Thursday, October 10, 2013
In order to access the status of the Maternal Health and its improvement, Indicators chosen are:
1. Maternal Mortality Ratio (MMR)
2. Percentage of births covered by skilled birth attendants
3. Life expectancy of women as a ratio of life expectancy of men
4. Age specific fertility rates of 15 to 24 years girls
The Maternal Mortality Ratio (MMR) is the number of women who die from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births. The incidence of maternal deaths is too rare an event to provide a robust estimate of the MMR by sample survey method. The present estimates are available from Sample Registration System (SRS) based studies taking into account the requirement of large sample size for sub-national estimates of MMR.
The national MMR level has come down from 327 per 100,000 live births in 1999-2001 to 212 per 100,000 live births in 2007-09, registering a decline of 35.2% over a span of eight years. As the MMR for the intervening period were observed as 301 in 2001-03 and 254 in 2004-06, the direction of the fall through out in MMR shows very healthy sign of development in the Maternal Health of Indian women over the years.
Life risk in motherhood is gradually diminishing across the country mainly due to promotion of reproductive healthcare facilities through government-run programmes. From 35% deliveries attended by skilled personnel in 1992-93, the proportion has increased to about 49% in 2005-06 and 52% by 2007-08. At this rate of change, India is likely to attain 62% delivery attendance by skilled personnel by 2015.
The slow progress in skilled attendance to deliveries is mainly due to poor progress in institutional deliveries. At the all India level, the coverage of institutional deliveries increased rather slowly: from 26.1% in 1992-93 (NFHS -1) to 33.6% in 1998-99 (NFHS -2) and then to 41% in 2005-06 (NFHS -3) and 47% in 2007-08 (DLHS – 3). Off late the Government Janani Sureksha Yojana has shown a good progress in this direction in many of the under developed EAG States as revealed through Annual Health Survey (2010-11). This scheme/yojana will definitely have impact at the All-Level and next All-India level surveys would reveal the same.
Life expectancy in India shows a continuous increasing trend. From 60.3 years in 1991-95, it has gone up to 63.4 years in 2002-06. The life expectance of women in India is more than that for men. This reversal happened during early 1980’s in India. It was 60.9 years in 1991-95 for women compared with 59.7 years for men and rose to 64.2 years in 2002-06 for women as against 62.6 years for men in the same year. This is quite indicative of the healthy signs of maternal health in India.
The Age-Specific Fertility Rate (ASFR) in India shows a declining trend across different age-groups. The ASFR for the women in the age-group 15-19 years was 51.1 in 2000 which has come down to 30.7 in 2011. Similarly, ASFR for the women in the age-group 20-24 years was 218.7 in 2000 which has come down to 196.7 in 2011. This too indicates the healthy directional change in maternal health status in India.
Tuesday, October 8, 2013
Indicators we have used for the purpose are the following:
1. Percentage of the poor covered by various food support programmes
2. Micro-nutrient supplements e.g. percentage of people having access to Vitamin A, iodized salt, etc.
The National Sample Survey Office (NSSO) in the Ministry of Statistics and Programme Implementation conducts socio-economic surveys covering various subjects on regular basis. As part of the NSS 61st round during the period July 2004–June 2005, the Household Consumer Expenditure Survey was conducted on large sample basis and this was the seventh quinquennial survey on the subject. This report analysed the Public Distribution System (PDS) as a source of household consumption as also beneficiary households of four food assistance schemes of the Government of India, namely, Food for Work, Annapoorna, Integrated Child Development Scheme and Midday Meal Scheme. Thus, for indicator 1 listed above, we are considering this report.
The Midday Meal scheme benefited children from an estimated 22.8% of rural households in 2004-05, the Integrated Child Development Scheme (ICDS) benefited 5.7% of rural households, the Food-for-Work Scheme, only 2.7%, and the Annapoorna scheme for the elderly, 0.9%. In urban India, while children from 8% of households benefited from the Midday Meal scheme, and the ICDS scheme benefited 1.8% households, only 0.2% urban households benefited from Annapoorna, and only 0.1% from Food for Work.
Among household occupational types in rural India, the (mostly manual) labour households – “agricultural labour” and “other labour” – had the highest proportions of households benefiting from each of the four schemes. Similarly, in urban India, “casual labour” households had the highest proportions of beneficiary households from each of the four schemes.
