Gujarat's six districts among 42 India's laggard ones: 'Very slow fall in under-5 mortality'

By Rajiv Shah
A high-level study, carried out by a group of scholars led by Prof Usha Ram of the Centre for Global Health Research, St Michael’s Hospital, University of Toronto, “Neonatal, 159 month, and under-5 mortality in 597 Indian districts, 2001 to 2012”, has found that Gujarat’s six districts figure among 42 of India’s top laggard districts showing very slow fall in under-five mortality rate (U5MR). Published in Lancet, the reputed international health journal, the study shockingly suggests that two of the six districts has majority tribal population – Dahod and Valsad – while the rest have tribal population but not in majority. Gujarat accounts for nearly 15 per cent tribal population.
U5MR is the sum total of child mortality under two different categories – neonatal mortality rate (NNMR), based on infant mortality of less than one month old, and the mortality rate of children between one month and 59 months (1-59mMR). The 42 districts out of 597 Indian districts chosen by the scholars are those which have reduced U5MR by two or less than two points per year per 1,000 live births between 2001 and 2012.
The “laggard districts” of Gujarat are Valsad, which could reduce the U5MR from 59 per 1,000 to 56.8, or by a 0.3 per annum; Panchmahals, from 83 to 84.9, or by 0.8 per annum; Sabarkantha from 79 to 70.0, or by 0.9 per annum; Dahod from 105 to 83.6, or by 1.9 per annum; Amreli, from 59 to 46.2, or by 2.0 per annum; and Vadodara, whose U5MR went up from 73 to 73.6, increasing by 0.1 per annum.
Significantly, Panchamahals, Sabarkantha and Vadodara were split in the recent past to carve out separate districts, hence the percentage of tribal population in these districts has considerably come down. Further, the data suggest that Vadodara is one of the three districts in India whose U5MR increased – the others being Raichur in Karnataka (where the per annum rise was to the tune of 0.1) and Jorhat in Assam (where the per annum rise was to the tune of 2.6).
Equally significant is the fact that India’s average U5MR in 2001 was 81.1 per annum every 1000 live births, which went down to 47.2 in 2012, suggesting a fall of 3.08 per annum. As against this, Gujarat’s U5MR, which was 73 per 1000 live births in 2001 fell to 52.2 per 1000 live births, or by 2.6 per annum, which is less than the national average.
The scholars’ further analysis suggests that, as for neonatal death rate (NNMR), Gujarat experienced a rate of 29 per 1000 in 2012, which is higher than eight states -- Kerala 7.3, Tamil Nadu 15.3, Maharashtra 21.6, Karnataka 23.2, Punjab 23.4, West Bengal 24.2, Haryana 26.9, and Himachal Pradesh 27.6.
Further the analysis suggests, it is after the neonatal period that things turn from bad to worse for Gujarat’s children. The mortality rate of children between 1 month and 59 months (1-59mMR) for Gujarat in 2012 was 23.2, which was higher among all 11 states qualified as “rich” by the scholars -- Kerala (5.9), Maharashtra (11.0), Tamil Nadu (12.0), Jammu & Kashmir (13.9), Himachal Pradesh (15.0), West Bengal (15.4), Punjab (16.5), Andhra Pradesh (17.7), Karnataka (19.4), and Haryana (22.6). The all-India average for 1-59mMR is 26.6 per 1000 deaths.

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