Progress and Prospects of Millennium Development Goals in India

F. Ram, S. K. Mohanty, Usha Ram

International Institute for Population Sciences, Mumbai

MARCH 2009

ACKNOWLEDGEMENTS

The study was successfully completed due to the efforts and involvement of many individuals at

different stages. We would like to thank everyone who was involved in the study and made it a

success.

We gratefully acknowledge the UNDP, New Delhi office for the generous support during the

project. The financial as well as technical guidance from the country office, was of immense

help in completing the project. We are thankful to Dr. Seeta Prabhu and Dr. Suraj Kumar for

their timely guidance and technical support.

We are thankful to Dr T.K.Roy, emeritus professor at the institute for his valuable suggestion at

different stages of the project. We are thankful to Dr R. Govinda and Dr. K. Biswal for their

insight in improving the report.

We are thankful to the Registrar, Account Officer and Library staff for their support and

cooperation. Thanks are due to all the members of the research team for their hard work and

sincerity. Last, we owe responsible for the mistakes and omission in the report.

F. Ram

S. K. Mohanty

Usha Ram

SUMMARY The millennium declaration marked a strong commitment to the right to development, to peace

and security, for gender equality, and eradication of the poverty in its all form and to promote

sustainable human development. The millennium declaration did not advocate to conduct survey,

rather urges to utilize the available statistical data for monitoring the progress. In India, the data

source for many of the indicators is relatively better. Among the various sources, the Census of

India (conducted once in every ten years), National Family and Health Survey (NI; HS), National

Sample Survey (NSS) as well as the All India Education Survey (A1ES) provides some of the

indicators periodically at sub national level. However, the data on various socio economic

indicators are not available uniformly for all states of India. Keeping these limitations in mind,

this research aimed at utilizing the available data from reliable sources in assessing the progress

at national and sub national level. A total of 13 of the 48 indicators are used in this report owing

to data availability, periodicity and reliability.

The objectives of this report is i) to assess the progress of the country and states of India in 13

indicators of MDGs using the data of recent past ii) forecast the trends of infant and child

mortality based on past trends iii) understand the casual linkage of infant and child mortality on

various factors, including the programmatic factors. The indicators selected arc percentage of population living below poverty line, prevalence of

underweight children, net enrolment ratio, proportion of people starting grade 1 who reach

grade 5, literacy rate of 15-24, gender disparity in enrolment of 6-14 years, gender disparity in

literacy rate of 15-24 years, under five mortality rate, infant mortality rate, immunisation of

children against measles, maternal mortality ratio, proportion of births attended by skilled health

professionals and proportion of population with access to safe drinking water. The base year

chosen is either 1990 or close to 1990 depending on the availability of data while the final year

is 2015.

The progress on these indicators is assessed by computing the actual annual rate of progress and

required annual rate of progress. On reduction in poverty level, it is found that the required annual

rate of progress is 2.27 percent while the actual rate of progress is 4.57 percent for the country,

during 1993-20004. If this trend continues, the target of poverty reduction might be achievable for

the country. But, the regional dimension of poverty showed that while some states are successful in

reducing the poverty ratio faster others failed to do so. The reduction of poverty in the poor state like

Orissa is far below the required rate of progress. Reduction in poverty level is not accompanied by

reduction in hunger, say, under weight of children. Though poverty has reduced the level of hunger

remained at the higher level. On education, the school attendance in primary level is high but the

primary school retention rate is quite low in most of the state. Gender inequality remains higher for

the states where the level is low. In addition to this, the youth literacy rate has not increased much

during this period. On mortality front, it is observed that reduction of infant mortality and child mortality

is lower than the required rate in India and most of the states.

The time trend of infant mortality showed that the infant mortality rate is likely to be 52 per 1000 live

birth for the year 2010 and 46 per 1000 live birth for the year 2015. However, the goal is to bring

down Infant mortality rate to below 27 for the year 2015 under MDG. The trend is also similar for

child mortality. To understand the relationship of infant and child mortality with other socio-economic

as well as programme factors, a set of regression equation are estimated. In the first step, the linear

regression was estimated with IMR as the dependent variable with independent variable such as

female literacy, poverty ratio, safe delivery as well as ante natal care using the state level data. It is

found that poverty has strong relationship with ante natal care and female literacy. Using the

decomposition analysis, it is found that women’s education is the most significant predictor of reduction

infant and childhood mortality.

CONTENTS

Page

I. INTRODUCTION…………………………………………………………. 1

1.1 Background…………………………………………………………...…....... 1 1.2 Millennium Development Goals in India: Data Availability and Constraints........... 3 1.3 Selected Indicators of Millennium Development Goals……………….........…... 7 1.4 Methodology………………………………………………………....………. 8

II. PROGRESS IN SELECTED INDICATORS OF MDGs IN INDIA AND

STATES…………………………………………………………...………… 11 2.1 Introduction………………………………………………………....………... 11 2.2 India’s Progress towards Millennium Development Goals…………..........…….. 11 2.3 Interstate Variation of MDG in India……………………………........………... 14

III. TRENDS AND PROSPECTS IN INFANT MORTALITY, CHILD MORTALITY

AND MATERNAL MORTALITY IN INDIA AND STATES... 34 3.1 Introduction………………………………………………………....………... 34 3.2 Prospects on reduction of Infant Mortality and Child Mortality in

India…………………………………………………………………..……… 35 3.3 Prospects on reduction of Infant Mortality and Child Mortality in states of

India…………………………………………………………………....…….. 41 3.4 Maternal Mortality in India and states………………………………….......….. 45

IV. LEVELS AND TRENDS IN POVERTY RATIO IN INDIA AND MAJOR

STATES……………………………………………………………...……… 61 4.1 Introduction………………………………………………………….....…….. 61 4.2 Methodology………………………………………………………....………. 61 4.3 Levels and Trends in Poverty Estimates: India……………………….........…… 62 4.4 Levels and Trends in Poverty Estimates: Inter-state variations………..........…… 63 4.5 Poverty and Hunger: India and States……………………………….......…….. 64

V. RELATIVE ROLE OF SELECTED FACTORS IN REDUCING CHILD

MORTALITY (SEQUENCING)…………………………………..………. 68 5.1 Introduction….... 68 5.2 Result of Regression Models with one explanatory variable………….........…… 69 5.3 Result of Regression models with more than one explanatory variable……......... 69 5.4 Relative role of factors in reducing the Infant Mortality Rate…………..........….. 70

i

Tables

Page

2.1 Methodology of computing the annual actual rate of progress (ARP) in selected 20

indicators, India and states

2.2 ARP and RRP of selected indicators of MDGs, India 21

2.3 Actual annual rate of progress in percentage of population living below poverty

line in India and states, 1993-04 22

2.4 Actual annual rate of progress in percentage of children underweight under age

three in India and states, 1992-05 23

2.5 Actual annual rate of progress in age specific school attendance rate of children

in 6-10 years in India and states, 1992-05 24

2.6 Actual annual rate of progress in ratio of children in class V to class I in India

and states, 1993-98 25

2.7 Actual annual rate of progress in literacy rate in the age group 15-24 years in

India and states, 1992-05 26 2.8 Actual annual rate of progress in gender equality in school continuation for children aged

