in increasing number of such
cases and the probable causes, people put in some important
points which were left out while preparing the survey. For example,

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the point of being a Dacoit prone area and its effect was not that
much evident as predicted earlier. Also, poorer areas have lesser
IMR than those areas which have a mixed blend of people i.e. not
very poor but not even middle class. But, as far as malnutrition is
concerned the case is exact opposite.
After collecting the data many new things came up in the light and
few went into the backend as they did not seem that important
afterwards. The further summarized data is mentioned in next
chapter describing all the aspects of the survey and the views of the
participating people.

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IV. Results and Discussions
After talking to the officials and getting to their views about the
problem of high infant mortality rate and malnutrition in Santa, I
tried to summarize the finding in following manner:
Pointing out the malnourishment
According to the most of the officials, they primarily point out the
malnourished infants by looking at their health. It’s pretty straight
forward as they pick those who apparently do not appear healthy.
For example if some child is thinner than he should at his age they
mark him or the children whose skeleton is visible or those who
develop some kind of disparity because of staying hungry for quite
some time. They also figure it out by holding them by their
shoulders and measuring the shoulders. After marking them, they
weigh them to ensure their prediction. When they find them falling
in the criterion they finally pen it down. That’s how they complete
their survey.
Surveys and Methods to figure out IMR and
Malnourishment
Throughout the nation the surveys at various levels are done to
collect the data in this regard. However, it is not easily accessible to
public but it can be accessed through RTI. The surveys are done at
Block level by further distributing them to Gram Panchayat level
and are mostly carried out by the “Anganbadi karyakarta” or
“Asha”. They work in local Anganbadis or dispensaries and have the
responsibility of villages’ health issues.

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Reasons behind high IMR and Malnourishment
Illiteracy:
It is rather surprising to notice that Satna has a considerably good
literacy rate. In Satna this rate is 70% which is well above national
average of 56%. But if we divide it gender wise, we can spot the
difference very clearly. Male literacy rate 76% is well clear of female
literacy rate of 62%. But, in order to make our study more justified
if we leave the city apart which has a literacy rate of 91% and go
towards the rural area the rate dips quite alarmingly. So, this
hampers the growth of the society, family and thus affects the
infants ultimately.
Poverty:
As mentioned earlier despite having slew of cement industries and
mines, Satna does not have a pleasant economic condition. People
in rural belt still depend upon agriculture for their day to day living.
The conditions around the city do not present a good picture as far
as agriculture is concerned. As discussed earlier Satna does not
have many rivers and those it has are seasonal only. So, the farmers
here depend entirely upon the heavens to rain good, but to their
bad luck it has not been fair with them over the years. As a result
they find it difficult to sustain the requirements of the family
especially the infants as they need more care. It leads to fatal
exercises of having them killed before they are born or immediately
after the births.
Lack of Sustainable Resources:
Satna lacks the resources required to create a healthy environment
for the residents by all means. As per the government officials
because of this lack of resources it becomes really difficult to help
people motivate and inspire them for better living standards.

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Talking about availability of sustainable resources required for a
decent life in the district, Mr C. P. Tiwari, Assistant Project Officer,
Zila Panchayat, Satna had this view:
“शिऺा का दय सतना षजरे भें अऩेऺाकृ त कभ है तथा ग्राभीण ऺेत्रों भें
भूरबूत ससविधाओ की कभी है|” i.e. “the literacy rate in Satna is
relatively lower than other cities and it also lacks the
sustainable resources needed for a decent life.”
Due to some unfortunate circumstances the people with extremely
low income or pay develop tendencies of giving up easily instead of
facing the situation. Killing of infants and increasing number of
feticides is among the examples of such practices. They tend to
choose this path when they feel tired of their condition and don’t
receive of kind of help needed desperately from the government to
sustain their lives.
Insufficient Health Services:
As per the survey I conducted most people feel the health services
which include hospital or dispensary or anganbadi. For that matter
Satna does not have any decent hospital either. There are two
decently big hospitals but their infrastructure lack the ability to
suffice the needs of the patients they encounter. Moreover, this
infrastructure problem grow graver with the level of hospitals, i.e.
in block level the government hospitals can’t even accommodate 10
patients simultaneously whereas anganbadi and “Samudayik
Swasthya Kendra” don’t even see the face of doctors for many days.
As a result very often there comes up the case of deaths of both
mother and child while delivering the baby.
Scarce of Nutritious and quality food:
It is a problem spread across the state. The food served in “Mid-Day
Meal” scheme run by the government of Madhya Pradesh is of
extremely low standard and consequently the children bear the

