The Scheduled Castes (SCs) and Scheduled Tribes (STs) in India have historically been situated at the bottom among all the social groups on various Human Development Indicators, be it health, education or poverty status. In terms of health, these two marginalized groups have the worst Child and Maternal Health Indicators e.g. Child Mortality Rates, Proportion of Underweight Children etc.
Two very crucial reports related to Human Development Indicators of India has been released recently, one the ‘Final Country Report-Millennium Development Goals‘ (Final MDG Report) and the other the All India report for ‘National Family Health Survey (NFHS) 4 (NFHS 4 All India Report). The Final MDG Report published by the Ministry of Statistics and Programme Implementation in November 2017 contains final updated information about the achievements of India as on target years of MDGs (2015) in respect of the eight MDGs related to health, education, poverty reduction and gender justice etc. The NFHS 4 All India Report has been released in January 2018 which provides information on reproductive and child health, morbidity, mortality, fertility, family planning, nutrition etc.
The NFHS 4 All India Report provides information on various health indicators according to social categories while the Final MDG Report provided just an overall analysis of achievements of the total population on various MDGs, including health. With the release of NFHS 4 All India Report, inference related to Child and Maternal health of SC and ST population can be drawn emphasising on how these disadvantaged groups have performed on the targets set under MDGs relating to child health in the last one and a half decade after the adoption of MDG by India at the United Nations in the Year 2000.
The present article describes how the SCs and STs have performed on the MDG related to Child Mortality in the last one and a half decade as compared to the total population. The article also provides an account of the schemes/policies of the government which are in tune to achieve the MDG related to Child Health and the progress of SCs and STs on the same.
The Goal 4 of MDG was to ‘Reduce Child Mortality’ and India targeted to reduce its child-mortality by 2/3rd, between 1990-2015. To measure the reduction of child mortality, two major indicators were used by the MOSPI in its Final MDG Report, first Under 5 Mortality Rate (U5MR) and the second, Infant Mortality Rate (IMR). The data on U5MR and IMR related to various social groups are available through various NFHS reports. The data from NFHS 1 (1992-93) could be used as the base year and data from NFHS 4 (2015-16) can be used as the target year to understand where does the SC and ST population stands on the targets set under MDG 4.
The Under-Five Mortality Rate (U5MR) is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of five if subject to current age-specific mortality rates. The Final MDG Report states that ‘India was very close to achieving the target of the U5MR set under MDG. According to Sample Registration System (SRS) as of the year 2015, the U5MR was 43 at all India level and MDG target for U5MR was 42‘.
However, the data collected by the NFHS on U5MR for all India as well as for SCs and STs presents a different story. In 1992-93, the U5MR at all India was 118.8, for SCs it was 149.1 and for STs, it was 135.2 which according to the target set under MDG 4, should have been reduced by 2/3rd to become 40.4 (all India), 50.7 (SCs) and 56.0 (STs) respectively in the year 2015. But data from NFHS 4, shows that the U5MR, at all India level is 49.7, for SCs 55.8 and for STs 57.2 respectively. The reduction in U5MR was maximum for SC population (93.3 points) followed by ST (78 points) and total population (69.1 points) in the time period 1992-2015.
Achievements in reducing Under 5 Mortality Rate, 1992-93 to 2015-16
The U5MR is still the highest for STs followed by SCs and total population. The STs have missed the target of reducing U5MR by 2/3rd under MDG 4 by a huge margin of 11.2 points, SCs missed the target by 5.1 points while at all India level the target is missed by 9.3 points.
Another worrying trend of U5MR, which NFHS data shows, is that there is still a significant gap between Rural and Urban U5MR. While this gap has decreased significantly since the 1990s, the Rural-Urban divide between U5MR is maximum for STs at 33.5 points and for all India and SC population, it is around 22 points as of the year 2015-16.
Rural-Urban Gap in Under 5 Mortality Rate, 1992-93 to 2015-16
The rural-urban difference in U5MR has reduced significantly for ST population in the last ten years from 41.9 points in 2005-06 to 33.5 points in 2015-16, but surprisingly in the same period, for SC and total population, there has been a negligible decline in the rural-urban difference in U5MR.
Another important indicator which the Final MDG Report used to monitor child mortality is Infant Mortality Rate (IMR). IMR is the number of death in children under one year of age per 1000 live births. The Country Report states that ‘in India, ‘IMR was estimated at 80 per 1,000 live births in 1990. As per SRS 2015, the IMR is at 37 vis-a-vis the target of 27 infant deaths per 1000 live births by 2015’.