6-17 years in India and states, 1992-05 27

2.9 Actual annual rate of progress in gender equality in literacy rate for the age group

15-24 in India and states, 1992-05 28

2.10 Actual annual rate of progress in levels of under five mortality rate in India and

major states, 1992-05 29

2.11 Actual annual rate of progress in levels of Infant Mortality Rate

in India and states, 1990-06 30

2.12 Actual annual rate of progress in percentage of children immunized against measles

in India and states, 1992-05 31 2.13 Actual annual rate of progress in percentage of births assisted by skilled health

professionals in India and states, 1992-05 32

2.14 Actual annual rate of progress in percentage of households covered with safe

drinking water in India and states, 1991-01 33

3.1 Results of Ordinary Least Square with Infant Mortality Rate as dependent variable

and time as independent variable under alternative models, India 36

3.2 Estimated trends of IMR (2010-15) in states of India assuming minimum level of IMR of 15 50

3.3 Estimated trends of IMR (2010-15) in states of India assuming minimum level of IMR of 26 51

ii

3.4 Estimated trends of IMR (2010-15) in states of India (Rural) assuming minimum level

Page

of IMR of 15 52

3.5 Estimated trends of IMR (2010-15) in states of India (Rural) assuming minimum level

of IMR of 26 53

3.6 Estimated trends of IMR (2010-15) in states of India (Urban) assuming minimum level

of IMR of 15 54

3.7 Estimated trends of IMR (2010-15) in states of India (Urban) assuming minimum

level of IMR of 26 55

3.8(a) Estimated trends of U5MR (2010-15) in states of India assuming minimum level

of U5MR of 17 56

3.8(b) Estimated trends of U5MR (2010-15) in states of India (male) assuming minimum

level of U5MR of 17 57

3.8(c) Estimated trends of U5MR (2010-15) in states of India (female) assuming minimum

Level of U5MR of 17 58

3.9 Estimates of under five mortality rates for India and states using SRS Data 59

3.10 Estimates of Maternal Mortality Ratio for 15 major states of India, 1992-93, 1998-99,

and 2003-04 60

4.1 Trends in the Percentage of Population below Poverty line and absolute number of

poor in India, 1973-74 to 2014-15 66

4.2 Levels and Trends in Percentage of Population below Poverty Line 66

4.3 Projected trends in the percentage of population below poverty line for major states

of India, 2000-15 67

5.1 Result of OLS with IMR as dependent variable and poverty, female literacy, safe

delivery and ANC as explanatory variable 69

5.2 Result of OLS with IMR as dependent variable and poverty, female literacy, safe

delivery and ante natal care as explanatory variable 70

5.3 Logit Estimates of the Probability of deaths of children aged 0-11 months and

12-59 months, India, 1992-93 and 1998-99 72

5.4 Decomposition of changes in mortality of children aged 0-11 months, India,1992-93

and 1998-99 73

5.5 Decomposition of changes in mortality of children aged 12-59 months, India, 1992-93

and 1998-99 73 5.6 Estimated child mortality (12-59 months) in percent, by selected individual characteristics,

India, 1998-99 73

iii

Figures

Page 2.1 ARP and RRP in poverty ratio in India and selected states, 1993-2004 15

2.2 ARP in poverty ratio in states of India, 1993-2004 16

2.3 RRP and ARP in primary school retention rate in India and states, 1993-98 17

2.4 Ratio of class V to class I of girls in states of India, 1990-00 17

2.5 RRP and ARP in IMR in India and selected states, 1990-2002 18

3.1 Trends and Prospects of Infant Mortality Rate in India (Total), 1971-2015 37

3.2 Trends and Prospects of Infant Mortality Rate in India by place of residence 1971-2015 38

3.3 Trends and Prospects of U5MR (Total) in India, 1988-2015 39

3.4 Trends and Prospects of U5MR (both sex) in India, 1988-2015 40

3.5 Trends and Prospects of Infant Mortality Rate in Major States of India, 2001& 2015 42

3.6 Trends and prospects of IMR in major states of India (Rural), 2001& 2015 44

3.7 Trends and prospects of IMR in major states of India (Urban), 2001& 2015 44

4.1 Trends in Poverty Ratio in India 63

Appendix 1.1 Data Source, Periodicity and constraints in measuring MDGs: India 75

iv

Abbreviations

IMR: Infant Mortality Rate

MMR: Maternal Mortality Ratio

CMR: Child Mortality Rate

U5MR: Under five Mortality Rate

ARP: Actual Rate of Progress

RRP: Required Rate of Progress

MRP: Mixed Recall Period URP: Uniform Recall Period

v

CHAPTER I

INTRODUCTION

We recognize that, in addition to our separate responsibilities to our individual societies,

we have a collective responsibility to uphold the principle of human dignity, equality and

equity at the global level. As leaders we have a duty therefore to all the world’s people,

especially the most vulnerable and, in particular, the children of the world, to whom the

future belongs.

__ UN Millennium Declarations 1.1. Background India is passing through the demographic, epidemiological and economic transition. On demographic

front, the birth rate in India has declined from 37 in 1972 to 24 in 2006 and the death rate has

declined from 15 to 8 (per 1000 population) during the same period. The life expectancy at birth for

the country has increased from about 52 years in 1978 to 64 years in 2004 indicating substantial

improvement in longevity (RGI, 2006). However, the Infant Mortality Rate (IMR) has remained

unacceptably high (57 per 1000 live births in 2006) and there are evidences of increase in the male

adult mortality. The disease pattern has undergone change from infectious to degenerative diseases,

suggesting the epidemiological transition. On economic front, the growth rate of Gross Domestic

Product (GDP) was more than 6 percent in 1990s and continued to grow at higher pace in recent

years. Similarly, the nineties had also witnessed accelerated economic growth and substantial reduction

in poverty.

The socio-economic and demographic development at national level conceals larger disparities among

the states of India. On demographic front, the North-South dichotomy is distinct. The southern

states of India (Kerala, Tamil Nadu, Andhra Pradesh and Karnataka) have attained replacement

level of fertility while it continues to be high in the Northern states. Studies have shown with accelerated

economic growth, regional disparities have widened in the 1990s (Joseph, 2004). The eastern states

1

Progress and Prospects of Millennium Development Goals in India

of India are stagnant in economic growth even with low level of human development. The various

economic, health and population policy measures of the 1990s are said to have little impact in reducing

the regional disparities. The National Human Development Report of Planning Commission, 2002,

highlighted the inter-state disparities in the state of human development in India. Using the 1991-97

data, Achary et. Al. (2004) found that the states of Gujarat and Maharashtra were the fastest growing

states in the country and experienced the growth rates comparable to the East Asian countries while

Assam experienced negative growth rate during the late nineties. Ahluwalia (2000) was of the view

of increasing dispersion in economic growth rate across the states since 1991.