27
results in long run. Although this is a state wide problem but
increasing number of Mafias in Satna gaining control over the
distribution of food under the scheme has made the condition even
worse.
Commenting on the same point Dr. G. P. Mishra, District Ayush
(Ayurved) Officer said:
“ऩोषक आहाय सेिा ससश्रसिा की कभी से कस ऩोषण ज्मादा शभरता है।” i.e.
“due to the lack of nutritious food schemes, the
malnourishment has grown further among the children in the
district.”
Higher Birth Rate:
According to Dr Mishra “higher birth rate” across the district is one
good reason as well. He said:
“फीभायी के इराज़ की कभी, ऩोषक आहाय के अशतरयक्त ज्मादा फच्चे होना
बी कायण है।” i.e “among other reasons Higher Birth Rate is a
prominent one as well.”
On interviewing further he made some intriguing and sparkling
observations which really provide an insight to this problem. This is
quite amazing and alarming to find out that there are numerous
families which have 7-8 children. They still have the mentality that
by having more children they will have more helping hands and
eventually will help them expanding their income. But,
unfortunately this practice has proven very futile as the economy
has gotten better over the years and the number of people to feed
become more than they can afford. Apart from this there are
families which after a birth of girl child go for another child hoping
for a boy. But, if they don’t get it in 2nd
chance they tend to go
further till they get one or they get more than enough number of
girl children. In the meantime the killings of girl child happen very

28
often as the frustrated family tends to lose hope and gets worried
about feeding them in long run.
Social and traditional Values:
Satna is still very backward as far as its social and traditional values
are concerned. Like the Khap Panchayats in Haryana they have
similar way of traditional mind-set over here. The society here is
still male dominated and male biased. They still want and prefer a
male child over a female one. When a girl child is born in the poor
families, they often worry about their futures and think of the
dowry they will have to pay at the time of marriage. Talking of
marriage, people in this part see a boy as an investment. They
consider him as a commodity on whose exchange they can get
money in the form of dowry during the marriage.
Unawareness:
Unawareness is problem which is present all over the country and is
primarily a reason for the failures of all the schemes run by the
governments for the welfare of the public. Dr J. H. Pandey, District
Health Officer, Satna raised a very valid point about unawareness
among the people of Satna. It was not meant only for the people
coming from rural background but the city residents as well. He
said:
“शििस भृत्मसदय औय कस ऩोषण के िेसे तो अशिऺा, वऩछड़ाऩन बी फहसत ज़रूयी औय
उल्रेखनीम कायण हैं, ऩयन्तस भेये हहसाफ से जागरूकता की कभी बी सफसे ज़रूयी
फातो भें से एक है। क्मूहक मोजनामे तो फहसत चरामी जा यही हैं सयकाय के द्वाया,
ऩयन्तस उनका राब जनता ठीक से नहीॊ उठा ऩा यही है|” i.e. “There are very
important reasons like illiteracy, backwardness but one I would like
to point out is lack of awareness as there are several schemes being
run by the state for this very cause but people have not been aware
enough to take advantage of them.”

