Decline in MMR & IMR in Assam encouraging, but malnutrition still a major hurdle

That Assam has seen a noticeable decline in the Maternal Mortality Ratio (MMR) – from 490 in 2001-03 to 125 during 2020-22 – is indeed commendable and the State government deserves credit for this. While sincere and sustained government interventions in the past 20 years have gone into improving this critical health index, there can be no room for resting over the positives. Rather, the need is to build further on the achievements and set a goal of getting ranked at par with the most advanced States on these counts. Kerala, for instance, has an MMR of just 4 and there is no reason why we cannot achieve such milestones if the will and commitment are there. On the Infant Mortality Ratio (IMR), too, Assam has done well to bring it down to 32 in 2022 from 68 in 2005. Among the biggest factors pushing up the MMR had been the low level of awareness, lack of universal institutional delivery, high prevalence of anaemic women between the ages of 18 and 29, and of course, the high percentage of women getting married before the legal minimum age. The recent crackdown on child marriage and early marriage is expected to bring MMR and IMR further down. While several of the factors having an adverse bearing on MMR and IMR are now being addressed, not much intervention has gone towards containing the high prevalence of anaemia in women.

Malnutrition in women and children is largely responsible for pushing up maternal and infant mortality rates. Poor economic background is a general reason for malnourished mothers and children but the inadequacy of the government interventions as well as their tardy implementation, too, has a bearing on this. Inadequate access to health services, a lack of quality care for the child and pregnant mother, as well as unhygienic practices also impact malnutrition. India’s primary policy response to child malnutrition, the Integrated Child Development Services (ICDS), has so far fallen short of addressing malnutrition, largely because of lacunae in service delivery. More than distributing food, there is a greater need for changing family-based feeding and disseminating dietary information. As for Assam, wide prevalence of malnourished mothers and children remains a disturbing concern. The number of underweight children in the age group 2-5 in Assam is fairly large, with the incidence as high as almost 50 per cent in certain districts. Similarly, a vast segment of adolescent girls and women, too, is anaemic due to poor diet. Notwithstanding some overall progress, several critical areas of healthcare in women and children continue to be a matter of concern. An integrated approach with a thrust on family planning, which is intrinsically related to maternal welfare, is a must to effect a lasting change.