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MP Reports A Child Death Every Five Minutes, Maternal Death Every Hour

By Anil Gulati

15 May, 2007

Madhya Pradesh is a second largest state which lies in the central region of India . It has a population of about 60.38 million people (re :census 2001) in its forty eight district spread across an area of 308,000 square kilometers. About 20 % of its population is tribal and majority of its population lives in rural area. Human development indicators of the state point out an urgency of the need of the state to bring intensive focus on survival of women and children of the state and their care. It is said that first three years of life play a critical role are a best start to a child's life, probably an area which needs attention in the state.

As per the latest National Family Health Survey Madhya Pradesh have highest rates of malnutrition among children. 60.3 % of its children in the age group of 0 – 3 years are under nourished. Though steps to improve the systems and respond to the situation are being made but probably with an issue like this which impacts survival need to save lives is immediate. State has 69, 238 approved integrated child development centre but only 49, 806 are functional. Integrated Child development centers, commonly known as anganwadi centres provide nutritional support to children, monitor its growth, provide immunization and others services to pregnant women and children including pre school education to child and counseling on right care practices to pregnant mother. But when thousands of these child care centres are not even functional indicates that we have been missing on reaching out to thousands of children in the state. One of its districts Sheopur was called 'World's hotspots of malnutrition' by a Joint Commission of Enquiry which was set up by Supreme Court Commissioners on the ongoing public interest litigation on the issue of right to food and malnutrition in the country.

State also has highest infant mortality rate in the country. At present infant mortality rate is 76 infant deaths per thousand live births - meaning out of every one thousand children born seventy six die even before their first birth day. If we calculate on an indicative terms this means that approximately every four to five minutes a child dies in the state of Madhya Pradesh. Even deaths rate within first month ( i.e. neo natal mortality rate) is also very high in the state and, which along with Uttar Pradesh and Bihar contributes 15 % of global neo natal mortality rate. As per Lancet 'child survival series' titled as Where and why are 10 million children dying every year? by Prof Robert E Black , Saul S Morris and Jennifer Bryce states that more than 10 million children die each year, most from preventable causes and almost all in poor countries. Six countries account for 50% of worldwide deaths in children younger than 5 years (which includes India), and 42 countries for 90%. The causes of death differ substantially from one country to another, highlighting the need to expand understanding of child health epidemiology at a country level rather than in geopolitical regions. Other key issues include the importance of under nutrition as an underlying cause of child deaths associated with infectious diseases, the effects of multiple concurrent illnesses, and recognition that pneumonia and diarrhoea remain the diseases that are most often associated with child deaths. Research studies point out that colostrum and exclusive breastfeeding till six months of age play a role in combating under nutrition and decreasing infant mortality. Even though breastfeeding is common in India and the state but only 14.6 % children are exclusively breastfed in Madhya Pradesh. 60 % of its children in the state under one year of age are not even fully immunized.

40 % of women in the state are said to have low body mass index or are under nourished and adolescent and women have high rates of anemia. State falls amongst six states in India which contribute maximum to maternal morality ratio in the country. It has maternal mortality ratio of 370 maternal deaths per one lakh live births, meaning a women dies every hour in the state while she gives birth to a new life or within 42 days after delivery. T he medical reasons could be many like hemorrhage, sepsis, unsafe abortion, obstructed labor, hypertensive Disorders. But importantly it is about providing basic facilities in rural areas including those at the time of delivery. Many underlying factors like anaemia, poor food quality, low status of women, and accessibility of medical facilities or high cost of private medical facilities due to unavailability of the state medical facilities contribute immensely to the above medical reasons and maternal deaths.

No doubt issue of survival of women and children are extremely crucial in the state of Madhya Pradesh - an area which needs most urgent attention in the state. State has recently announced many schemes, measures to combat the situation, results of which are coming but when need is such grave and with implementation glitches of such measures are immense coupled with weak infrastructure probably we may need to think differently, effectively but with keeping local perspectives in mind not just replicate successes elsewhere. Women and Children need highest focus in the state and not only by one or two departments, but by all Ministries. Monitoring of the situation should be part of all decisions and discussions which happen in all Ministries and in all the arenas of the state right from political debates, cabinet discussions, civil society and media debates and all decisions in this regards should get highest attention.

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