29
Unavailability of Clean Drinking water:
Satna, barring for winters, deals with a severe shortage of drinking
water supply. As mentioned earlier in the report the rivers in Satna
mostly have water only during rainy and following season which is
not very drinkable either. Before being utilised it needs to be
treated chemically so that it does not harm the public. But
unfortunately Satna does not have those kinds of resources and
people residing nearby them use that water anyways. Moreover,
the ground water table is pretty low as well and what’s more
concerning is the quality of water coming out from them. Actually
soil in Satna is full of minerals and also has components of lime
stones which pollute the water colossally.
Inability to accustom with modernization:
As mentioned earlier the people in Satna are socially and culturally
very traditional and tend to stick to their ancient values they find it
hard to change themselves with time. Dr Gaurav Sharma, Project
Officer, Zila Parishad/Panchayat, Satna echoed the same. He stated:
“निीनता को आसानी से आत्भसात कय ऩाने भें महाॉ के रोगो को फड़ी
ऩयेिानी आती है|” i.e. “people here find it difficult to
accustom with modernization.”
One example which comes in view cementing this thought and
which also concerns our problem is, the efforts made by state
government to limit the children per family which have been
severed and rejected out-rightly by the people. These methods are
not outrageous to say but they haven’t gone down well with the
public given their traditional and unwilling state of mind.
Regional Imbalance:
The regional imbalance refers to the difference between the farther
points of the district. For example on east side it’s fully covered
with mountains having infested by myriad Dacoits over the years

30
whereas on north-eastern part we have its boundary shared with
one of the most backward area of the state i.e. Bundelkhand. This
imbalance is apparent on the status of development of the
respective areas which directly have an effect on the status of
families residing in those parts and consequently on the problem
we are dealing with. It’s like a chain reaction; everything leads to
another and thus playing their roles in aggravating this problem.
This point was pointed out by Dr Gaurav Sharma, he said:
“सतना का ऺेत्रपर अऩेऺाकृ त फहसत फड़ा है, षजसके कायण ऺेत्रीम
असाभनता फहसत है। परस्िरूऩ छोटे छोटे गािो की ऩरयषस्तशथमा अरग
हैं औय उनको सभझना एिॊ उनका सभाधान कयना थोडा भसषककर हो
जाता है।” i.e. “Satna is a big district and hence have a regional
imbalance. Villages on farther side have diverse conditions
and it becomes difficult to manage them properly.”
These views were echoed by Mr Ashok Sen, Tehsilsdar, Amarpatan
division in a different way:
“स्िमॊ वऩछड़े होने के साथ साथ सतना फहसत वऩछड़े इराको से शघया हसआ
है| ” i.e. “Satna being a backward city itself is also surrounded
by highly backward areas like Bundelkhand, Tarai etc.”

31
Following are the observations and summary of the data I was able
to collect from questionnaire 2:
Among the “others”, most prominent was Poverty. Satna is an
industrial city per se but still large chunk of people reside in villages
and like rest of India, feed themselves on Agriculture. But, as Satna
is a drought hit area Agriculture has not been a very profitable
business over the years and its impact has been evident in
increasing IMR, feticides and malnourishment.
38%
22%
26%
14%
Reason behing high IMR in Satna
Illiteracy
Insufficient Health
Resources
Old fashioned thinking
Others

32
One question which will remain pertinent perhaps for good 20
more years is the biasedness towards the boy child. The data
collected clearly show that even after 65 years of independence
and despite all the efforts put in by all kind of state machineries
society has still not been able to weigh a girl child and a boy child
equally. In cities and may be in larger part of country this problem
might have been reduced but it has not vanished yet. Be it Haryana
or Rajasthan or even Satna. Although Satna does not see that much
amount of female feticides as does Haryana or Rajasthan but it still
remains a big problem and contributes to increasing IMR heavily.
90%
10%
Society favours boy over girl?
Yes No

33
To eradicate this problem along with other health issues the state
government has been putting in lots of efforts. There are schemes
like Janani Suraksha Yojana, Ladali Laxmi Yojana etc meant to
minimise the female feticides and casualities during delivery, but
somehow the results are not that encouraging and more than 55%
people think that these efforts are failure so far.
44%56%
Schemes by Government, a failure?
Yes
No
26%
32%
42%
Fear of Dacoits Poverty Others
Reasons behind Female feticides in
TARAI Regions

34
Among “others” there were some sparkling developments as I was
told female feticides in Tarai regions are less than those of areas
having upper caste people. According to Miss Vidya Pandey who
runs an NGO especially dedicated towards Female Feticides and
development of Infants around the district this rate is considerable
low in tribal areas like Tarai and other parts of Satna. In fact the sex
ratio in Majhgawan block which encircles this region is best among
other blocks in Satna. According to almost 20% of the people I
surveyed the lack of literacy is the main reason behind female
feticides in the region.
0
5
10
15
20
25
A little A lot Not at all Cant Say
Impact of Bundelkhand

