While diseases and their impact on the population’s health are urgent concerns, in India even child birth and pregnancy, though not diseases, are reasons for high morbidity and mortality. India accounts for the largest number of maternal deaths in the world — an estimated 70,000 deaths in one year, or a quarter of all maternal deaths in the world. 
    Of these, almost half are caused by haemorrhage or excessive bleeding (30%) and sepsis or infection (16%), which can be reduced through effective obstetric care facilities. Even Bangladesh, no economic superpower, claims it has reduced the maternal mortality rate (MMR) from 320 per 100,000 live births in 2001 to 194 per 100,000 in 2010. In India, the MMR continues to be as high as 230 deaths per 100,000 live births. 
    Despite the Janani Suraksha Yojana (JSY), a scheme to boost institutional deliveries, just 47% of the deliveries are in hospitals or other health facilities. More than half still take place at home, of which only about 5% are assisted by skilled health personnel. The coverage of the JSY is an abysmal 13% according to the latest district level health survey. 
    Every year, 17.26 lakh children under age five die in India. Most of these deaths happen even before the first birthday as indicated by the infant mortality rate of 50 deaths per 1,000 live births in 2009. While this is an improvement from 53 in 2008 and 58 in 2005, Bangladesh has put India to shame by reducing its IMR from 102 per 1,000 live births in 1990 to 41 in 2009. 
    The government’s health setup does not manage to deliver even basic services such as universal immunization, with just 54% children fully immunized. Only 34% children with diarrhoea received oral rehydration salt (ORS) despite its proven efficacy in tackling diarrhoea. Only about a quarter of all children are breastfed for 6 months despite irrefutable evidence that it improves child survival dramatically. With such basic services and awareness lacking, it is no surprise that 50% of the children who die before they are five die within the first 28 days of birth. 
    After almost two decades of underinvestment in public health, the reiteration of the government’s commitment to the sector was marked by the launch of the National Rural Health Mission (NRHM) in 2005. Under this, the government made provisions for the huge unmet demand for preventive health services. The NRHM hired over 8.5 lakh women as Accredited Social Health Activists (ASHAs), mostly village women with minimum Class VIII education, to provide preventive health services in villages including taking pregnant women for antenatal check ups, organising immunization camps, dispensing basic drugs and educating people about hygiene practices. About 6.5 lakh have completed their training and have started work. Though ASHAs have boosted the utilisation of public health facilities in many places, the facilities themselves have not been upgraded to take the increased load.—RN