The Millennium Development Goals (MDGs) have been widely accepted as a yardstick for measuring

the development progress across the countries. The MDGs comprise of eight goals, 18 targets and

48 indicators. The year 1990 (or the closest year for which data is available) has been considered as

the base year and the year 2015 as the end period for this purpose. Many of the indicators are

quantifiable using available data from official statistics and surveys conducted by countries and

international agencies. Nevertheless, there are some indicators for which data is not available, even

at national level. India, as a signatory to the Millennium Declaration (2000), aims at achieving the MDG by the year 2015. Given the diversity in demographic and developmental indicators and federal structure of

Indian democracy, it is essential to plan and target to achieve the goals not only at the state level but

preferably at the district level. The national goals may not be achievable unless more attention is paid

to the areas which are lagging behind (poor performing states). As of now, there are 29 states and 6

Union territories in India which are at different stages of socio economic development. Among the

major states of India (with population of more than 10 million), the state of Kerala ranks at the top in

the human development index while Bihar ranks at the bottom (Mohanty and Ram 2004).

As per MDG mandate, the prime responsibilities for achieving these goals lie with the individual

countries. To monitor the progress globally, it is necessary to track the progress nationally and identify

the key obstacles. The data availability for many of these indicators are relatively better for India and

major states, compared to a number of South Asian countries. The Census of India (conducted once

2

Chapter 1: Introduction

in every ten years), National Family and Health Surveys (NFHS), National Sample Survey

Organization (NSSO) and the All India Education Survey (AIES) provide information on many

indicators periodically at sub-national level. Even so, data is not available uniformly for all states of

India, on all desired indicators. For example, there are concerns on data availability for smaller

states, particularly those in the north eastern region and poses bigger challenge in measuring the level

of socio-economic development. It may be mentioned that no specific survey is proposed to collect

data for MDG indicators and it aimed at using the available data from various sources. Furthermore,

forecasting is another important aspect for planners and policy makers, as it provides guidelines to

programme and prefix the efforts to be taken to go along predetermined path. Additionally, it may

also provide alternatives strategies that may be planned to achieve the goals.

In this context the main objective of this research is to examine the data availability, data constraint

and to assess the progress in MDGs for India and its states. The study also provides the prospects

of achieving some of the target in next 10-15 years. The relative contribution of various factors like

education, poverty, and economic development in improving the health of the population and in

particular reducing the infant and child mortality is also examined.

It may be mentioned that the time series information is assumed to encompass all the changes, social

and economic taking place in the society or in population and therefore would enable to get better

predictions. But this would happen under the steady-secular conditions. In case, there is strong

programme intervention this may not capture such conditions. On the other hand cross sectional

model assumes structural relation to prevail in future. 1.2. Millennium Development Goals in India: Data availability and

Constraints The data availability for measuring the indicators of MDG in Indian context over the time may be

classified under three broad categories:

1. Indicators for which periodic information are available

2. Indicators which can be compiled by improving the system, and

3. Indicators for which information is not available.

3

Progress and Prospects of Millennium Development Goals in India

Appendix1.1 shows the source and periodicity of the data availability for these indicators. Goal 1 is

eradication of extreme poverty and hunger and the target is to halve the proportion of people whose

income is less than one dollar a day (target 1), and halve the proportion of people who suffer from

hunger between 1990 and 2015 (target 2). The corresponding indicators are proportion of population

below one dollar per day (Purchasing Power Parity, Indicator 1a), poverty head count ratio (Indicator

1b), poverty gap ratio (Indicator 2), share of poorest quintile in national consumption (Indicator 3),

prevalence of underweight children under-five years of age (Indicator 4) and proportion of people

below minimum level of dietary energy consumption (Indicator 5).

Among these indicators, the World Bank usually provides estimates on the proportion of population

below one dollar a day. The estimates on poverty headcount ratio are provided by the Planning

Commission, Government of India based on consumption expenditure data collected by the National

Sample Survey Organization, under the ministry of statistics and program implementation, Government of

India. These estimates are provided at five-year interval for all the states and the union territories

(UTs) of India. However, in recent years, the estimates of poverty derived from consumption data

are subject of intense debate and discussion owing to the reference period, the fixed basket of goods

and services and the price level. The share of poorest quintile in national consumption can also be

computed using the NSSO data at the sub-national level. Estimates on underweight of children by

age are available from data collected in all the three rounds of National Family Health Survey (NFHS).

In addition to this, the NFHS also provides height for age, weight for age and weight for height which

may be used to monitor the progress. These indicators would provide us the fair idea about the state

of poverty and hunger as well as the progress there in.

Goal 2 aims at achieving Universal Primary Education. The corresponding target is to ensure that, the

children everywhere (both boys and girls) would be able to complete full course of primary schooling

by the year 2015. The indicators used for quantifying the above goal are Net Enrolment Ratio in

primary education, proportion of pupils starting grade I who reach grade V, primary school completion

rate and literacy rate of population aged 15-24 years. The data on literacy and school enrolment are

4

Chapter 1 : Introduction usually obtained from a number of sources such as Census of India, NSSO, All India Education

Survey (AIES) and the Selective Educational Statistics and other large scale surveys such as National

Family and Health Survey (NFHS) and District Level Household Survey (DLHS). The census of

India provides information on literacy rates in every 10 years disaggregated by sex, religion and

caste (Scheduled caste, Scheduled Tribe). The All India Education Survey also provides data on

these indicators. The NSSO provides school enrolment and literacy in an interval of time. The school

enrolment and literacy can also be computed from large scale survey such as NFHS. However the

proportion of pupils starting grade I who reach grade V is difficult to obtain from either census or

NSSO. It may be possible to obtain this information from selected educational statistics of

Government of India. These reports also give school enrolment by sex at the state level

Goal 3 is about gender equality and women empowerment and the corresponding target is the

elimination of gender disparity in primary and secondary education preferably and in all level of

education no later than 2015. The suggested indicators are ratio of girls to boys in primary, secondary

and tertiary education, ratio of literate females to literate males aged 15 to 24 year, share of women

in the wage employment in the non-agricultural sector and proportion of seats held by women in

national parliament. The source for gender disparity in literacy and enrolment are the same as those

mentioned for goal 2. The data on proportion of seats held by women in national parliament may be

obtained from election commission and other published sources. However, data on share of wage

employment is scanty and to obtain such statistics serious effort need to be made either by way for

gathering primary data or by developing a suitable methodology for estimation of wage by sex in

non-agricultural sector.

Goal 4 aims at reducing the child mortality by two-thirds between 1990 and 2015. The corresponding

indicators are Under-five Mortality Rate, Infant Mortality Rate (IMR) and proportion of children

aged one year immunized against measles. The Sample Registration System (SRS) provides annual

and reliable estimates of IMR for India and states which can be used for monitoring the progress.

The under five mortality rate can also be derived from the SRS based Abridged Life Table. The

5

Progress and Prospects of Millennium Development Goals in India

NFHS also provides the estimates of under-five mortality rate by states and for the country. The data on the immunization of children in the age group of 12-23 months are provided by NFHS and other related surveys. These three indicators are available at sub-national level. While the estimates of IMR and under-five mortality are available annually, data on immunisation coverage are in interval of five years from NFHS. The estimates of immunisation at the district level are provided in the Reproductive and Child Health Survey (RCH) in its various rounds.

Goal 5 aims at improving Maternal Health with the target of reducing the 1990 maternal mortality ratio (MMR) levels by three quarter by 2015. The indicators are maternal mortality ratio and the proportion of births attended by skilled health personnel. The estimate on MMR is available from the SRS and NFHS at the national level. Estimates of MMR at sub-national level through surveys are very difficult and may contain large sampling error. Hence the MMR for the sub-national level should be used carefully. However, proportion of birth attended by the skilled health professional is available from NFHS and RCH. These estimates are also disaggregated by place of residence, caste, and other household characteristics.