35
86%
14%
Reason of higher IMR amongst the
poor
Lack of appropriate
health services
Delivery in a scarce
and lacking
environment
18%
15%67%
0%
Reason behind Malnourishment
Insufficient schemes Corruption Lack of Knowledge Cant say

36
Suggestive Steps:
Increasing literacy in rural areas
Literacy is a major factor in improving IMR and MMR figures. Sates
like Kerala with almost 100% literacy rate have the IMR (13) and
MMR (27) figures as good as of the North American or Scandinavian
nations whereas states like UP or Bihar has poor IMR and MMR
figures. Literacy would help in bringing a general awareness
regarding healthy practices. For e.g. as per HUNGaMa report only
9% of mothers use soap to wash their hands before taking a meal.
Government schemes like Total Sanitation Campaign (TSC) now
rechristened as Nirmal Bharat Abhiyan (NBA), Janani Suraksha
Yojana (JSY), and Janani Shishu Suraksha Yojana (JSSY) would get a
better penetration among the target group with increased literacy.
Yes No
42%
58%
Enough no. of hospitals in the locality

37
Spreading awareness and advertising government's
policies
Awareness follows literacy automatically and is a key factor to
tackle the socio-economic problems of the country. Success in
dealing with most of these problems is a direct function of
awareness among the people. 60% of all open defecation takes
place in India alone. Despite of government funding for even
private toilets penetration of TSC was not satisfactory as people are
not aware of the graveness of the matter and the scheme. While on
the other hand JSY has got tremendous success by doubling the
figures of institutional delivery from 39% to 78%. Awareness among
the people viz-a-viz the scheme and its importance was a key factor
in deciding its success. Given the importance of awareness
government started spending heavily in different awareness
programmes through various means. For e.g. advertisement of
government schemes on national TV, radio, vernacular and national
newspapers, posters on public transport, Hoardings on streets,
paintings on wall of government building like Panchayat Bhawan,
Anganbadi, school, etc. New interactive means like street-play;
IVRS, etc. are also being employed.
Providing good quality food
Quality of food provided to targeted group by state machinery
under different schemes like PDS, Antyoday Anna Yojana (AAY),
Mid-Day-Meal (MDM), ICDS etc. is not up to the mark and the
nutritional value of the food served is also not satisfactory viz-a-viz
our peers across the globe like Brazil, Mexico, etc. Improving on
these two aspects would be of a great help. It has been quoted as
one of the reasons for high IMR and low CSR by HUNGaMa as well.
Improving infrastructure in Anganbadis
We are lagging in infrastructure of Anganbadi centres and
Anganbadi workers. As per need and government regulations there
should be one Anganbadi centre/250 people but we are still pretty

38
far from achieving this figure which on ground varies from one
centre/300 to 1000 people. Number of workers required is also
almost half. Taking note of the issue government has decided to
double the number of workers in 12th
Five year plan and increased
health expenditure to tackle malnutrition and IMR.
Necessity of “Need Based Programmes”
India is a country with all type of diversity. Geographically,
linguistically, economically, culturally India is highly diverse. This
diversity leads to different social issues in a different degree or
extent in different regions. Given this diversity a uniform
centralized top-down approach can’t be practiced and we need to
move towards a bottom-up localized approach to tackle different
social evils. For e.g. Ladli Laxmi Yojana might be of great significance
for a state like Madhya Pradesh but not for Kerala or Nagaland. On
one hand main problem for malnutrition in Orissa is acute poverty
and lack of understanding of tribal culture but for regions like Indo-
gangetic problems in-proportionate allocation of resources is the
main problem. We need programmes which can cater the specific
needs and issues of the concerned community instead of some
generic approach.
Focus on Comprehensive Human Development
Social problems don’t exist in isolation and more than often are
interrelated and aggravate each other. For e.g. poverty leads to
illiteracy and illiteracy leads to poverty and thus creates a vicious
trap. Similarly, problem of malnutrition and declining sex ratio is
related with many other issues like illiteracy, poverty, existing
malpractices on the name of tradition in a patriarchal society, etc.
Understanding the crux of problem government has started to
focus on concept of Comprehensive Human Development. Million
Development Goals of UN is a major milestone in this direction.
Focus is needed on all inter-related aspects of Human
Development. Health, Education and employment opportunities are

