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Death in a booming economy

IT IS IRONICAL that in the era of high economic growth rates, an unconscionably large number of women and children are dying in India for want of adequate healthcare and nutrition, earning for the country an unenviable place among nations making "slow progress" in reducing maternal and infant mortality. A few States, above all Kerala, have reduced the loss of life among women giving birth (the maternal mortality ratio or MMR) and among children in the first year of life (infant mortality rate or IMR) through socially progressive policies. The national record, however, is appalling: the MMR and the mortality rate of children in the first four weeks and before they reach ages one and five continue to mock the healthcare system. The World Health Report 2005 provides another occasion to review the performance of various States in these basic health indicators. It does little credit to an aspiring global power that 10 per cent of its 27 million children born in a year will perish before they are five years old.

The literature available on key development indicators offers strong pointers to poverty and inequities in healthcare delivery as primary reasons for high death rates among women and infants. It is widely acknowledged that the major factors that influence the health outcomes of pregnant women and newborn children are nutrition levels, access to institutional deliveries, emergency obstetric facilities, and immunisation. The National Family Health Surveys and other studies point to significant variations in the health status of pregnant women in different Indian States and social settings, with Scheduled Castes and Tribes, the urban and rural poor, and people living in the least developed States generally getting the lowest levels of care.

There can be little doubt that health policy and practice in some of the bigger States are in need of a radical transformation if they are to meet national and the millennium development goals by 2015. Medical science has progressed to such a level that virtually every death in maternity can be viewed medically as one too many. The World Health Organisation recommends that governments must provide at least one emergency obstetric and neonatal care facility for every half million population. But even progressive States such as Tamil Nadu, which is implementing a World Bank-funded health project, cannot hope to achieve such a ratio in the short term. There is a strong case for a national action plan to help the least developed States, identified all too clearly by the World Health Report, to upgrade their obstetric and neonatal facilities with Central funding — as much as it takes. For decades, many States have failed to make the most basic life-saving interventions in reproductive and child health, with calamitous human and social consequences. Making up for past deficiencies and failures cannot be contingent on international grants and loans. It must be pursued with vigour and full budgetary support.

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