Millennium goals: Top international study finds Gujarat’s performance worst among rich states in fight against under-five mortality

healthBy Rajiv Shah

A new study, carried out by a group of scholars led by Prof Usha Ram of the Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, “Neonatal, 159 month, and under-5 mortality in 597 Indian districts, 2001 to 2012: estimates from national demographic and mortality surveys”, has found that Gujarat’s performance in achieving the millennium development goal (MDG) for bringing down mortality rate of under-five children has been the poorest among the group of 11 rich Indian states. A complete study of all Indian states and their districts, the big richer states focused are – Andhra Pradesh, Gujarat, Maharashtra, West Bengal, Karantaka, Tamil Nadu, Haryana, Punjab, Jammu & Kashmir, Kerala and Himachal Pradesh. 

The scholars – who include Prabhat Jha, Faujdar Ram, Kaushalendra Kumar, Shally Awasthi, Anita Shet, Joy Pader, Stella Nansukusa and Rajesh Kumar – have found that in Gujarat, in 2012, the under-five mortality rate (U5MR), was 52.2 per 1,000 live births. This is the highest of all other richer states. In  Haryana it was found to be 49.5, followed by Andhra Pradesh’s 47.2, Jammu & Kashmir’s 44.1, Karnataka’s 42.6, Himachal Pradesh’s 42.5, West Bengal’s 39.6, Punjab’s 39.9, Maharashtra’s 32.6, Tamil Nadu’s 27.3, and Kerala’s (which is the lowest) 13.2. Significantly, Gujarat’s U5MR is higher than at least one of the nine of the poorer “focus states”, chosen by the Government of India, for achieving the MDG – Uttarakhand (51.5). The MDG target of the United Nations is 38 per live births till 2015.

In what can be considered as a strong and direct comment on its governance, the study has also found that, among the richer states, Gujarat has the highest number of districts – six (out of 26) – which, at the current pace of efforts, cannot achieve MDG of 38 U5MR per 1000 live births in the next five years.  Other districts from richer states are from Jammu & Kashmir (four districts), Karnataka (three districts), Andhra Pradesh (two districts) and Haryana (one district). Significantly, Uttarakhand, one of the “poorer focus states”, has just two districts which cannot hope to achieve MGD in U5MR in the next five years. What is equally disparaging is that, Gujarat’s annual rate of decline of U5MR between 2001 and 2012 was 2.6 per 1000 live births, as against the national average 3.7.

Under five mortality rate per 1000 live births
Under five mortality rate per 1000 live births

The Gujarat districts which will not be able to achieve the MDG over the next five years are – Banaskantha (six years), Patan (nine years), Sabarkantha (eight years), Panchmahals (nine years), Dahod (12 years), and Vadodara (nine years).  Two other districts, which are perhaps the richest in Gujarat and richer vis-à-vis most other districts of India, Anand and Kheda, too, will take another five years to achieve the MDG at their current pace – their 2012 U5MR is 59.7 and 62.2. In all, there are 222 districts in India which cannot achieve MDG in another five years, out of which 194 are in poorer states, while the rest are in the richer states, including the smaller states like Goa and Delhi which not part of focus in the study. The largest number of districts, whose lag is more than five years are in Uttar Pradesh (56), followed by Madhya Pradesh (40), Rajasthan (22), Bihar (20) and Orissa (20).

Interregional variations in U5MR are sharply visible in Gujarat. Dahod, a predominantly tribal district, tops with 83.6 U5MR in every 1000 live births, followed by Vadodara’s 73.8, Patan’s 72.7 and Sabarkantha’s 70.8. Interestingly, the lowest U5MR in Gujarat is in Surat (28.7), which is the second biggest urbanized district after Ahmedabad. Most interestingly, Tapi, also with 28.7 U5MR, is a predominantly tribal district. Yet, regrettably,  none of the Gujarat districts fall in the “best performing” districts which have registered a sharp six or more per annum decline in U5MR between 2001 and 2012 – these include 47 districts of India, 46 from the “rich” states (excluding Gujarat, of course) and one from poorer states (Dungarpur district, Rajasthan). In Gujarat, the highest decline in U5MR was registered by a tribal district, Narmada (5.1), followed by Jamnagar (4.8), Navsari (4.6), Surat (4.3), Tapi (4.3) and Kutch (four).

At the same time, Gujarat’s six districts are found to be in the list of 42 worst-performing districts by registering a decline of two or less U5MR than per annum between 2001 and 2012. These are Vadodara (0.1), Valsad (0.3),  Panchmahals (0.9), Sabarkantha (0.9), Dahod (1.9) and Amreli (2.0). What is even more interesting is that, Gujarat’s these six districts find in the company of 17 “worst performing” districts from richer states – these include Andhra Pradesh follows Gujarat with four districts, Jammu & Kashmir with two districts, and one district from Karnataka.  There is no explanation from the Gujarat officialdom as to why its performance has been so poor, and how, given these realities, Gujarat’s all districts will be able to achieve the MDG, as specified by the United Nations.

Per annum decline in under five mortality between 2001 and 2012: Variation among Gujarat districts
per annum decline in under five mortality 2001-12: Variation between Gujarat districts

The study, published in “Lancet”, the world’s leading general medical journal, has been carried out in the context of the fact that India has the largest number of child deaths of any country in the world. It says, “Worldwide achievement of the UN 2015 MDG for under-5 mortality will depend on progress in the subregions of India.” Pointing out that “under-5 mortality fell at a mean rate of 3.7 per cent per year between 2001 and 2012”, it adds, of the 222 (37 per cent) of 597 districts will be able to “achieve MDG only after 2020. These 222 lagging districts are home to 41 per cent of India’s live births and 56 per cent of all deaths in children younger than 5 years.”

The study says, “Deaths in children younger than 5 years fell in India from about 2.5 million in 2001 to 1.5 million in 2012, yet India still has the largest number of deaths in children younger than 5 years of any country in the world. India’s large population and its enormous variation in social circumstances, access to health services, and other correlates of under-5 mortality mean that national statistics mask large local variation in sex-specific under-5 mortality and how this changes over time.”  It points out,  the nine poorer states, mentioned above, contain nearly half of all people in India and just over half of all births, but 1.0 million (71%) of the 1.5 million deaths in children younger than 5 years.

The study particularly says that what is equally worrying is, “the number of districts lagging behind (in the goal of achieving the MDG of 38 per 1000 live births) has increased in the richer states of Andhra Pradesh, Gujarat, and Karnataka.” And, “only in the states of Kerala and Tamil Nadu have all districts achieved MDG.”  The study adds, “At current rates of progress, MDG will be met by India around 2020, by the richer states around 2015, and by the poorer states around 2023. Most Indian districts will only achieve the MDG for under-5 mortality well beyond 2015, and India as a whole will only achieve it by about 2020.”

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