Goal 6 aimed at combating HIV/AIDS, malaria and other diseases. The corresponding targets are to halt these by 2015 and begun to reverse the spread of HIV/AIDS and Malaria and other major diseases. The indicators listed for the HIV/AIDS are HIV prevalence among pregnant women aged 15 to 24 years, condom use rate of the contraceptive prevalence rate, percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS, contraceptive prevalence rate and ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years. The HIV/AIDS prevalence among pregnant women aged 15 to 24 years, the comprehensive knowledge of HIV/AIDS and the condom use rate may be obtained from NFHS. For the first time, the NFHS 3 collected blood sample and tested for HIV/AIDS throughout the country. Though the NACO provides some of the indicators relating to HIV/AIDS, those are subject of discussion. Similarly for malaria and other diseases, the corresponding indicators are prevalence and death rates associated with malaria, proportion of population in malaria risk areas using effective malaria prevention and treatment measures, prevalence and death rate associated with tuberculosis, proportion of tuberculosis cases detected and cured under directly observed treatment. It may possible to obtain some of these indicators from the Indian Council of Medical Research (ICMR).

6

Chapter 1: Introduction

Goal 7 aims at ensuring environmental sustainability. The corresponding indicators are- proportion of land area covered by forest, ratio of area protected to maintain biological diversity to surface area, energy use (kilogram oil equivalent) per one dollar Gross Domestic Product (Purchasing Power Parity), Carbon dioxide emissions (per capita) and consumption of ozone-depleting CFCs (ODP tons), proportion of population using solid fuels, proportion of population with sustainable access to an improved water source (urban and rural), proportion of urban and rural population with access to improved sanitations and proportion of population with access to secure tenure. The indicators such as the safe drinking water and sanitation are collected in the census and large scale population based surveys. The major sources of drinking water as classified in national census or survey are tap, tube well, tanker, pucca well, tanker, river and canal and others. The NFHS in all its round also provided the source of drinking water and toilet facility at state level. Other indicators may be obtained from the ministry of statistics and programme implementations.

Goal 8 is linked to global cooperation, which is defined as Official Development Assistance (ODA). The indicators outlined for the above purpose may be obtained from the national statistics, various departments of the Government of India and publications of international organizations.

1.3. Selected Indicators of Millennium Development Goals As discussed before, data for many of the indicators of MDG are available for the country and for the states of India. While the information is periodic for some of the indicators, it is not so for the others. We have selected 13 indicators of MDG owing to data availability, periodicity and reliability. The base year chosen is either 1990 or close to 1990 depending on the availability of data while the final year is the latest year for which data is available.

These indicators are:

1. Percentage of population living below poverty line

2. Prevalence of Underweight children

3. Net Enrolment Ratio in primary education

4. Proportion of pupils starting grade 1 who reach grade 5

5. Literacy rate of 15-24 years olds

6. Ratio of girls to boys in primary, secondary and tertiary education

7. Ratio of literate women to men 15-24 years old

7

Progress and Prospects of Millennium Development Goals in India

8. Under five Mortality Rate

9. Infant Mortality Rate

10. Proportion of 1 year-old children Immunized against measles

11. Maternal Mortality Ratio

12. Proportion of births attended by skilled health professionals

13. Proportion of population with sustainable access to an improved water sources, urban and rural

1.4. Methodology

The following methods are used in the analysis i) Computation of actual annual rate of progress (ARP) and required rate of annual

progress (RRP) ii) Forecasting of IMR and under five mortality rate and iii) Decomposition analysis.

1.4.1. The actual rate of annual progress (ARP) and required rate of annual

progress (RRP) Some of the selected indicators are positively linked to development while others are negatively related. The indicators which are negatively related to development, the desirable value is close to 0 while it is 100 for others. The indicators for which the desirable value is close to 0 are poverty, hunger and under five mortality while for school education, gender equality in education, sanitation and drinking water, it is 100.

The methodology used for computing the ARP for those variables where the desirable value is 0 is;

(Xt1Xt0)/Xt0)

_________________ t1 - t0

where,

t0 is the year 1990 (or year closest to 1990 for which data are available) t1 is the most recent year for which data are available, and

Xt0 and Xt1 are the values of the indicator for base year and end year respectively The methodology used to compute the ARP where the desirable value is 100 per cent

(Xt1 )Xt0

100/ (

Xt0)

is; t1 - t0

8

Chapter 1: Introduction

Required Annual Rate of Progress (RRP) The required annual rate of progress is the rate which is necessary to reach the MDG. It is calculated as

Where,

mdg- t0

1/2 for safe water and sanitation, -2/3 for

Under five mortality and 1 for primary enrolment and gender equality in education)

tmdg is the year by which the target is to be met, and

t0 is the year closest to 1990 for which data are available. For convenience the rate are expressed in percentage point. The methodology discussed above is the same as that of outlined in Human Development Report, 2004 (UNDP 2005).

1.4.2. Projecting IMR and under five mortality rate The Infant Mortality Rate is projected using alternative regression models and given below.

Model 1: ln (IMR-15) = a + bt Model 2: ln (IMR-26) = a+bt

Model 3: IMR = a+ b t

where IMR is the Infant Mortality Rate

- t is the time period

- 15 and 26 are the lower limit assumed in two alternative scenarios

The similar methodology is used for projecting under five mortality rates.

1.4.3. Estimation of Maternal Mortality

Even the large-scale survey could not provide the estimate of maternal mortality at sub national level

owing to sample size. In such cases, indirect techniques are devised to provide the estimate of

maternal mortality. The review of methods of estimating maternal mortality is discussed in chapter 3.

In this exercise, we have used the regression method, proposed by State Institute of Health and

Family Welfare, Hyderabad (2004).

9

Progress and Prospects of Millennium Development Goals in India The regression equation is given as;

ln (MMR)= 8.845 - 0.721 ln (safe delivery), where MMR is the maternal mortality ratio

1.4.4. Trends in poverty estimates

The poverty trend is estimated using the regression equation

Log (Pt – 5) = a + b t

where,

Pt is the poverty level for the period t

a and b are regression coefficient at time t 5 is the minimum poverty level assumed

1.4.5. Sequencing: Prioritizing Investment criterion In the first step, we have attempted to examine relationship of infant mortality rate with female literacy,

safe delivery and antenatal care. The regression coefficient and their predictability are examined for

each of the variable. Further, more than one independent variable are incorporated in the regression

model to examine the change in predictability. Finally, using the National Family Health Survey Data,

the decomposition analyses is carried out to determine the role of relative factor in reducing infant

and child mortality. The detail methodology is discussed in chapter five.

10

CHAPTER II

PROGRESS IN SELECTED INDICATORS OF MDGs IN INDIA AND STATES

2.1. Introduction In this chapter we have measured the actual and annual rate of progress of 13 indicators of MDGs

for the country and for the major states of India. The base year for some of the indicator is not the

same owing to data constraints. 2.2. India’s Progress towards Millennium Development Goals Table 2.1 shows the data source, base year, final year and the actual and required rate of annual

progress of selected indicator for the country. The base year is close to 1990 while the current year

is the most recent period for which data are available. In total we have discussed the 13 indictors

(out of 48 indicators) outlined in MDG. Also, some of the indicators are close to the stated indicators

though not the exactly same. The actual and required annual rates of progress, as outlined by UNDP

are the main basis of examining the progress (UNDP 2005). The data source of national and state

level analyses are same. The base year, final year, the ARP and RRP of the 13 indicators, for India

is given in table 2.1. In the first section, we have carried out the analysis for the country and in the

following section the analyses has been carried out for the states of India.