Among social groups, the Scheduled Tribes had the highest proportion of Food-for-Work beneficiary households in both rural and urban India, and also the highest proportion of ICDS beneficiaries. Rural households possessing more than 0.40 hectares of land had a higher representation among recipients of benefits from the schemes than households possessing 0.40 hectares of land or less. The class of households possessing 0.41-1.00 hectares of land had the highest proportions of Food-for-Work and Midday Meal beneficiary households among six classes of rural households formed on the basis of size of land possessed. The Midday Meal scheme benefited over 10% of rural households in most State/UTs (between 18% and 33% in 12 major States).
Ration cards were held by 81% of rural households and 67% of urban households. Below Poverty Line (BPL) cards were held by 26.5% of rural households and 10.5% of urban households. Antyodaya card holders formed less than 3% of rural households and less than 1% of urban households. In rural areas, BPL cards were held by 43% of “agricultural labour” households and 32% of “other labour” households. In rural India BPL cards were held by 40% of Scheduled Tribe (ST) households, 35% of Scheduled Caste (SC) households, about 25% of Other Backward Classes (OBC) households, and 17% of the remaining households. In urban areas, however, it was the Scheduled Castes which had the highest percentage (17%) of households holding BPL cards, while ST and OBC households had about 14% each.
As many as 51% of rural households possessing less than 0.01 hectares of land had no ration card at all, while in all other size classes 77-86% households held a ration card of some type. In respect of ration cards meant for the poor, the class possessing “0.01-0.40 hectares” was the one with the highest proportion of cards for both BPL (32%) and Antyodaya (4%).
51% of households in the lowest size class “<0.01 hectares” had no ration card at all, while in all other size classes 77-86% households had a ration card of some kind. The highest proportion of households with ration cards was 86%, seen in the classes “0.41-1.00 hectares” and “1.01-2.00 hectares”. In respect of ration cards meant for the poor, the class “0.01-0.40 hectares” was the class of households with the highest proportion of cards for both BPL (32%) and Antyodaya (4%). It was followed by the class “0.41-1.00 hectares” (BPL, about 28%, Antyodaya, 3%). The bottom class “<0.01 hectares” had 22% of its members holding BPL cards, but this was smaller than the overall proportion of BPL card holders taking all classes together (26.5%). Likewise, Antyodaya cards were held by 2.7% of households in the bottom class, compared to 2.9% for all households.
Iodine is an important micronutrient. A lack of iodine in the diet can lead to Iodine Deficiency Disorders (IDD), which can cause miscarriages, stillbirths, brain disorders, and retarded psychomotor development, speech and hearing impairments, and depleted levels of energy in children. Iodine deficiency is the single most important and preventable cause of mental retardation worldwide. Iodine deficiency can be avoided by using salt that has been fortified with iodine. As per NFHS-3 (2005-06), just over half (51 percent) of the households were using salt that was adequately iodized. There was virtually no change since the time of NFHS-2 (1998-99), when 50 percent of households were using adequately iodized salt. In NFHS-3, 25 percent of households were using salt that was inadequately iodized, and the remaining 25 percent were using salt that was not iodized at all. The use of adequately iodized salt was much higher in urban areas (72 percent) than in rural areas (41 percent). There is a sharp and steady rise in the use of adequately iodized salt as the income of the household increases. Eighty-five percent of households in the highest income quintile use adequately iodized salt, compared with only 30 percent of households in the lowest income quintile.
The consumption of a wide variety of nutritious foods is important for women’s and men’s health. Adequate amounts of protein, fat, carbohydrates, vitamins, and minerals are required for a well-balanced diet. Meat, fish, eggs, and milk, as well as pulses and nuts, are rich in protein. Dark green, leafy vegetables are a rich source of iron, folic acid, vitamin C, carotene, riboflavin, and calcium. Many fruits are also good sources of vitamin C. Bananas are rich in carbohydrates. Papayas, mangoes, and other yellow fruits contain carotene, which is converted to vitamin A. Vitamin A is also present in milk and milk products, as well as egg yolks.
NFHS-3 asked women and men how often they consume various types of food (daily, weekly, occasionally, or never). Among these food groups, women consume dark green, leafy vegetables most often. Almost two-thirds of women consume dark green, leafy vegetables daily and an additional 29 percent consume them weekly. More than half of women (53 percent) consume pulses or beans daily and an additional 37 percent consume them weekly. Milk or curd is consumed daily by 40 percent of women and weekly by 16 percent of women, but 11 percent never consume milk or curd and 33 percent consume milk or curd only occasionally. Consumption of fruits is less common. Sixty percent of women do not consume fruits even once a week. Very few women consume chicken, meat, fish, or eggs on a daily basis, although more than one-quarter of women consume these types of food weekly.
