Wednesday, July 11, 2012

Will India be achieving fourth Millennium Development Goal on Child Mortality?

The Target for Fourth Millennium Development Goal (MDG) is: “Reduce by two-thirds the mortality among children under five in 1990”.
Where India stand now:

India’s Under Five Mortality (U5MR) was estimated at 125 per 1000 live births in 1990 and thus target for this MDG in case of India is to have U5MR as 41.7 per 1000 live births or to reduce it by 83.3 per 1,000 live births by the end of 2015.  India’s U5MR declined from 125 per 1,000 live births in 1990 to 59 per 1,000 live births in 2010 (as per official agency estimate).
India: Under5 Mortality Rate (U5MR) per 1000 live Births
1990 (Est)
2015 (Target)
Sample Registration System, ORGI, GOI.
In another five years, U5MR is expected to further decline to 47.6 per 1,000 live births, if the trend in the entire available data is used. 
As per UNDP, India would be falling short of the target and is expected to be 70 per 1,000 live births instead of 42 per 1,000 live births by 2015.
As it is well known that India has been focusing on Child Health since 2005 through its flagship scheme of National Rural Health Mission.  If one uses the trend seen just after 2005, the achievement would be around 43.7, which is much near to the set target of 42 per 1,000 live births.   
In view of these statistics, child survival in India needs sharper focus than being attempted particularly in the higher U5MR States than national average. These States are Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh (these are not in order of priority).  These states of India are likely to fall significantly short of their respective targets. Focus should be on better managing neonatal and other childhood illnesses. The other States namely, Andhra Pradesh, Goa, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Karnataka, Kerala, Maharashtra, Punjab, Sikkim, Tamil Nadu, West Bengal and other north-eastern states are likely to achieve their targets possibly even earlier than 2015.

Saturday, July 7, 2012

Will India be achieving fifth Millennium Development Goal ?

The Target for Fifth Millennium Development Goal is: “Reduce by three quarters the maternal mortality ratio in 1990”.
Where India stand now:
Maternal mortality in India continues to be a major concern given the reduced social, cultural and economic status of Indian women that inhibits them from adequate access to health facilities. Though it is a major social concern, there are no reliable estimates available on maternal mortality for early 1990’s.
The estimates available are from the National Family Health Surveys (I and II) and by the Sample Registration System (SRS) officially for few years. The average maternal mortality ratio at the national level estimated for 1998-99 in NFHS II was 540 per 100,000 live births which was higher than the previous estimate of 424 maternal deaths for 1992-93 (NFHS I). These figures are inconsistent and can not be relied upon as the sample size requirement for estimating the same is much more to have reliable estimates.  From the SRS, we have the following estimates:
Maternal Mortality Ratio (MMR) per 1,00,000 Live Births
As per UNDP, MMR for India was 437 per 100,000 live births in 1990-91.  For 1990, so we may adopt this estimate which is also consistent with NFHS I estimate.
From a Maternal Mortality Rate (MMR) of 437 per 100,000 live births in 1990-91, India is required to reduce MMR to 109 per 100,000 live births by 2015. Between 1990 and 2009, there has been some improvement in the Maternal Mortality Rate (MMR) which has declined to 212 per 100,000 live births as compared to 437 in 1990. Safe motherhood depends on the delivery by trained personnel, particularly through institutional facilities. However, delivery in institutional facilities has risen slowly from 26 percent in 1992-93 to 78.5 percent in 2010-11. Consequently, deliveries by skilled personnel have also increased at the same pace.
UNDP says that India will miss the fifth MDG target by 26 points.  But we think contrary because of the following analysis: 
If the decreasing trend depicted in the official estimates of MMR continues and this would be because of National Rural Health Mission in place in India, one may easily see that this MDG Goal would be achieved quite comfortably as the linear regression estimate for 2015 is less than 91 ( instead of requirement of 109).   Yes, it may not be achievable in respect of a few bigger states of India i.e., out of EAG States like Uttar Pradesh, Bihar, and Madhya Pradesh and these states, no doubt, are as big or even bigger than many European countries as far as number of females in the reproductive age group is concerned.