Estimates of poverty are usually provided by the planning commission, Govt. of India based on

consumption expenditure data. These estimates of poverty are a subject of intense debate and

discussion owing to varying reference period, fixed basket of goods and services and the fixed price

line. For example, the estimates of 2004-05 are provided on mixed recall period (with a reference

period of 30 days for food and 365 days for non-food items) and uniform recall period (reference

period of 30 days for both food and non-food items). We have used the estimates based on mixed

recall period (MRP) for the period 1993-2005, as it is comparable over the years. Based on the

estimates of MRP, the percentage of population living below poverty line in India had declined from

11

Progress and Prospects of Millennium Development Goals in India

36% in 1993-94 to 26% in 1999-2000 and further to 22% in 2004-05. Accordingly, the actual rate

of annual progress is computed at 3.58 percent. However, the required rate of annual progress

(RRP) is estimated at 2.27 percent, lower than the actual rate. Here the target is to reduce the

poverty ratio by half from the base year and so the value of ⟨ is taken as ½. If the trend in decline of

poverty continues, the target of poverty reduction might be achievable for the country. Though the

MDG goal may achievable at national level, it will not be so for many of the poor states. The second indicator is for hunger i.e., the reduction in underweight children of underage three. The

reference age was five years in NFHS 3 while it was three years in earlier rounds. To make the

estimates comparable, the underweight for children is taken for three years of age for all the three

period. The percentage of children under age three who were underweight for age had declined from

51.5 % in 1992-93 to 47% in 1998-99 and further to 45.9% in 2005-06 for the country. The actual

rate of progress is lower (0.84) than the required rate of progress (2.17) for the country. This tends

to suggests that the progress in reduction of hunger is slower than that of poverty.

The classes in primary school vary across the states of India. While in some states of India, the class I-

IV is labeled as primary it is class I-V or class I -VIII in other states of India. The present exercise is

confined to children in the age group 6 –10 and labeled as primary school going age. The net

enrolment in primary school is computed as the percentages of children in the age group 6-10 who

are attending school and derived from the NFHS data. From the table it is found that the actual rate

of progress in primary school enrollment is 0.7 percent compared to the required rate of progress of

4.35 percent. If the trends continue, the target of achieving universal primary education may

be feasible. Many empirical studies have revealed that it is not the school enrolment but school

dropout which is challenging for the country. Moreover, there is concern on various issues such as

quality of education and teacher absenteeism in primary schools across the states of India. Using

the data of All India Educational Survey of 1993 and 1999-2000, it is found that there is small

increase in the proportion of children in grade I who reached grade-V. We have computed the

retention rate as the

12

Chapter 2 : Progress in selected indicators of MDGs in India and states ratio of proportion of pupil starting grade 1 who reaches grade V. It has increased from 48.89 percent

in 1993 to 56.81 percent in 1999-2000. In other words the actual rate of progress in retention in

primary school is 3.5 percent against the required rate of progress of 4.55 percent (Fig 2.2). The

implication is that it is necessary to make intervention for reducing the school dropout. This is a very

crude method of estimation of retention rate and thus gives an approximation. It does not take into

account the number of repeaters and late entrants to grade I-V. Using the NFHS data we have computed the youth literacy rate (literacy rate in the age group of 15- 24 years). The literacy rate in the age group of 15-24 years has increased from 69.5% in 1992-93

to 76.3 % in 1998-99 and to 80.8% in 2005-06. The actual annual rate of progress was 2.85

percent compared to required rate of 4.35 percent during 1992-05. The progress made in improving

the youth literacy rate is a reflection on improvement in primary education in recent past (say in last

ten years), which is quite slow for the country.

The gender disparity in enrolment (6-17 years) in the country has improved during 1992-05. The

actual rate of annual progress is (3.62 percent) lower than the required rate of progress (4.35 percent)

for the country. Similarly, the gender disparity in the youth literacy has improved though the actual

rate of annual progress is lower than the required rate of progress. On reduction of mortality, the

under-five mortality rate has declined from 109 to 95 per 1000 live births during 1992-93 and 1998-99 and further to 74 in 2005-06. The goal is to reduce the under five mortality by 2/3rd during

1990 and 2015. The actual rate of progress made in reduction of under-five mortality rate is 2.46

percent while the required rate is 2.89 percent. Similarly, the infant mortality rate is one of the sensible

indicators of development and also included in the list of indicators of MDG. The infant mortality rate

for the country has declined from 80 to 57 per 1000 live births during 1990 and 2006. Accordingly,

the actual annual rate of progress made in reduction of infant mortality rate is 1.80 percent against

required rate of 2.67 percent for the country. The progress made in the reduction of infant mortality

rate is slower than school enrolment and the poverty ratio. The reduction in infant mortality rate in 1990s was slow compared to 1980s despite improvement in health care utilisation of the country.

13

Progress and Prospects of Millennium Development Goals in India

The coverage of measles has increased from 42.2% in 1992-93 to 50.7% in 1998-99 and to 58.8%

during 2005-06 for the country. The actual rate of annual progress in coverage of measles is 3.03

percent per annum against the required rate of 2.9 percent per annum during 1992-05. On maternal mortality, the estimates need to be used carefully. The estimate on maternal mortality

provided by sample registration system was 408 for the period 1997. Some researchers had provided

the indirect estimates of maternal mortality (Ranjan 2004). Using the maternal mortality estimates of

sample registration system 1997 and 2007 we have computed the actual annual rate of progress.

The progress in maternal mortality is slow. The actual rate of progress in reduction of maternal

mortality was 2.60 percent against the required rate of progress of 4.69 percent per annum. Similarly

the maternal health, measured with respect to the birth attended by health professionals is below the

desired level. The proportion of births attended by skilled health professional has increased from

34.2% in 1992-93 to 42.3% in 1998-99 and 46.6% in 2005-06. While the actual rate of progress

is 3.26 percent, the required rate of progress is 2.79 percent per annum. With respect to the coverage of

safe drinking water, the actual rate of progress is lower compared to the required rate of progress. We

observed that in many of the indicators except that of poverty ratio and the immunisation against

measles, the actual rate of progress is lower than the required rate of progress 2.3. Interstate Variation of MDG in India Given the diversity in demographic and developmental aspect, it is likely that the national progress

conceal large interstate disparities within the country. Accordingly, these goals are examined at the

state level. The required rate of progress for the states is shown in through table 2.3-2.15. The states

are arranged in ascending order of progress during the period.

The regional dimension of poverty showed that while some states are successful in reducing the

poverty ratio faster while others failed to do so (Fig 2.1). The actual annual reduction of poverty in

14

Chapter 2 : Progress in selected indicators of MDGs in India and states percentage point is higher than the required rate for the country but it is not so for the poor states,

such as Orissa, and Madhya Pradesh. In fact the state of Orissa had made very little reduction in

poverty reduction during the period and the level remains as the highest. The implication is that these

states may be categorized as high priority states for poverty reduction.