39
key factors to decide human development. Improved education
would lead to improved awareness about the problem of
malnutrition and an increased purchasing power of common people
would help in fighting the menace of malnutrition.
Constant follow up and monitoring of health services by
Ministry/Department of Woman and Children
Development (WCD)
Ministry of Woman and Child development is the nodal ministry to
oversee comprehensive development of children. It has a major
role to play in coordinating with other concerned
ministries/departments like Ministry of HRD, Ministry of Health and
Family planning, Ministry of Social Welfare, Ministry of Tribal
Welfare, Ministry of Minority affairs etc. apart from this horizontal
coordination the Ministry of WCD also need to do vertical
coordination with different state governments and Zila Panchayats,
etc. This coordination and overseeing mechanism is imperative in
ensuring efficient execution of different schemes and eradicating
the problems. The Min. of WCD also needs to take appropriate
action on report of Woman Commission and Commission for
Protection of Child Rights. Apart from distributing resources to
different agencies ministry also has a major role to play in ensuring
accountability in use of the resources allocated.
Directions for future Study
As per the advice of the officials the study should be directed
towards the socioeconomic conditions of the district. Satna despite
being an industrial city is not as developed as one should expect it
to be. The geographical location does not support its condition
either. Satna is a drought hit area and does not have rivers either.
There are only two small rivers running across the district along
with a few streams but none of them have water for even half of
the year. So, agriculture being the mostly followed occupation is
not helped by this fact. As a result there is a grave situation in

40
villages as far as economic condition is concerned. This lead to the
drastic measure they take when faced by some severe problems.
Number of children is a part of it. Generally people in Satna have
more children than they should have in proportion to their wealth
and property. So, going in the same direction when they feel they
can’t afford more this kind of killings happen. This is not the sole
reason but is among the most prominent ones as this is a common
phenomenon across the lengths and breadths of the district and
same kind of explanation has been given by the local authorities
which seem pretty sensible too.
Given the fact that Satna has always been socially a backward place,
one may easily be convinced with the current scenario of the
district. Historically Satna is not a very rich city; it does not boast big
names or richness like other parts of India or may be even Madhya
Pradesh. So, it goes way back and ever since freedom this place has
not seen much of development despite being one of the political
and industrial hubs of the state.
Satna is one of the leading cement producers in India. It has every
big cement industry in its vicinity which in turn has had its impact
on the district. Theoretically it should give rise to myriad job
opportunities for the locals and also provide them a decent living by
buying raw products from the locals. Apart from the cement
industries Satna is hub of many limestone and few bauxite mines
but instead of giving an earning opportunities to the local they have
caused such environmental pollution which in turn as created an
uneasy ambience for living.

41
References
1. Annual Health Survey, Madhya Pradesh (2011), Census of India.
Retrieved from
http://censusindia.gov.in/vital_statistics/AHSBulletins/files/03-
Madhya_Pradesh_AHS_Bulletin.pdf
2. Arulampalam, W. and Bhalotra, S.,(2006), Persistence in Infant
Mortality: Evidence for the Indian States. Retrieved from
http://ftp.iza.org/dp2488.pdf
3. Census of India (1991), MapsofIndia. Retrieved from
http://www.mapsofindia.com/maps/india/india-map-infant-
mortality-rate.jpg
4. Demographics, Infant Mortality Rate, India (2012). Retrieved from
http://www.indexmundi.com/g/g.aspx?c=in&v=29
5. Friedman, H.S., US Infant Mortality Rate Higher Than Other
Wealthy Countries (2011). Retrieved from
http://www.huffingtonpost.com/howard-steven-friedman/infant-
mortality-rate-united-states_b_1620664.html
6. HUNGaMA (Hunger and Malnutrition) Survey Report 2011. Read on
http://hungamaforchange.org/HungamaBKDec11LR.pdf
7. Infant Mortality Rate (Total Deaths per 1,000 Live Births) (2012),
Global Health Facts. Retrieved from
http://www.globalhealthfacts.org/data/topic/map.aspx?ind=91
8. Last JM, (2001) A Dictionary of Epidemiology, 4th ed. New York,
Oxford University Press
9. Level & Trends in Child Mortality Report (2011), World Bank.
Retrieved from
http://data.worldbank.org/indicator/SP.DYN.IMRT.IN
10. Marya Shakil, CNN-IBN (2009), Infant mortality rate highest in
India. Retrieved from
http://content.ibnlive.in.com/article/05-Oct-2009india/infant-
mortality-rate-highest-in-india-report-102751-3.html
11. Mahaprashasta,A. A., The Hindu (2009), Dying of hunger.
Retrieved from
http://www.hindu.com/thehindu/thscrip/print.pl?file=2008110725
2205200.htm&date=fl2522/&prd=fline&

