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Orissa plagued with highest Infant Mortality

"Since infant mortality often serves as a key development indicator and that reflects the combined impact of various programmes implemented for socio-economic development of people, Orissa's high infant mortality rate has a greater significance."

HNF Bureau : June 29, 2007

Running ahead in terms of attracting investments for industrialisation, Orissa is lagging behind all in terms of controlling Infant Mortality as it has the highest infant mortality rate in the country. IMR in Orissa was at 97 per 1,000 births as per the National Family Health Survey 1999 which has come down to 70 per 1000 live births (LB) last year, as said by a senior medical Officer. However, the figure is yet higher than the figure of 60 per 1000 LB as targeted to achieve by 2005.

About 86,000 infants die in the state every year because of poor healthcare facilities for mother and child, malnutrition and lack of awareness although government is talking high about its Reproductory Child Health (RCH) campaign that is being pursued across the state and the functioning of Infant Mortality Reduction Mission (IMRM). So government's claim of reducing Infant Mortality Rate (IMR) to 30 per 1000 LB by 2010 seems to be an high sounding but absurd dream.

Infant mortality is a serious problem in the tribal populated districts of Orissa. The majority of infant deaths occur in the drought-prone regions of Kalahandi, Bolangir, Koraput, Phulbani and Keonjhar, which are also malaria endemic zones. Pregnant women from these parts experience a variety of medical problems ranging from malaria, maternal anaemia and morbidity to abortion, stillbirth, pre-term and low birth weight (LBW) babies and intra-uterine growth retardation. Pregnant mothers of most of the tribal families are unable to get adequate and proper food during their pregnancy as the other family members are not aware or economic condition of the family doesn't permit to spend specially on the food of one particular member.

The other major problem is accessibility to the healthcare facilities extended by the government. Most of the PHCs are located in towns that are 10 - 15 kms. away from many tribal villages. So visiting for regular check up is the most inconvenient thing for the whole family.

Despite several programmes already in place for women and children, Orissa continues to be plagued by high levels of infant mortality. Orissa's IMR is not only higher than the national average of 60 per 1,000 live births as calculated in the 2003 family health survey report, it equals the average IMR in Sub-Saharan Africa. Over 60% of infant deaths occur at the neonatal stage in the first month of life underlining the poor reproductory health and inadequate newborn-care facilities provided in the state. The main causes of infant death in Orissa are poor maternal health, low birth weight, malnutrition, infections and diseases such as diarrhoea and malaria.

Since infant mortality often serves as a key development indicator and that reflects the combined impact of various programmes implemented for socio-economic development of people, Orissa's high infant mortality rate has a greater significance. Poverty and lack of basic infrastructure facilities like roads and transportation, especially in the interior villages, makes the existing healthcare services inaccessible to many.

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Interventions by the government departments in partnership with voluntary organisations have achieved a little only since critical areas such as the protection of ante-natal lives and infants against malaria, and the improvement of newborn-care services are yet to be addressed.

Only 22.6% of births in Orissa are institutional where as in Kerala, which has the lowest IMR (14 per 1,000 live births) figures in India, almost all deliveries take place in hospitals and private clinics. As per the NFHS report, relatives and untrained persons attend nearly 66.5% of births in Orissa. State's low institutional delivery rate is mainly due to lack of physical access to Hospitals or Maternity Centres, poor health care facilities and, above all, the costs involved in purchasing drugs and undergoing treatment. While many healthcare centres in rural areas manage without regular doctors, lack of proper facilities like hygienic labour rooms and a shortage of medicines and equipment prevent existing doctors from pursuing the essential line of treatment.

Orissa has 1,351 PHCs and 180 hospitals. But, only one-fourth of households across rural Orissa (28%) are having a government healthcare provider within a kilometre of their residence. As per a recent study conducted by the Public Affairs Centre on the state of Orissa's public services, the location of the nearest healthcare centre is a critical element that should taken seriously and addressed.

Another fact that leads to the growth of IMR is high death rate of pregnant mothers in Orissa that is at 360 per lakh, much higher than the national average of 301. Kerla has been the most successful state in controlling maternity death rate at 16 per lakh.
The discriminatory social status of women in Orissa also have a negative impact on child survival. Girl-children, from the age of one month to five years, experience a higher level of child morbidity and mortality than boys. They also receive less attention regarding healthcare and food. Though in the first month, congenital and other causes increase mortality among boys, after one month of age, environmental and behavioural factors including care-seeking behaviour during illness are disadvantageous to girl-children. One of the most significant detrimental outcomes of low birth weight is growth retardation in young girls, perpetuating a cycle of female malnutrition through adulthood and into the next generation.

Although the government-sponsored ICDS (Integrated Child Development Scheme) has managed to generate greater awareness, the effects have been far from expectation. Although anganwadi workers (AWWs) play a major role in persuading pregnant women, adolescent girls and their family members to access healthcare facilities, they and other ICDS staff are not trained or equipped to guide people for proper care of LBW babies or sick newborns.

In Keonjhar district, where large scale opencast mining is the major business, dust pollution is the primary reason for infant mortality. There is considerable variation in the IMR for different parts of Orissa. The causes of infant deaths are different in different regions in Orissa. So the need of time is a district-specific action plan.



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