Infant mortality in Assam

The latest SRS (Sample Registration System) data on IMR (Infant Mortality Rate) in India has nothing much to cheer about Assam. The IMR in the State continues to be quite high while the momentum of its decline has slowed down. The IMR being a key indicator of the overall health scenario in a country or a region, the State has many development goals to meet to bring it down at a faster rate to be among the frontrunner States. The IMR is the number of infants per 1000 live births, who die before their first birthday. Among all states and union territories Nagaland and Mizoram have the lowest IMR of 3 while Madhya Pradesh has the highest IMR of 46. The SRS bulletins show that Assam's IMR declined by only one point from 41 in 2018 to 40 in 2019 while the country's IMR declined from 32 to 30. Kerala with IMR 6 continues to be the only State with single-digit IMR among 21 bigger States and Union Territories including Assam. While IMR has declined by 50% in Kerala over a period of five years from 12 in 2015 to 6 in 2019, it has declined by just 14.9% from 47 to 40 in Assam during this period. Apart from Assam and Madhya Pradesh, the other two States with IMR 40 and above are Uttar Pradesh (41) and Chhattisgarh (40). A closer look at the data reveals that high IMR (42) in rural Assam compared to much less IMR in the urban areas (19) continues to drag the state and is a sign of distinct and sharp rural urban divide in overall health scenario. The Population and Women Empowerment Policy of Assam Government has set the target of brining down IMR to below 30 by 2030. The state picking up the momentum in brining down IMR over the next nine years will be important to achieve the goals. The National Population Policy of India set the IMR target to be brought down to 30 by 2010. As the target set by Assam has already been achieved in 2019 by India at the county level and many states have brought it further below this level, the state governmentreviewing its target and setting a much lower IMR in single digit by 2030 will be critical to catch up with other states. Such a revision will have to be backed by strong reforms and investment in the health sectors besides focussed efforts to achieve the sustainable development goals. Poor access to healthcare, child marriage and teenage pregnancy, poor income level of parents, prevalence of anaemia among women, premature deliveries, non-institutional deliveries, poor nutritional status of lactating mothers are some of the causes and determinants of IMR. The fifth series of National Family Health Survey reveals high prevalence of teenage pregnancy in rural Assam. The NFHS-5 survey conducted in 2019-20 brought to light that percentage of women in the age group of 15-19 years who were already mothers or pregnant at the time of the previous survey was 13.6 while 31.8 % of mothers in the age group of 20-24 years were married before eligible marriage age of 18 years. Teenage pregnancy results in poor nutritional status of infants and not just raises the probability of their death before age 1 but also puts the mother's life at risk. It is heartening to note that institutional births have significantly increased from 70.6% in 2015-16 to 84.1 in 2019-20. Institutional births in urban Assam increased to 93.5% as against the target of 95% set in population policy but is comparatively still less in rural Assam (82%) which partly explains the wide rural urban gap in IMR in the State.

The increase in the percentage of women aged 15-19 years who are anaemic from 42.7% in 2015-16 to 67.4 in 2019-20, however, poses new challenges before the health authorities and health interventions to reduce their iron deficiencies reaching out to them needs to be prioritised. Education plays the most crucial role in women's empowerment and prevention of child marriage and teenage pregnancy. The NFHS-5 data who that only 29.6 % women in Assam in the age group of 15-49 years have 10 or more years of schooling as against 77.2 % literate women in the state. This indicates high drop-out rate of girl children and calls for strong educational reforms to end the mismatch between literacy rate and educational level of women in the State. Raising the household income level is crucial factor influencing women's education. While the Assam government has been extending financial assistance to low-income household under its flagship programme 'Orunodai' and a host of other schemes and programmes, agricultural activities across the State must be remunerative to increase the household income in rural Assam. Ensuing proportionate increase in all development indices is the key to bring down IMR.