42
12. Miniño, Arialdi M., M.P.H., and Sherry L. Murphy, B.S (2010),
NCHS Data Brief. Retrieved from
http://www.cdc.gov/nchs/data/databriefs/db99.htm
13. Seventh Report of the Commissioners of the Supreme Court, in the
case: PUCL v. UOI & Ors. Writ Petition (Civil) No. 196 of 2001,
(November, 2007). Retrieved from
http://www.righttofoodindia.org/data/comm2007seventhreport.pdf
14. UNICEF, (2009), Basic Indicators. Retrieved from
http://www.unicef.org/infobycountry/stats_popup1.html
15. UNICEF (2011), Health. Retrieved from
http://www.unicef.org/india/health.html
16.11th edition, Bal Sanjeevani Abhiyan report (November 2007)

43
Annexures
Questionnaire I
आऩ रोग कै से ऩता कयते हैं की फच्चा कु ऩोषित है?
__________________________________________________
 (How does the government point out if the child is
malnourished?)
__________________________________________________
आऩ रोग कोई सर्वे कयर्वाते हैं क्मा एसे आॊकड़े इकट्ठे कयने के
लरए?
__________________________________________________
 (Do you perform some sort of survey to collect data in this
regard?)
__________________________________________________
अगय कयर्वाते हैं तो क्मा लििु भृत्मु दय (Infant Mortality Rate)
औय कु ऩोिण से सम्फॊलधत प्रोपोभाा मा प्रश्नार्वरी होगी, र्वो उऩरब्ध
कयर्वा सकते हैं?
__________________________________________________
 (If yes, can you please let me have the questionnaire/survey
related to IMR and Malnourishment)
__________________________________________________

44
औय अगय भुझे मह ऩता कयना है की सतना भें एसा क्मा है की महाॉ
ऩय अन्म जजरो से ज्मादा भृत्मु दय है, तो भेया अध्ममन ककस कदिा
भें होना चाकहए?
__________________________________________________
 (If I want to get into the reasons why Satna has more IMR
than any other district in Madhya Pradesh, rather India, then
in which direction shall I motivate my study?)
__________________________________________________
सतना भें कु ऩोिण बी अन्म जजरो से फहुत ज्मादा है, उसके कायण
क्मा हो सकते हैं?
__________________________________________________
 (Also Satna has more number of malnourished children then
tribal belts of Odhisha and Chhattisgarh and Madhya
Pradesh, what could possibly be the reasons behind that?)
__________________________________________________
मे सफ जानकायी आऩ रोग के से इकट्ठी कयते हैं, औय अगय उन
कायणों (कु ऩोिण औय अलधक भृत्मुदय) से सम्फॊलधत कोई
जानकायी मा षर्वस्तृत षर्वर्वयण उऩरब्ध कयर्वा सकते हैं?
__________________________________________________
 (How do you collect information/date in this regard and can
you share the detailed report of your department with me?)
__________________________________________________