Fig 2.1: ARP and RRP in poverty ratio in India and selected states, 1993-2004

Among the major states of India, the states of Uttar Pradesh, Rajasthan and Maharashtra had made

slow progress than national average (Fig 2.2). Based on the progress states performed higher than

the national average as well as higher than the required rate of progress may be labeled as fast

progressing states, those performed below national average but above the required rate may be

labeled as moderately progressing states and below the required rate of progress as slow progressing

states. The specific programme is required for reduction of poverty in the slow progressing states.

15

Progress and Prospects of Millennium Development Goals in India Fig 2.2: ARP in poverty ratio in states of India, 1993-2004

With respect to weight for age, the progress is slower for many states than that of national average.

The states performing below national average are Rajasthan, Madhya Pradesh, Kerala, and Haryana.

Though the poverty reduction is substantial in 1990s for many of the states and for the country, it is

not so in reduction of hunger, measured by underweight of children (Table 2.4).

The progress towards the universal primary education, measured by the Age Specific School

Attendance Rate in the age group 6-10 years is encouraging. Barring the state of Bihar almost all

states has performed better in improving the school attendance. Many of the states which have

shown lower rate of annual progress have already had higher level in 1990s and so the marginal

variation does not necessarily mean that the progress is slow. Retention rate of children in the primary

school, measured as the ratio of class V to class I at two point of time and the actual rate of progress

of the states in retention of primary schooling of the states is shown in table 2.6. Most of the states

except Maharashtra, Goa, Karnataka, Assam, Gujarat and Punjab are lagging in the retention of

children in primary school.

16

Chapter 2 : Progress in selected indicators of MDGs in India and states Fig 2.3: RRP and ARP in primary school retention rate in India and states, 1993-98

The ratio of class V to class I of girls in the states of India are arranged in ascending order and shown

in Fig 2.4. It is lowest is in the state of Rajasthan while for some of the states the ratio is more than

100. All of the states that have achieved the replacement level of fertility have experienced the where

the ratio as more than 100. Fig 2.4: Ratio of class V to class I of girls in states of India, 1999-00

17

Progress and Prospects of Millennium Development Goals in India

Most of the states of India are lagging in the required progress of youth literacy rate. While the

primary attendance seems to be high, it is not so in case of youth literacy rate. It may be due to more

emphasis on universal primary education in recent years. It is further noted that the states where the

level of school enrolment is low, the extent of gender inequality is high.

With respect to infant and child mortality, for some states, it appears that there is little change in infant

mortality rate in recent years. The current level of IMR is highest in the state of Orissa and lowest in

the state of Kerala. The required rate of progress in reduction of IMR is 2.67% and the actual

reduction is 1.80% for the country. The states where the actual rate of reduction is higher than the

required rate are Manipur, Arunachal Pradesh, Kerala and Sikkim. The states which have noticed

very little reduction in infant mortality rate during 1990 and 2006 are Rajasthan, Bihar, Assam,

Haryana and Andhra Pradesh. However the pattern is better with respect to under five mortality.

The utilization of maternal health has increased in many of the states of India during 1992-93 and 2005-06.

Fig 2.5: RRP and ARP of IMR in India and selected states, 1990-2002

18

Chapter 2 : Progress in selected indicators of MDGs in India and states From the above discussion we may infer the followings

1. The reduction in poverty level in recent decades is satisfactory. However, the

reduction in poverty level among poor performing states like Orissa and Madhya

Pradesh is very minimal

2. Reduction in poverty level is not accompanied by reduction in hunger, say, under

weigh of children under age three. Though poverty has reduced the level of hunger

remained at the higher level.

3. The school enrolment in primary level is high but the primary school retention rate

is low in many of the states.

4. Gender inequality remains higher for the states where the level is low. However

the youth literacy rate has not increased much during this period.

5. The actual rate of reduction in IMR is lower than the required rate for the country

and many stats of India.

6. The utilization of maternal health services (birth attended by skilled health

professionals) has increased in many of the states of India.

19

Progress and Prospects of Millennium Development Goals in India Table 2.1: Methodology of computing the annual actual rate of progress (ARP) in

selected indicators, India and states

Sr. Indicators Source Value of Method No. Alpha

1 Poverty Planning 0.5 Xt1-Xt0/Xt0/t1-t0

Commission, Govt. of India

2 Underweight children NFHS 0.5 Xt1-Xt0/Xt0/t1-t0

3 Literacy Rate 15-24 NFHS 1 Xt1-Xt0/(100-Xt0)/t1-t0

4 Gender disparity in literacy NFHS 1 Xt1-Xt0/(100-Xt0)/t1-t0

5 ASER, 6-10 NFHS 1 Xt1-Xt0/(100-Xt0)/t1-t0

6 Prop start grade 1 and reaching grade 5 AIES, SES 1 Xt1-Xt0/(100-Xt0)/t1-t0

7 Gender disparity in Enrolment (6-14 ) years NFHS 1 Xt1-Xt0/(100-Xt0)/t1-t0

8 Infant Mortality Rate SRS 0.67 Xt1-Xt0/Xt0/t1-t0

9 Under five mortality rate NFHS 0.67 Xt1-Xt0/Xt0/t1-t0

10 Immunization against measles NFHS 0.67 Xt1-Xt0/Xt0/t1-t0

11 Births attended by health professionals NFHS 1 Xt1-Xt0/Xt0/t1-t0

12 safe drinking water NFHS 0.5 Xt1-Xt0/(100-Xt0)/t1-t0

13 Maternal Mortality Ratio SRS, Indirect estimate 0.75 Xt1-Xt0/Xt0/t1-t0

Note: t0 is year 1990 (or year closest to 1990 for which data are available)

t1 is the most recent year for which data are available, and

Xt0 and Xt1 are the values of the indicator for base year and end year respectively

20

Chapter 2 : Progress in selected indicators of MDGs in India and states Table 2.2: ARP and RRP of selected indicators of MDGs, India

Available Indicator Source Base Recent Levels Levels Alfa Required Annual

Year Year in in ( ) rate of rate of base current annual required

Year Year progress progress (t0) (t1) (RRP)

1. Percentage of population Planning 1993- 2004 35.97 21.8 ½ 2.27 3.58 living below poverty line Commission 94 -05 (based on mixed recall period) (Indicator 1 b)

2. Prevalence of Underweight NFHS 1992-93 2005-06 51.5 45.9 ½ 2.17 0.84 children (Indicator 4)

3. Net Enrolment Ratio (Age NFHS 1992-93 2005-06 73.4 75.5 1 4.35 0.60 Specific School Attendance Rate, 6-10) (Indicator 6)

4. Proportion of pupils AIES, 1993 1999-2000 48.89 56.81 1 4.55 2.9 starting grade 1 who reach and grade 5 (Indicator 7 a) Selected

educational statistics,

5. Literacy rate of 15-24 NFHS 1992-93 2005-06 69.5 80.8 1 4.35 2.85 (indicator 8)

6. Gender disparity in NFHS 1992-93 2005-06 83.1 91.1 1 4.35 3.62 Enrolment, 6-17 years (Indicator 9)

7. Gender disparity in literacy NFHS 1992-93 2005-06 71.1 83.6 1 4.35 3.3 rate of 15-24 years (Indicator 10) 8. Under five Mortality Rate NFHS 1992-93 2005-06 109 74 2/3 2.90 2.46

