http://articles.timesofindia.indiatimes.com/2014-01-30/india/46827217_1_infant-mortality-narmada-waters-sardar-sarovar
'Infant mortality varies within states'
Subodh 
Varma<http://timesofindia.indiatimes.com/toireporter/author-Subodh-Varma.cms>,
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.



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