45
Questionnaire II
सतना भें लििु भृत्मु दय प्रदेि भें सफसे ज्मादा है, आऩके
कहसाफ से इसका सफ से फड़ा कायण क्मा है?
a) अशिऺा
b) अऩमााप्त स्िास््म साधन
c) रूह़ििादी सोच
d) अन्म
__________________________________________________
 What could be the reason behind Satna having highest IMR?
a) Illiteracy
b) Insufficient health services
c) Traditional way of thinking
d) Others
सतना भें रडको की तुरना भें रडककमों की भृत्मु दय ज्मादा
है, क्मा हभ आज बी रड़का चाहते हैं एक रड़की की फजाम?
a) हाॉ
b) नहीॊ
 In Satna death rate of girl child is more than that of male
child, do we still want a boy instead of a girl?
a) Yes
b) No
हभाया सभाज आज बी रडको की ज्मादा इज़्त एर्वॊ देखबार
कयता है फजाम रडककमों की?
a) हाॉ

46
b) नहीॊ
 Do we still care and treasure a boy child more than a girl
child?
a) Yes
b) No
क्मा सयकाय द्वाया चरामी जा यही आिा एर्वॊ जननी सुयऺा
मोजना एकदभ षर्वपर हैं?
a) हाॉ
b) नहीॊ
 Are the Janani Suraksha Yojna and Asha Aganbari karykarta
schemes failures for the state government in this direction?
a) Yes
b) No
तयाई ऺेत्रो भें कन्मा भ्रूण हत्मा का प्रभुख कायण क्मा है?
a) डाकस ओ के डय से
b) गयीफी के कायण
 What could be the main reason behind increasing female
feticides?
a) Fear of dacoits
b) Poverty
फुॊदेरखॊड जेसे ऩीछे इराके से सटे होने से ककतना नुकसान
है?
a) फहसत

47
b) थोडा
c) वफरकस र नहीॊ
d) कोई याम नहीॊ
 Being adjacent to relatively backward Bundelkhand region is
a disadvantage?
a) A lot
b) A little
c) Not at all
d) Can’t say
गयीफो भें लििु भृत्मु दय ज्मादा होने का प्रभुख कायण क्मा
हो सकता है?
a) स्िास््म ससविधाओ का अबाि
b) उशचत भाहौर एिॊ देखयेख भें प्रसूशत न होना
 What could be the main reason of higher IMR amongst the
poor?
a) Lack of appropriate health services
b) Delivery in an scarce and lacking environment
कु ऩोिण का प्रभुख कायण क्मा है?
a) सयकाय की मोजनामे अऩमााप्त हैं
b) भ्रष्टाचाय फहसत है,षजसके कायण राब नहीॊ शभर ऩाता
c) जनता अनशबऻ है
d) ऩता नहीॊ
 What is the main reason of malnourishment?
a) Not sufficient number of schemes from government

48
b) Corruption, which hinders public to take advantage of such
schemes
c) Lack of knowledge among the people
d) Can’t say
आऩके कहसाफ से आऩके इराके भें कडस्ऩेंसयी/अस्ऩतार की
सुषर्वधा आर्वश्मकतानुसाय है?
a) हाॉ
b) नहीॊ
 According to you, your locality has either a dispensary or a
hospital with enough beds to suffice the local crowd?
a) Yes
b) No
आऩके कहसाफ से लरॊग अनुऩात भें असभानता का सफसे फड़ा
कायण क्मा है?
____________________________________________
 What according to you is the biggest reason of disparity in
sex ratio?
____________________________________________
आऩके अनुसाय ऐसे कौन से कदभ उठामे जाने चाकहए जजससे
लििु भृत्मुदय भें लगयार्वट रामी जा सकती है?
____________________________________________

49
 According to you, what steps are necessary to minimize the
infant mortality rate?
__________________________________________________
कन्मा भ्रूण/लििु के उत्थान के लरए ककस प्रकाय के कदभ
उठामे जाने ़रूयी हैं?
__________________________________________________
 What necessary steps must be taken towards the
development and nourishment of girl infants?
__________________________________________________
अॊतत:, आऩके अनुसाय सतना जजरे भें फढती लििु भृत्मु दय
का सफसे प्रभुख कायन क्मा हो सकता है?
__________________________________________________
 Finally according to you, what could be the main reason
behind the increasing Infant Mortality Rate in Satna?
__________________________________________________

Infant Mortality Rate

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