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Can Maharashtra meet child mortality target by 2011? by Rahi Gaikwad

Four years ago, High Court asked the State to bring the rate to almost nil

Infant mortality rate stands at 33, two points down from 35 in 2006

Rural infant mortality at 53 has not declined since NFHS-2 done in 1998-1999

Four years ago, alarmed by the level of child mortality in Maharashtra, the Bombay High Court directed the State government to “ensure that by September 30, 2011, the infant mortality rate due to malnutrition is brought down to almost nil in tribal as well as non-tribal areas.”

Just nine months left, the State is nowhere close to meeting this target.

According to official estimates, the State's infant mortality rate is 33, just two points down from 35 in 2006, the year when the court issued the order. Whereas, malnutrition affects 40 per cent of Maharashtra's children aged below six.

Dr. Abhay Bang of SEARCH (Society For Education, Action and Research In Community Health), appointed by the High Court to a high-level committee on malnutrition, told The Hindu that the rural infant mortality rate in Maharashtra was 53, as per the National Family Health Survey-3. “It has not declined even by one point since the National Family Health Survey-2 done in 1998-1999.”

Referring to a State government affidavit of September 20, 2006 on child mortality in 15 tribal districts, Justice R.M. Lodha observed: “Is it not a slur on society that even after decades of Independence, the State is having a large number of child deaths due to malnutrition as a major contributory factor? In almost all the affidavits filed on behalf of the State government from time to time, the statement has been made that the State government is doing its best to combat child deaths, and that the welfare schemes are being implemented, but the figures that have come on record belie the claim.” (Sourced from a compilation by Human Rights Law Network.)

Data obtained from the Department of Woman and Child Development show that the percentage of children suffering from acute malnutrition has been steadily falling since 2003. However, the new World Health Organisation (WHO) guidelines, introduced in June 2010, have spiked malnutrition figures. For instance, in the tribal district of Gadchiroli, 0.51 per cent of the 98,000 children weighed were found acutely malnourished in 2009-2010. Compare this with the Monthly Progress Report (MPR) for September 2010: it shows 6.77 per cent of the more than 77,000 children weighed as severely underweight.

This is true for each of the nine districts for which data was made available. The backward district of Nandurbar, whose Tembli village came to limelight for the launch the Unique Identification Number, has 10.25 per cent of children in the severely underweight category, as per the Monthly Progress Report for September. To make matters worse, child malnutrition has increased in the district.

The percentage of acutely malnourished children in Nandurbar increased from 0.39 in 2008-2008 to 0.77 in 2009-2010. The percentage of moderately malnourished children also went up.

A series of child deaths in just one slum colony in Mumbai recently drove home the fact that child malnutrition was not a feature of tribal and backward districts alone.

“It is practically not possible to reduce malnutrition to zero, but deaths due to malnutrition can be reduced drastically,” Mr. Bang said. He referred to a disturbing thinking in the government. “Since Maharashtra is an advanced State, it had set itself a target of 20 IMR as against the target of 30 for the nation. However, at a committee meeting about a year ago, there was a suggestion from the government for [diluting] this target to 30. I had opposed it and even written to the government, but I never got any reply.”

In the recently concluded winter session of the State legislature, the issue of deaths due to child malnutrition was hotly discussed. The Opposition took the government to task for the poor implementation of the Integrated Child Development Services, and for its propensity to form dime a dozen committees.

Recently, Chief Minister Prithviraj Chavan visited Melghat in Amravati, one of the worst affected districts. “He promised that the SEARCH pattern of training accredited social health activists would be undertaken. Only time will tell how it is implemented,” Mr. Bang said.

It will also tell whether the government can comply with the court order.