Given India’s dismal spending on health care, it doesn’t come as any surprise that maternal and child health levels in the country are abysmal. It was only last year that the Prime Minister’s office directed the Planning Commission to boost public health-care spending from a paltry 1.4 per cent of GDP to 2.5 per cent. The new figure still leaves India at the bottom of the pile; it has the lowest public expenditure on healthcare as a proportion of GDP among all the BRICS nations, and among the lowest in the world.
The sheer size of India’s economy means that in concrete terms, the actual amount might not seem particularly low — but looking a little deeper at per capita government spending on health gives a clearer picture, working out to about $43 per person, whereas Sri Lanka spends $87 and China $155. Among those most vulnerable to being affected by this, naturally, are mothers and newborn children. A report released by the Census office on Friday shows that there has been some progress despite this — substantial progress, in fact, with the maternal mortality ratio (MMR) in the country declining by over 40 per cent in the past decade. But much remains to be done.
As of 2012, the MMR stands at 178 per 100,000 deaths. This is a long way off the Millennium Development Goals target of 103, meant to be achieved by 2015, a virtual impossibility at this point. Not surprisingly, the breakup shows that southern states perform considerably better than northern ones with Assam, UP and Uttarakhand performing the worst. Infant mortality, meanwhile, stands at 42 deaths per 1,000 live births. But both these statistics are somewhat misleading. If one were to factor in the women who suffer long-lasting illnesses after childbirth and the children who die in their first year or so, the picture would be substantially grimmer.
Working out the measures that need to be taken isn’t rocket science. They fall into two broad categories. The first is medical infrastructure: 70 per cent of maternal deaths in the country are preventable and caused most commonly by heavy bleeding and high blood pressure. These are eminently treatable if the infrastructure is up to it. It simply isn’t. The single biggest giveaway is that the number of institutional births — those taking place in hospitals — remain below par in northern states. Although government programmes and policies such as Janani Shishu Suraksha Karyakarm have helped in that regard, there is a linked problem at work here. Simply ensuring that the child is born in a hospital is not good enough; the hospital should also have staff and facilities of a sufficient standard. This is often not the case.
The second category is socio-cultural. Simply put, MMR and child mortality rates can be brought down only when early age of marriage and, consequently, early childbearing are tackled. As matters stand now, 47 per cent of girls are married before they turn 18. Toss in lack of education and empowerment leading to repeated childbearing and lack of nutrition — 36 per cent of Indian women are malnourished and 55 per cent anaemic — and it’s a recipe for disaster. Over the past decade or so, the government has shown that it finally recognises the extent of the problem, at least. Now it must move to build on the gains shown in the Census report.