2. Infant Mortality: Infant mortality is the death of a child less than one year of age. It is measured
as infant mortality rate (IMR), which is the number of deaths of children under one year of age
per 1000 live births.
Forms of infant mortality:
Perinatal mortality is late fetal death (22 weeks gestation to birth), or death of a
newborn up to one week postpartum.
Neonatal mortality is newborn death occurring within 28 days postpartum.
Neonatal death is often attributed to inadequate access to basic medical care, during
pregnancy and after delivery. This accounts for 40–60% of infant mortality in
developing countries.
Post neonatal mortality is the death of children aged 29 days to one year. The major
contributors to post neonatal death are malnutrition, infectious disease, and
problems with the home environment.
U5MR: The under-5 mortality rate is the number of children who die by the age of
five, per thousand live births per year.
3. Factors promoting the IMR and U5MR
Low Birth Weight
Preterm Birth,
Poor Maternal Nutritional Status,
maternal sickness during pregnancy
unhygienic home environments
teenage pregnancy,
Malnutrition in children which lead to diarrhea and dehydration, and ultimately
death.
Poor Economic Status of Parents
Environmental conditions
Gender Bias( favoring male over female)
lack of access to affordable and professional health care resources
Low Birth Spacing( The gap between births)
Educational attainment of mother
4. The infant mortality rate is also called the infant death rate. Child
mortality is a sensitive indicator of a country’s socio-economic
development. In fact reducing infant mortality is a millennium
development goal (MDG).MDG-4
Reducing Infant Mortality Rate is given high Priority in many of the
schemes and policies some of them are
National Population Policy-2000
National Health Policy- 2002
National Rural Health Mission-2005
Lets have a look on the MDG’S
5. The Millennium Development Goals (MDGs) are the eight
international development goals that were established following
the Millennium Summit of the United Nations in 2000,
following the adoption of the United Nations Millennium
Declaration. All 189 United Nations member states at the time
(there are 193 currently), and at least 23 international
organizations, committed to help achieve the following
Millennium Development Goals by 2015:
6.
7. Analysis of Achieving millennium development goal-4
REDUCE CHILD MORTALITY
Reduce by two-thirds, between 1990 and 2015, the under-five Mortality Rate
Under Five Mortality Ratio (U5MR) was estimated at 125 deaths per 1000 live births in 1990. In order
to achieve the target , the U5MR is to be reduced to 42 deaths per 1000 live births by 2015. As per
Sample Registration System 2013, the U5MR is at 49 deaths per 1000 live births and as per the
historical trend, it is likely to reach 48 deaths per 1000 live births, missing the target narrowly.
However, an overall reduction of nearly 60% happened during 1990 to 2013, registering a faster
decline in the recent past, and if this rate of reduction is sustained, the achievement by 2015 is likely
be very close to the target by 2015.
In India, Infant Mortality Rate (IMR) was estimated at 80 per 1,000 live births in 1990. As per SRS
2013, the IMR is at 40 and as per the historical trend; it is likely to reach 39 by 2015, against the target
of 28 infant deaths per 1000 live births by 2015. However, with the sharp decline in the recent years,
the gap between the likely achievement and the target is expected to be narrowed.
The Coverage Evaluation Survey estimates the proportion of one year old children immunized
against measles at 74% in 2009. Although, there is substantial improvement in the coverage which
was 42% in 1992-93, yet at this rate of improvement, India is likely to achieve about 89% coverage by
by 2015 and thus India is likely to fall short of universal coverage.
17. Initiatives of the Government of India to Control IMR
In the Alma ata declaration of 1978 the government envisaged a national goal of
achieving IMR rate 60 by 2000.In the span of 30 years IMR rate decreased from
146 to 66.
In 1977 the family planning programme was evolved into Family Welfare
Program such that Maternal and Child Health became part of Family welfare
program. The basic idea behind this was reduction in birth rates will also control
infant mortality rates and also contribute to safe motherhood.
The National Diarrhoeal Disease Control Program began in 1978.
In 1979 the Expanded Program of Immunization (EPI) was established to
provide the Tetanus Toxoid(TT) Vaccine to pregnant woman and BCG, DPT, Polio
and Measles Vaccine to children.
The Universal Immunization Program (UIP) and Oral Rehydration Therapy (ORT)
both launched in 1985. The Safe motherhood program initiated during the Eighth
plan period were the part of the family welfare program.
18. The Acute Respiratory Infection (ARI) Control program was launched in 1990.
In the early 1990 these programs (The Universal Immunization Program (UIP) ,
National Diarrhoeal Disease Control Program, The Safe motherhood program, Acute
Respiratory Infection (ARI) Control program) were integrated and strengthened to
shape the Child Survival and Safe Motherhood program (CSSM).
In 1997 the CSSM program was further expanded to Reproductive and Child Health
(RCH) program with greater focus on reproductive rights of woman.
The national Population Policy ( 2000) and national Health Policy ( 2002) addressed
the issues of child survival and maternal health and increased the outreach and
coverage of the comprehensive package of RCH services through the government
and voluntary NGO’s partnership.
In 2005 The National Rural Health Mission was launched its major aim was to improve
the availability and access to quality healthcare, especially for those residing in rural
areas, including poor, woman and children.
19. The major goals of the mission are to reduce Infant Mortality Rate( IMR) and
Maternal Mortality Rate ( MMR), Improve the universal access to public health
services such as women’s health, child health, water, sanitation,& hygiene,
immunization and nutrition and enhance the prevention and control of
communicable and non-communicable diseases.
No only some states have achieved our MDG-4 they can be seen in the following table
20. Goal Number Goal Indicator Targets by 2015 Achieved states
4 Reduce Infant
Mortality Rate
Infant
Mortality Rate
(IMR)
28 Kerala(12),Tamil Nadu(21),
Maharashtra(25), Delhi
U.T.(25)
4 Reduce Child
Mortality
Under 5
Mortality Rate
( U5MR)
42 Kerala(13), Maharashtra
(28), Punjab(38), Tamil
Nadu(25), West
Bengal(38), Delhi U.T.(32),
Karnataka( 40).