Again for IMR as well, the NFHS presents a different situation. According to NFHS, in 1992-93, the IMR was 86.3 at all India level, 107.3 for SCs and 90.5 for STs which according to the target set under MDG 4 should have been reduced by 2/3rd to become 29.3 (all India), 36.5 (SCs) and 30.8 (STs) respectively in 2015. However, the data from NFHS 4 (2015-16), shows that IMR at all India level is 40.7, for SCs 45.2 and for STs 44.4. The reduction in IMR was highest for SC Population (62.1 Points), followed by ST (46.1 points) and total population (45.6 points) in the time period 1992-2015.
Achievements in reducing Infant Mortality Rate, 1992-93 to 2015-2016
The IMR is highest for SCs followed by STs and total population. At all India level the target of reducing IMR by 2/3rd in the period 1990-2015 has been missed by 11.4 points, the SCs missed the target by 8.7 points while the ST population have missed the target by 13.6 points.
Like U5MR, in the case of IMR also, there exists a huge gap between, rural-urban IMR. The gap is highest for STs (23.8 points) followed by SCs (18.5 points) and total population (17 points) as in the year 2015-16.
Rural-Urban Gap in Infant Mortality Rate, 1992-93 to 2015-16
The rural-urban difference in IMR at all India level as well as for SC population has very marginally reduced in the period 2005-06 to 2015-16. Also, in the same period, the rural-urban difference in IMR has increased for STs from 20.1 points in 2005-06 to 23.8 points in 2015-16.
The Final MDG Report also mentioned the schemes and policies of the government which are in tune to achieve the targets set under MDG relating to Child Health. One such major scheme is Integrated Child Development Services (ICDS). The ICDS Scheme is one of the flagship programmes of the Government of India and is the foremost symbol of country’s commitment to its children and nursing mothers, as a response to the challenge of providing pre-school non-formal education on one hand and breaking the vicious cycle of malnutrition, morbidity, mortality etc. The beneficiaries under the Scheme are children in the age group of 0-6 years, pregnant women and lactating mothers. The ICDS Scheme offers a package of 6 services, viz, i. Supplementary Nutrition ii. Pre-school non-formal education iii. Nutrition & health education iv. Immunization v. Health check-up and vi. Referral services. ICDS scheme runs on shared funds between the centre and the state.
ICDS was expected to contribute to the attainment of the MDG 4 which includes the reduction in IMR and U5MR. The amount spent under the scheme by various states and the number of beneficiaries under the scheme had fallen in the last couple of years despite the fact that India is yet to achieve the target set under MDG to reduce malnutrition among children.
Expenditure under ICDS scheme at all India level, 2012-2017 (Rs. In Crores)
The supplementary Nutrition Program under ICDS is the major component of ICDS providing supplementary nutrition to children of age 6 months to 6 years and Pregnant Women and Lactating mother. The total number of Supplementary nutrition beneficiaries under ICDS scheme was 1032.32 lakhs on 30.09.2013 which has reduced to 949.39 lakhs as on 19-12-2017.
Also, the share of Child Budget out of Total Union Budget has reduced significantly in the last five years. The Child Budget constituted 4.80% of the total Union Budget in the year 2012-13 (RE) which has declined to just 3.30% of the Total Union Budget in the year 2017-18 (BE).
The Share of Child Budget expressed as the percentage of GDP has reduced by almost half in the last five years. Child Budget accounted for 0.70% of the total GDP in the year 2012-13 (RE) which has reduced to just 0.40% in the year 2015-16 (BE).
Under MDG 4, the child mortality has reduced significantly at all India level as well as for SC and ST population but still, SC and ST population has the highest Child Mortality indicators. Even though there has been a tremendous reduction in the mortality incidences among SC children, still India failed to achieve the target set under MDG 4 to reduce child mortality (Under 5 Mortality as well as Infant Mortality) by 2/3rd between 1990-2015. The Child Mortality is still highest for the ST population and even the rural-urban difference in child mortality is highest among the ST population. In the last ten years, there has been a negligible reduction in the rural-urban divide in child mortality for all the social groups and shockingly, the rural-urban divide in IMR has increased for ST population since 2005-06.
After the termination of Millennium Development Goals in the year 2015, MDG 4 (Reducing Child Mortality) has now been transformed into the Sustainable Development Goals 2 and 3. The analysis presented here based on the insights from Final Country Report MDG and National Report of NFHS 4, clearly indicates that Child Mortality needs utmost attention from the government in terms of increased budgetary support as well as targeted policies/schemes.
The government should increase its focus towards rural health to bring parity between rural and urban areas in terms of child mortality. In the upcoming budget session, the budgetary allocation to schemes like ICDS and component for Child Budget must be increased in a comprehensive manner to tackle the current situation of Child Mortality with a special focus on ST and SC population.
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