(Indicator 13) 9. Infant Mortality Rate SRS 1990 2006 80 57 2/3 2.67 1.80

(Indicator 14) 10. Immunisation of children NFHS 1992-93 2005-06 42.2 58.8 2/3 2.9 3.03

against measles (Indicator 15) 11.Maternal mortality ratio SRS, 1997 2003 407 301 3/4 4.69 2.60

(Indicator 16) 1997 12. Proportion of births NFHS 1992-93 2005-06 34.2 46.6 ¾ 3.26 2.79

attended by skilled health professionals (Indicator 17)

13. Proportion of population Census of 1992-93 2005-06 62.3 77.9 ½ 2.08 1.7 with access to safe drinking India water Indicator 30)

Note:

Base year is taken 1993 for poverty, 1992 for indicators of NFHS $ Indirect estimates of Ranjan, 2004, Safe drinking source: Water from tap or tube well/ hand pump or tanker (as defined in census).

21

Progress and Prospects of Millennium Development Goals in India Table 2.3: Actual annual rate of progress in percentage of population living below

poverty line in India and states, 1993-04 Goal 1: Eradicate Extreme Poverty and Hunger Indicator 1b: Poverty Headcount Ratio Base Year: 1993-94 Current Year: 2004-05 = -1/2

Required Annual Rate of Progress in Percentage Point: 2.27

Poverty estimates based on mixed recall period

Actual Annual Rate of progress in percentage point

Rank in poverty

estimates

Poverty ratio based on uniform recall period

Sr. No.

States/ India

1993- 1999- 2004 - 1999- 2004- 2004- 1994 2000 2005 1993-2004 1993-1994 2000 2005 2005

1 Assam 40.86 36.09 15.0 5.75 12 12 6 19.7

2 Haryana 25.05 8.74 9.9 5.50 4 2 2 14.0

3 Punjab 11.77 6.16 5.2 5.07 1 1 1 8.4

4 Kerala 25.43 12.72 11.4 5.02 5 3 4 15.0

5 Andhra Pradesh 22.19 15.77 11.1 4.54 2 6 3 15.8

6 Tamil Nadu 35.03 21.12 17.8 4.47 8 8 9 22.5

7 Gujarat 24.21 14.07 12.5 4.40 3 4 5 16.8

8 Karnataka 33.16 20.04 17.4 4.32 7 7 7 25.0

9 West Bengal 35.66 27.02 20.6 3.84 9 10 10 24.7

10 Bihar 54.96 42.6 32.5 3.72 15 14 14 41.4

All India 35.97 26.1 21.8 3.58 - - - 27.5

11 Uttar Pradesh 40.85 31.15 25.5 3.42 11 11 12 32.8

12 Rajasthan 27.41 15.28 17.5 3.29 6 5 8 22.1

13 Maharashtra 36.86 25.02 25.2 2.88 10 9 11 30.7

14 Madhya Pradesh 42.52 37.43 32.4 2.16 13 13 13 38.3

15 Orissa 48.56 47.15 39.9 1.62 14 15 15 46.4

Source: For estimates of 1993-1994 & 1999-2000 data obtained from Economic Survey, GOI, 2001-02,

Ministry of Finance, Economic Division. Page 239, Table 10.5 and for 2004-2005 data obtained from

Planning commission, Govt. of India http://planningcommission.nic.in/news/prmar07.pdf.

22

Chapter 2: Progress in selected indicators of MDGs in India and states Table 2.4: Actual annual rate of progress in percentage of children underweight under

age three in India and states, 1992-05 Goal 1: Eradicate Extreme poverty and Hunger Indicator 4: Prevalence of underweight children under age three Base Year: 1992-93 Current Level: 2005-06 = -1/2

Required Rate of Annual Progress = 2.17

Net enrolment ratio, 6-10

Actual Annual Rate

of Progress

Major states 1992-1993 1998-1999 2005-2006 1992-2005

Punjab 46.0 28.7 27.0 3.18 Tamil Nadu 45.7 36.7 33.2 2.10 Mizoram 28.4 27.7 21.6 1.84 Maharashtra 51.4 49.6 39.7 1.75 West Bengal 54.8 48.7 43.5 1.59 Uttar Pradesh 59.0* 51.8 47.3 1.53 Delhi 40.9 34.7 33.1 1.47 Andhra Pradesh 45.0 37.7 36.5 1.45 Karnataka 50.6 43.9 41.1 1.44 Assam 49.2 36.0 40.4 1.38 Himachal Pradesh 43.7 43.6 36.2 1.32 Orissa 52.4 54.4 44.0 1.23 Goa 34.1 28.6 29.3 1.08 Tripura 45.2 42.6 39.0 1.06 Manipur 26.8 27.5 23.8 0.86 All India 51.5 47.0 45.9 0.84 Bihar 62.6* 54.3 58.4 0.52 Arunachal Pradesh 38.4 24.3 36.9 0.30 Gujarat 48.1 45.1 47.4 0.11 Rajasthan 44.3 50.6 44.0 0.05 Meghalaya 44.4 37.9 46.3 -0.33 Madhya Pradesh 57.4* 53.5 60.3 -0.39 Kerala 27.0 26.9 28.8 -0.51 Nagaland 27.5 24.1 29.7 -0.62 Haryana 34.6 34.6 41.9 -1.62 Jammu & Kashmir - 34.5 29.4 - Sikkim - 20.6 22.6 -

Source: Fact Sheet, National Family Health Survey-3 (2005-06). *Estimates of Uttar Pradesh, Bihar, Madhya Pradesh for the period 1992-93 refers to four years preceding the survey of undivided Uttar Pradesh, Bihar, Madhya Pradesh Note: Estimates for UP, Bihar & MP of 1992-93 taken from NFHS1 National report, page-286

- Not available / not computed

23

Progress and Prospects of Millennium Development Goals in India Table 2.5: Actual annual rate of progress in age specific school attendance rate of

children in 6-10 years in India and states, 1992-05 Goal 2: Achieve Universal Primary Education Indicator 6: Net Enrolment ratio (Age specific school attendance rate, 6-10) Base Year: 1992-93 Current Level: 2005-06 = 1 Required Rate of Annual Progress: 4.35

Net enrolment ratio, 6-10

Actual Annual Rate of Progress

India/States 1992-1993 1998-1999 2005-2006 1992-2005

Assam 72.8 82.0 88.0 4.29

Tamil Nadu 90.2 94.8 95.3 4.02

Gujarat 78.4 86.8 88.2 3.49

Andhra Pradesh 67.8 86.0 82.2 3.44

Orissa 73.0 85.3 84.2 3.19

Rajasthan 59.1 79.3 74.8 2.94

Uttar Pradesh 61.3 80.9 72.8 2.28

West Bengal 71.1 85.1 78.8 2.03

Madhya Pradesh 62.1 82.5 71.8 1.98

Karnataka 76.9 88.9 79.7 0.94

Himachal Pradesh 91.2 98.6 92.2 0.90

Tripura 78.7 91.3 81.0 0.81

All India 73.4 82.9 75.5 0.60

Maharashtra 84.9 91.6 85.8 0.44

Bihar 49.2 61.6 49.9 0.10

Haryana 83.2 91.3 79.9 -1.52

Punjab 84.4 94.2 81.2 -1.55

Kerala 95.6 94.3 91.4 -

Source: Computed from NFHS 1, 2 & 3.

