Prime Minister Narenda Modi kicked up a storm last month in the run-up to the Kerala Assembly Elections when he compared the infant mortality rate of Kerala’s Scheduled Tribe community with Somalia. The IMR figures were at the centre to the controversy because they are considered one of the reliable indicators of public health and overall development in a state.
The National Family Health Survey (NFHS-4) released by the Ministry of Health and Family Welfare offers a picture of the state of health in South India for the year 2015-16. However, data for Kerala is yet to be released. At 21 deaths per 1000 live births, Tamil Nadu has the lowest infant mortality rate (IMR) among the four southern states, while Andhra Pradesh with 35 infant deaths under the age of one witnessed the highest. The IMR of both Karnataka and Telangana stood at 28 deaths for 2015-16.
Fewer children are dying in infancy in South India and this is reflective of the overall trend in India. Although Andhra Pradesh has the highest IMR among the southern states, the NFHS-4 data shows that the numbers have dropped over 10 years from 54 deaths per 1000 births in 2005-06 to 35. Neighbouring Karnataka also has fewer infants dying from 43 in 2005-06 to 28 deaths per 1000 live births.
Across the four states, there are more infants dying in rural areas than in urban centres. Andhra Pradesh has double the number of infant deaths in rural areas compared to cities.
So, just why does Andhra Pradesh have such high infant mortality? A 2014 TOI report quoting then AP commissioner of Vaidya Vidhana Parishad, P Kanakadurga points to bifurcation of the state having an impact on the health system.
The NFHS survey found there were 99% of institutional births in Tamil Nadu versus 91.6% in neighbouring Andhra Pradesh. The numbers drop further when it comes to births at a public health facility (government centres) with 66.7% in Tamil Nadu compared to 38.3% in Andhra Pradesh. The poor numbers point to Andhra Pradesh’s sorry state of affairs when it comes to public health services.
Experts also point to factors such as nutritional status of mothers, their age, immunisation, and delayed initiation of breastfeeding impact infant mortality rate.
The NFHS data also provides an average rate of out of pocket expenditure per delivery in public health facilities. It costs over Rs 4000 for a delivery in Telangana, making it the most expensive state while Andhra Pradesh is the cheapest at Rs 2138 per delivery.
(Graphics by Akruti Rao)