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Subodh Varma, TNN | Jan 30, 2014, 06.25AM IST
NEW DELHI: It is well known that quality of life greatly varies amongst different states within India. Some states have greater industrial or agricultural output, higher income levels, better educational and health indicators while others are still struggling with backwardness. But what is much less known is that within states too there are wide and astonishing variations. State level averages often hide huge and unconscionable disparity on life and death issues.
Recently released data on infant mortality rates (IMR) – a key measure of health and wellbeing – shows that it varies widely within states like Maharashtra, Karnataka, Madhya Pradesh and Gujarat. IMR refers to the number of new born babies that die before reaching one year age, as a proportion of 1,000 live births. These deaths are most commonly due to treatable diseases or malnutrition. The data is part of the Sample Registration System (SRS) survey covering 7.35 million persons, conducted by the Census Office in 2012.
In Gujarat's arid districts of Kachch, Banaskantha and Surendernagar IMR is high at 51. This region is at the tail end of the Narmada waters coming from Sardar Sarovar. In contrast, the relatively better off Saurashtra region's six districts exhibit an IMR of just 31. Saurashtra is agriculturally much more advanced, and fed by Narmada waters. Gujarat's average IMR is 45, slightly higher than the national average.
Narayan Singh, a doctor at a primary health centre in Kachch told TOI that doctors' availability and access to healthcare services are two key factors that determine IMR. In Kachch, private doctors are less as the region is poor, while government centres are unable to cope with all patients. Villages are far flung and people can't reach the health facility in time.
"A single doctor in a PHC, cannot handle cases round the clock. In certain cases specialists are required. Ayurvedic doctors cannot do this kind of work," he said, explaining the higher IMR in the district.
Maharashtra has an IMR of 30, well below the national average of 42. But seven districts of the Vidarbha region have an IMR of 51, about 70% higher than the state average. In effect, Vidarbha's babies face the same future as those in Rajasthan or Uttar Pradesh, although Maharashtra state average won't tell you that. In northern Maharashtra, Nandurbar, Dhule, Nashik and Jalgaon districts have an IMR of 23 less than the state average.
Access to healthcare is only one of the many factors that will determine infant mortality, says T Sundaraman, executive director of the National Health Systems Resource Centre, which provides technical support to the government's National Rural Health Mission.
"Basic issues seem to be education, especially women's education, access to safe water and sanitation, and malnutrition. The number of health care professionals (nurses+doctors) per 1,000 population, both public and private, would also contribute to better or worse performance for a given level of education", he said.
In Madhya Pradesh, six districts of the central region which includes the state capital Bhopal have a shockingly high IMR of 70, while the Vindhya region which includes the southern Bundelkhand districts has an IMR of 68. The state average is 60, the highest in the country. Surprisingly, the South Western region of MP which is mostly tribal dominated has the lowest IMR of 46.
Karnataka's three districts in the Coastal and Ghat region have an IMR of just 16, comparable to the adjacent northern Kerala's 14. But once you move into interior Karnataka, the situation worsens – in the seven southern districts, including Bangalore, Mysore and Kolar, the IMR is 44, higher than the state average of 36.
The IMR in Rajasthan's southern and south-eastern regions which includes Kota, Udaipur, Chittorgarh, Baran and Dungarpur is 66, much higher than the state average of 54. This tribal region is arid in its western reaches but not so much in the east. In Odisha, the tribal dominated southern region, has an IMR of 68 compared to the state average of 55. In many states, variations in IMR are limited. These include lower IMR states like Punjab, Tamil Nadu, West Bengal and Kerala, and high IMR states like Uttar Pradesh and Assam.