The pattern of food consumption by men is similar to that of women, but men are more likely than women to consume milk or curd regularly. Men are less likely than women to completely abstain from eating chicken, meat, fish, or eggs. The last row of each panel shows the frequency of consumption of fish, chicken, or meat. Overall, 33 percent of women and 24 percent of men are vegetarians according to this measure.
Trends in percentage composition of consumer expenditure in case of an average rural and urban Indian since 1993-94
The salient features in the trends in percentage composition of consumer expenditure in case of an average rural and urban Indian since 1993-94 to 2011-12 are as below:
ü The rural Indian consumption expenditure has a downward trend for food total. It has decreased from 63.2% in 1993-94 to 48.6% in the year 2011-12. Within the food items, small increasing trend has been noticed in case of beverages, fruits and nuts and egg, fish & meat (non-vegetarian items).
ü For non-food items, obviously the trend is in opposite direction. It has increased from 36.8% in 1993-94 to 51.4% in the year 2011-12. Within the non-food items, small downward trend has been noticed in case of intoxicants including pan & tobacco and for clothing & bedding overall trend is seen to be increasing one, but with some fluctuations in both the directions.
ü The urban Indian consumption expenditure has also a downward trend for food total. It has decreased from 54.7% in 1993-94 to 38.5% in the year 2011-12.
ü For non-food items, obviously the trend is in opposite direction. It has increased from 45.3% in 1993-94 to 61.5% in the year 2011-12. Within the non-food items, small downward trend has been noticed in case of intoxicants including pan & tobacco and for clothing & bedding overall trend is seen to be increasing one, but with some fluctuations in both the directions.
The National Sample Survey Office (NSSO), Ministry of Statistics and Programme Implementation has released the key indicators of household consumer expenditure in India, generated from the data collected during July 2011–June 2012 in its 68th round survey just recently.
Some salient findings of the survey relating to monthly per capita expenditure (MPCE) based on modified mixed reference period (MMRP) are as follows:
1. The all-India estimate of average MPCE was around Rs.1430 for rural India and about Rs.2630 for urban India. Thus average urban MPCE was about 84% higher than average rural MPCE for the country as a whole, though there were wide variations in this differential across States.
2. For rural India, the 5th percentile of the MPCE distribution was estimated as Rs.616 and the 10th percentile as Rs.710. The median MPCE was Rs.1198. Only about 10% of the rural population reported household MPCE above Rs.2296 and only 5% reported MPCE above Rs.2886.
3. For urban India, the 5th percentile of the MPCE distribution was Rs.827 and the 10th percentile, Rs.983. The median MPCE was Rs.2019. Only about 10% of the urban population reported household MPCE above Rs.4610 and only 5% reported MPCE above Rs.6383.
4. For the average rural Indian, food accounted for 52.9% of the value of consumption during 2011-12. This included 10.8% for cereals and cereal substitutes, 8% for milk and milk products, 7.9% on beverages, refreshments and processed food, and 6.6% on vegetables. Among non-food item categories, fuel and light for household purposes (excluding transportation) accounted for 8%, clothing and footwear for 7%, medical expenses for 6.7%, education for 3.5%, conveyance for 4.2%, other consumer services (excl. conveyance) for 4%, and consumer durables for 4.5%.
5. For the average urban Indian, 42.6% of the value of household consumption was accounted for by food, including 9% by beverages, refreshments and processed food, 7% by milk and milk products, and 6.7% by cereals and cereal substitutes. Education accounted for 6.9%, medical accounted for 5.5%, fuel and light for 6.7%, conveyance for 6.5%, clothing & footwear for 6.4%, other consumer services (excl. conveyance) for 5.6%, durable goods for 5.3% and rent for 6.2%. Taxes and cesses account for just 0.8%.
6. Comparatively, for an average rural Indian incur more consumption expenditure in proportion on food items except fruits and beverages, medical, intoxicants, fuel and light and clothing & footwear
We normally use two indicators for assessing the status of Hunger Poverty. These two Indicators are:
1. Malnutrition in children under five years
2. Malnutrition for overall population (in average intake).
In developing countries like India, children and adults are vulnerable to malnutrition because of low dietary intakes, infectious diseases, lack of appropriate care and inequitable distribution of food within the household. Three standard indices of physical growth that describe the nutritional status of children are:
Ø Height-for-age (stunting);
Ø Weight-for-height (wasting);
Ø Weight-for-age (underweight).
