Syllabus: GS-II & V: Health

Why in the News?

Assam has reported substantial progress in reducing the Infant Mortality Rate (IMR) between 2018 and 2023. The state’s IMR declined by over 41% since 2011-13. This development is significant given Assam’s historically high IMR, especially in rural regions. 

About IMR

• Definition: Infant Mortality Rate (IMR) is the number of deaths of children below one year of age per 1,000 live births in a given year.
• Indicator: It is a critical indicator of a state’s healthcare quality, maternal health, socio-economic development, and public health infrastructure.
• Related Metrics:
  • Neo-Natal Mortality Rate (NMR): Deaths within the first 28 days.
  • Early Neo-Natal Mortality Rate (ENMR): Deaths within the first 7 days.
  • Peri-Natal Mortality Rate: Stillbirths and early neonatal deaths.
  • Under-Five Mortality Rate (U5MR): Deaths before age 5.
    

Assam’s Progress in IMR

• 2018 IMR: 41 deaths per 1,000 live births.
• 2023 IMR: 30 deaths per 1,000 live births.
  • Rural IMR (2023): 32
  • Urban IMR (2023): 15
• Decline Since 2011-13: From 54.9 (2011-13) to 32.1 (2021-23), i.e., a 41% reduction.
• Neo-Natal Mortality Rate (2023): 21 overall (22 in urban areas, 12 in rural).
• Under-Five Mortality Rate (2023): 33 overall (35 rural, 16 urban).
• Stillbirth Rate: 6 per 1,000 live births.

Assam has the widest rural-urban IMR gap in India — rural (32) vs urban (15).

India’s Overall Performance in IMR

• National IMR (2023): 26.3 per 1,000 live births (down from 42.3 in 2011-13).
  • Rural IMR: Declined by 36.3% (2011–2023).
  • Urban IMR: Declined by 36% (2011–2023).
• Best Performer: Manipur (IMR = 3).
• Worst Performers: Chhattisgarh, Madhya Pradesh, Uttar Pradesh (IMR = 37).
• Neo-Natal Mortality Rate: 19 nationally in 2023 (21 in rural, 13 in urban).
  

Centre’s Steps to Improve IMR

• National Health Mission (NHM): Flagship programme for maternal and child health.
• India Newborn Action Plan (INAP), 2014: Target to reduce neonatal mortality to single digits by 2030.
• Rashtriya Bal Swasthya Karyakram (RBSK): Provides systematic screening and management for children’s health.
• Janani Suraksha Yojana (JSY): Promotes institutional deliveries.
• Janani Shishu Suraksha Karyakram (JSSK): Free medical care for pregnant women and sick infants.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA): Free antenatal care for pregnant women.
• LaQshya Initiative: Improving quality of care in labour rooms and maternity wards.
• POSHAN Abhiyaan: Focus on maternal and child nutrition.
  

Assam’s Interventions in Reducing IMR

• Strengthening FRUs (First Referral Units): Better handling of maternal and infant emergencies.
• Expanding Special Newborn Care Units (SNCUs): To reduce neonatal deaths.
• Mobile medical units: In regions like BTR, initiatives such as the Rog Nirmul BTR Mission deployed mobile healthcare services.
• Community Health Interventions: ASHA workers, Janani Suraksha Yojana adoption.
• Awareness Drives: Promoting institutional deliveries and breastfeeding. 
  • Targeted campaigns, like SAANS (Social Awareness & Action to Neutralize Pneumonia Successfully), address preventable causes of child mortality such as pneumonia..
• Recent Boosts: New medical colleges and hospitals (e.g., PMCH, GMCH expansion) improving access.
  

Future Directions

• Bridging Rural-Urban Divide: Improve health infrastructure and transportation in remote rural areas.
• Focus on Neonatal Deaths: Since 70% of infant deaths occur in the first 28 days, targeted neonatal care is crucial.
• Combat Malnutrition: Link IMR reduction with nutrition interventions under POSHAN 2.0.
• Digital Health Solutions: Telemedicine and AI-enabled monitoring in rural Assam.
• Affordability of Care: Scale up free care schemes and reduce out-of-pocket expenditure.
• Capacity Building: Train more paediatricians, neonatal nurses, and rural health workers.
  

Conclusion

Assam’s sharp decline in IMR reflects the impact of sustained government interventions, improved institutional deliveries, and neonatal care expansion. However, the persistent rural-urban gap and high share of neonatal deaths highlight the need for targeted interventions in rural and tribal belts. For India to meet SDG targets of ending preventable child deaths by 2030, states like Assam must sustain their momentum with innovative healthcare models, nutrition security, and community participation.

Mains Practice Question

1. Infant Mortality Rate (IMR) is a critical indicator of a nation’s health infrastructure. Discuss the factors behind Assam’s recent progress in reducing IMR, the challenges that persist, and suggest policy measures to achieve further reduction in line with India’s SDG commitments.

The Assam Tribune