Lessons from Manipur's declining infant mortality rate

Dr Laitonjam Valentina *

Healthy babies and their mothers at the state level Healthy Baby and Best Mother Competition in November 2009 :: Pix - HL

Among the many achievements that Manipur can flaunt of, the story of the declining Infant Mortality Rate of Manipur in the last few decades is one such feat that needs to be shared and studied. So much that the Ministry of Women and Child Development have taken notice and sought to identify the possible factors/good practices in the area of maternal and child health in Manipur so that the same can be emulated by other states/region.

Infant Mortality Rate (IMR) is the number of deaths of children less than one year of age per 1000 live births. According to Sample Registration System (2014), Assam (54), Madhya Pradesh (54), Odisha (51) and Uttar Pradesh (50) are the states with highest IMR. Lowest IMR were reported from states of Goa (9), Manipur (10) and Kerala (12).

The Millennium Development Goals have targeted to reduce the under-five mortality rate by two thirds between 1990 and 2015. Infant Mortality Rate is one of the indicators to measure the progress of achievement of this target. IMR for the country as a whole declined by 33 points in the last two decades at an annual average decline of 1.65 points, it declined by six points between 2008 and 2010 with IMR at national level being 47 in 2010. With the present improved trend due to sharp fall during 2008-09, the national level estimate of IMR is likely to be 44 against the MDG target of 27 in 2015. In 2010, the States of Goa (10), Kerala (13), Manipur (14), Nagaland (23) have achieved the national MDG target for IMR. Only the State of Manipur is likely to achieve the State level MDG target by 2015 with current Infant mortality Rate of 10 (SRS, 2014).

Infant mortality may be due to medical reasons such as low birth weight, malnutrition, neonatal infection, birth trauma, diseases such as diarrhoea, pneumonia, Sudden Infant Death Syndrome, etc. and other social and environmental factors such as socio-economic conditions, gender inequality, birth spacing, mother's education level etc. Care during pregnancy, care of new born, nutritional practices, utilization of ICDS and other allied services are also of prime importance in reducing Infant mortality.

Scenario of health care of Manipur

The success story of Manipur's declining Infant mortality cannot be attributed to better provision of medical care facility in Manipur as compared to the rest of the country. This has been proved by District Level Household & Facility Survey (DLHS), 2012-13 reports that states that pregnant women who has received full vaccination as per DLHS 4, 2012-13 is only 54.1 per cent and institutional delivery accounts for just 61.1%. Prevalence of anaemia is also rampant among expecting mothers. 65.3 per cent women (15-49 aged) are anaemic and pregnant women (15-49 aged) having anaemia is 71.5 per cent.

Percentage of pregnant women who consumed 100g or more Iron and Folic Acid (IFA) tablets is 42.1, which is an improvement over the Coverage Evaluation Survey(2009) data of 31.0. However, the percentage of pregnant women whose blood pressure was taken; pregnant women who had full antenatal care, which in addition to the above includes pregnant women who had blood tests; and pregnant women whose abdomen was examined was only 38 per cent. The corresponding figure for DLHS 4, 2012-13 is only 61.1 per cent and the percentage of children with low birth weight is 7.1 per cent.

The percentage of household with improved source of drinking water is 57.1 per cent and percentage of households having access to improved toilet facility is 78.7. The proportion who received any assistance under Janani Suraksha Yojana (JSY) during delivery is only 10.9% (CES, 2009). As per DLHS 4, 2012-13, for children under 3 years breastfed within one hour of birth is only 43.4 per cent; children aged 0-5 months exclusively breastfed is 71.7 per cent; children aged 12-23 months receiving breast feeding along with complementary feeding is 49.9 per cent and 72.4 per cent of children (6-59 months) are anaemic.

In a better picture, the doctor to population ratio in Manipur is 1:1000 as against all India figure of 1: 1700 and trained nurse ratio is 1:600. Another salient feature is that Manipur utilises 4.5% of GDP for health care and all India average is 1.2%.

Therefore, declining infant mortality rate of Manipur cannot be solely attributed to success of welfare programs and good medical facilities since many states such as Kerala, Andhra Pradesh etc. have better health care facilities.

Sublime influences – Role of women

A major criteria that affects Infant Mortality Rate is education of women as education of girls is inversely correlated to Infant Mortality Rate. However, Manipur with a female literacy rate of 71.73% is doing better than Kerala which has a female literacy rate of 100.76% as per 2011 Census.

It may be mentioned that a UNICEF publication entitled "The Progress of Indian States" way back in 1995 carried an article "Freedom, Women's Advancement and Child Survival: Learning from Manipuri women". The report says that "The clue to better child survival conditions in Manipur can be found in the freedom that women of this state enjoy particularly respect of marital and occupational choice adding that women in Manipur face far less pressure to marry and much less discrimination than in other parts of the country". The average age of marriage for girls is 24 years.

The Manipur story points that "active participation by women in public affairs can and does contribute to better conditions for children and society at large". Rightfully, women in Manipur enjoy better status than the rest of the country with better work participation and contribution to economy. National Family Health Survey (NFHS) 3 data of 2005-06 reported that Manipur had the highest percentage of married women who decided alone or jointly with their husbands on how their earning would be used (95.6 per cent). Being a patrilineal society, all family desire for son but there are rare reports of specific desire to have only male child. It has also been collaborated by Medical officers that there is generally no attempt on the part of parents to identify sex of the child or to indulge in acts of female foeticide.

The emergence of independence and empowerment of Manipuri women can be traced back to history as it bear witness to the role of women in Manipuri society. Perhaps Nupi Lan (Women's War) is the only instance in history that showcased the plight of women as they agitated against the mighty British empire in their struggle for independence. Also, Meira Paibis (Women Torch Bearers) is a women organisation that serves vigil to reduce drug and substance abuse and safeguards human rights. In the heart of Imphal city is a Mother's market (Ima Keithel), run solely by women and reported to be one of its kind – a true symbol of equality, work participation and independence.

The fact that Manipuri women have enjoyed her freedom outside household spheres has significantly contributed in decreasing mortality of infants. Socio-cultural milieu, rituals, absence of dowry and caste system, women empowerment, women in politics etc. are some of the characteristics which probably make Manipur stand out when compared to other states.It may be mentioned that in order to throw light on many of the positive practices adopted in maternal and child care that are contributing to low IMR in the state of Manipur, significant researches are required and the existing data on the relationship of social and cultural practices that aids in reduction of IMR are too inadequate and incomplete to substantiate.

It has been rightly said that the development of a society and nation at large is impossible without women empowerment. Ironically, amidst the talks of empowered status of women in Manipur, crimes against women have been high in the recent past. At such, stringent laws that protect women against crimes and violence are mandatory to curb such incidents. The empowerment and autonomy of women, education and improvements in their political, social, economic and health status, are recognized by the International Conference on Population and Development (ICPD) as highly important ends in themselves.

In addition, they are seen as essential for the achievement of sustainable development. Let the rest of the country see the goodness in our culture as we embark upon this journey to make our women and children safe, healthy and empowered.