As per the Third National Family Health Survey (NFHS-3, 2005-06), almost half of children under five years of age (48 percent) were stunted and 43 percent were underweight. The proportion of children who are severely undernourished (more than three standard deviations below the median of the reference population) is also notable — 24 percent according to height-for-age and 16 percent according to weight-for-age. Wasting is also quite a serious problem in India, affecting 20 percent of children under five years of age.
In NFHS-2 (1998-99), the nutritional status of children was measured only for the children under three years of age. The proportion of children under three years of age who are underweight decreased from 43 percent in NFHS-2 to 40 percent in NFHS-3, and the proportion severely underweight decreased from 18 percent to 16 percent. Stunting decreased by a larger margin, from 51 percent to 45 percent. Severe stunting also decreased, from 28 percent to 22 percent. However, the improvement in height-for-age combined with a somewhat slower improvement in weight-for-age actually produced an increase in wasting and severe wasting over time. The decrease in stunting over time was greater in rural areas than urban areas. The prevalence of underweight in children who were underweight decreased slightly more in urban areas than rural areas, but there was very little improvement in the percentage of children who were severely underweight in urban areas.
The national level official poverty lines for the base year (1973-74) were expressed as monthly per capita consumption expenditure of Rupees 49 in rural areas and Rupees 57 in urban areas, which corresponded to a basket of goods and services that satisfy the calorie norms of per capita daily requirement of 2400 kcal in rural areas and 2100 kcal in urban areas, which were considered minimum required dietary energy for healthy living. The cutoff lines have been updated for price rise for subsequent years. However, the new poverty lines thus calculated do not match the minimum dietary energy levels as expressed by the calorie norms. This may be due to the problem with price indices used for the purpose. Due to this one may say that poverty lines which are officially declared has problem of underestimation. This is revealed from the National Sample Survey (NSS) data of the 61st round (2004-05) for calorie consumption for each expenditure class. At the national official poverty lines (at 2004-05 prices) of Rupees 356 per capita per month for rural areas and Rupees 539 per capita per month for urban areas, the calorie intake works out to be about 1820 kcal for both rural and urban areas, which is much below 2100/2400 kcal norm for healthy living or food security. In fact, it is also revealed from NSS results of the previous quinquennial rounds of consumption expenditure surveys that total calorie consumption of the bottommost quartile of per capita expenditure in rural India has consistently declined since 1987-88, from 1683 kcal in 1987-88 to 1624 kcal in 2004-05. The total of calorie intake of the top quartile of the rural population has similarly declined from 2863 kcal in 1987-88 to 2521 kcal in 2004-05. The proportion of population that has dietary energy consumption below 2100/2400 kcal in India tends to rise since 1987-88 with about 64% below the norm in 1987-88 increasing to 76% in 2004-05.
According to the National Sample Survey data of the 66th round (2009-10), average dietary energy intake per person per day was 2147 Kcal for rural India and 2123 Kcal for urban India. The proportion of households with calorie intake below 2160 Kcal per consumer unit per day (80% of 2700 Kcal, a level used in NSS tabulation for comparisons) was 62% for rural and 63% for urban households in the bottom decile class. The proportion declined progressively with MPCE level. In the next decile class, it was about 42.5% in the rural sector and 45% in the urban sector. The proportion was only about 2.5% for the top 10% of population ranked by MPCE. Due to above mentioned problem of price indices, one may say with more confirmatory manner that poverty lines which are officially declared had been under estimated.
SAARC Development Goals (SDGs) are regionalized from of Millennium Development Goals, with some additional targets and indicators, for the period of five years, 2007-12. The terminal year of SDGs has been extended from 2012 to 2015 to coincide with the Millennium Development Goals.
Goal-wise complete list of indicators used in various statistical appraisals has been given as under:
SDGs Framework: Goals & Indicators
Goal 1: Eradication of Hunger Poverty
Indicator 1: Malnutrition in children under five years
Indicator 2: Malnutrition for overall population (in average intake)
Goal 2: Halve proportion of people in poverty by 2012
Indicator 1: Percentage of people living on less than 1$ per day (PPP terms)
Indicator 2: Head count poverty ratio based on nationally determined poverty line(s)
Goal 3: Ensure adequate nutrition and dietary improvement for the poor
Indicator 1: Percentage of the poor covered by various food support programmes
Indicator 2: Micro-nutrient supplements e.g. Percentage of people having access to Vitamin A, iodized salt, etc.
Goal 4: Ensure a robust pro-poor growth process
Indicator 1: Budgetary/ fiscal expenditure for pro-poor growth sectors as Percentage of GDP, and as Percentage of total government expenditures
Indicator 2: Percentage of poor covered by micro-credit and similar programmes
Indicator 3: Reduction of income/consumption inequality (Gini Coefficient)
Indicator 4: Rate of growth of employment (disaggregated)
Indicator 5: Assets ownership by poor (quantifiable indicators to be developed)
Goal 5: Strengthen connectivity of poorer regions and of poor as social group
Indicator 1: Transport connectivity for the poor in rural areas (e.g., length of rural roads, availability of boats per 1000 population, average time/distance to reach nearest road/major population centre)
Indicator 2: Communications connectivity: Percentage of people using telephone/cell Phone
Indicator 3: Percentage of rural population having access to electricity
Indicator 4: Representation of the excluded in local government
Indicator 5: Mass media connectivity: percentage of people using TV and radio
Goal 6: Reduce social and institutional vulnerability of the poor, women and children
Indicator 1: Percentage of children who are working
Indicator 2: Share of women in employment
Indicator 3: Coverage or amount of public expenditure as Percentage of GDP on Social Protection for the Vulnerable Groups
Indicator 4: Early marriage
Indicator 5: Birth registration
Indicator 6: Sex ratio at birth
Goal 7: Ensure access to affordable justice
Indicator 1: Average time required in disposal of legal disputes
Indicator 2: Access to alternate disputes resolution
Indicator 3: Access to free legal aid for the poor (marginalized group)
Goal 8: Ensure effective participation of poor and of women in anti-poverty policies and programmes
Indicator 1: Percentage of women in local governments/ parliament/ civil services
Indicator 2: Gender Budgeting
Goal 9: Maternal health
Indicator 1: Maternal Mortality Ratio (MMR)
Indicator 2: Percentage of births covered by the skilled birth attendants
Indicator 3: Life expectancy of women as a ratio of life expectancy of men
Indicator 4: Age specific fertility rate of 15 to 24 years girls
Goal 10: Child health
Indicator 1: Immunization coverage (measles can be a proxy)
Indicator 2: Under 5 mortality rate (U5MR)
Indicator 3: Infant Mortality Rate
Indicator 4: Neo-natal mortality rate
Goal 11: Affordable health care
Indicator 1: Out of pocket expenditure on health as Percentage of total household expenditure
Indicator 2: Total government expenditure on health as a Percentage of GDP
Indicator 3: Percentage of budget allocated to primary health care vis-à-vis total health budget
Indicator 4: Number of doctors per 1000 population
Goal 12: Improved hygiene and public health
Indicator 1: Percentage of population with access to safe drinking water
Indicator 2: Percentage of population having access to sanitation
Indicator 3: Policies on health education
Indicator 4: Prevalence rate of HIV/AIDS, TB, Malaria
Goal 13: Access to primary/community schools for all children, boys and girls
Indicator 1: Percentage of children having access to primary schools by distance
Indicator 2: Gross Enrolment Rate/Net Enrolment Rate
Indicator 3: Public expenditure on education in terms of GDP
Indicator 4: Gender parity at primary and secondary level
Goal 14: Completion of primary education cycle
Indicator 1: Survival rates (along with drop-out)
Goal 15: Universal functional literacy
Indicator 1: Adult literacy rate
Goal 16: Quality education at primary, secondary and vocational levels
Indicator 1: Percentage of trained teachers
Indicator 2: Students teacher ratio
Indicator 3: Percentage of schools with toilets for girls
Goal 17: Acceptable level of forest cover
Indicator 1: Percentage of forest cover
Indicator 2: Percentage or extent of community/social forest
Goal 18: Acceptable level of water and soil quality
Indicator 1: Chemical fertilizers/ pesticides consumption per ha of arable land
Indicator 2: Percentage of contaminated wells/water sources
Goal 19: Acceptable level of air quality
Indicator 1: Carbon dioxide emissions
Indicator 2: Particulate matter in the major metropolitan centers
Indicator 3: Percentage of firewood in total energy mix
Goal 20: Conservation of bio-diversity
Indicator 1: Percentage and number of protected areas out of the total land area
Indicator 2: Number of protected species
Goal 21: Wetland conservation
Indicator 1: Number and Percentage of protected wetland/Ramsar sites
Goal 22: Ban on dumping of hazardous waste, including radio-active waste
Indicator 1: Solid waste generation per capita
Indicator 2: Percentage of waste treated
Indicator 3: Regulatory framework for hazardous waste treatment in place
While the SDGs express the regional will for a comprehensive and strategic response to the problem of poverty and social development, the formulation of specific targets and indicators for these goals were left to be carried out at the individual country level.