- Not computed.

24

Chapter 2 : Progress in selected indicators of MDGs in India and states Table 2.6: Actual annual rate of progress in ratio of children in class V to class I in

India and states, 1993-98 Goal 2: Achieve Universal Primary Education Indicator 6: Proportion of Pupils starting grade 1 who reach grade 5 (ratio of Class 5 to class I, 6-10) Base Year: 1993 Current Level: 1999-2000 = 1 Required rate of progress: 4.55

Ratio of class V to class I

State/India 1993-1994 1998-1999

Actual Annual Rate of Progress

Maharashtra 61.6 84.70 12.0 Karnataka 50.7 75.28 10.0 D&N Haveli 39.9 61.54 7.2 Assam 32.5 54.90 6.6 Gujarat 58.1 71.13 6.2 Punjab 73.3 81.02 5.8 Manipur 48.4 59.67 5.8

Slow Progress

(Actual Rate of Progress is lower than Required Rate of Progress) Madhya Pradesh 57.3 66.54 4.4 Andhra Pradesh 39.5 51.82 4.3 Arunachal Pradesh 38.2 50.46 4.1 West Bengal 39.2 50.93 4.0 Tripura 40.9 52.26 3.9 Nagaland 38.6 49.40 3.8 INDIA 48.9 56.81 3.5 Meghalaya 29.9 40.31 2.6 Haryana 79.0 80.58 1.5 Orissa 47.7 51.76 1.5 Himachal Pradesh 71.3 72.90 1.1 Delhi 71.5 72.70 0.9 Mizoram 40.5 42.76 0.8 Rajasthan 29.6 31.96 0.7 Uttar Pradesh 45.6 47.24 0.6 Bihar 36.7 35.06 -0.5

Source: Computed from All India Education Survey 19993 and selected educational statistics, 1999-00 data.

25

Progress and Prospects of Millennium Development Goals in India Table 2.7: Actual annual rate of progress in literacy rate in the age group 15-24 years

in India and states, 1992-05 Goal 2: Achieve Universal Primary Education Indicator 6: Literacy rate of 15-24 years Base Year: 1992-93 Current Level: 2005-06 = 1 Required rate of progress: 4.35

Literacy Rate, 15 - 24

Actual Annual Rate of Progress

States 1992-1993 1998-1999 2005-2006 1992-2005

Himachal Pradesh 82.7 93.5 97.2 6.43

Tamil Nadu 74.6 83.6 92.5 5.41

Maharashtra 77.2 83.8 92.0 4.98

Haryana 70.4 83.1 88.3 4.66

Kerala 95.6 98.7 98.1 4.45

Karnataka 63.2 74.0 84.2 4.39

Assam 68.0 75.0 84.9 4.07

Andhra Pradesh 57.7 68.4 80.0 4.05

Orissa 62.1 74.8 80.9 3.81

Punjab 74.8 84.3 87.2 3.79

Tripura 83.5 90.8 90.9 3.44

Madhya Pradesh 58.4 69.8 76.6 3.37

Gujarat 72.5 77.0 84.3 3.30

Meghalaya 71.3 78.4 83.5 3.27

Uttar Pradesh 56.4 66.3 74.7 3.23

Arunachal Pradesh 67.4 79.9 80.2 3.01

Goa 92.6 94.2 95.5 3.00

All India 69.5 76.1 80.8 2.85

Rajasthan 54.0 63.8 70.8 2.81

Manipur 87.2 88.2 91.5 2.60

West Bengal 71.9 75.5 81.3 2.59

Bihar 50.7 57.6 66.0 2.39

Jammu and Kashmir 77.3 70.7 83.3 2.04

Nagaland 87.3 85.3 87.2 -0.05

Source: Computed from NFHS1, 2 & 3.

26

Chapter 2 : Progress in selected indicators of MDGs in India and states

Table 2.8: Actual annual rate of progress in gender equality in school continuation for

children aged 6-17 years in India and states, 1992-05 Goal 3: Promote Gender Equality Indicator 9: Ratio of girls to boys in primary, secondary and tertiary education

(ratio of school attendance of girls to boys in percentage) Base Year: 1992-93 Current Level: 2005-06 = 1 Required rate of Progress: 4.35

Net enrolment ratio, 6-10

Actual Annual Rate of Progress

India/States 1992-1993 1998-1999 2005-2006 1992-2005 Delhi 98.60 98.57 100.00 7.69 Nagaland 99.18 94.67 100.00 7.69 Goa 97.65 97.37 100.00 7.69 Tripura 94.02 96.76 100.00 7.69 West Bengal 87.72 92.67 99.27 7.24 Assam 88.23 93.05 99.10 7.10 Himachal Pradesh 93.17 99.23 98.76 6.29 Karnataka 84.12 93.77 95.93 5.72 Madhya Pradesh 77.56 88.06 93.60 5.50 Uttar Pradesh 66.93 83.13 89.59 5.27 Punjab 93.65 97.59 97.85 5.08 Andhra Pradesh 78.84 89.36 90.84 4.36 Maharashtra 87.74 96.20 94.31 4.12 Bihar 59.65 76.85 80.89 4.05 Jammu and Kashmir 86.24 86.22 93.39 4.00 All India 83.10 88.76 91.06 3.62 Rajasthan 55.59 72.79 75.80 3.50 Tamil Nadu 93.42 97.87 96.39 3.47 Manipur 93.70 95.94 96.54 3.47 Haryana 86.46 94.80 92.52 3.44 Orissa 78.53 88.92 88.03 3.40 Arunachal Pradesh 86.43 90.26 90.72 2.43 Gujarat 86.46 91.00 89.06 1.48 Mizoram 97.83 97.40 97.77 -0.21 Meghalaya 100.00 102.02 100.00 - Kerala 100.00 99.95 100.00 -

Note: Not computed for the state of Kerala and Meghalaya as the ratio of girls to boys is 1

For Sikkim the survey in 1992-93 was not conducted Source: Data computed from NFHS1, 2 & 3.

- Not computed

27

Progress and Prospects of Millennium Development Goals in India Table 2.9: Actual annual rate of progress in gender equality in literacy rate for the

age group 15-24 in India and states, 1992-05 Goal 3: Promote Gender Equality Indicator 9: Ratio of literate women to 15-24 years of age (ratio of female literacy

to male literacy in the age group 15-24 in percentage) Base Year: 1992-93 Current Level: 2005-06 = 1 Required rate of Progress: 4.35

Ratio of literate women to men 15-24 years old

Actual Annual Rate of Progress in Percentage Points

States/India 1992-1993 1998-1999 2005-2006 1992-2005

Meghalaya 89.9 95.2 101.8 9.1 Mizoram 95.1 99.1 100.1 7.9 Tripura 79.1 92.9 98.6 7.2 Kerala 91.9 99.5 99.4 7.1 Nagaland 90.0 93.2 98.9 6.9 Himachal Pradesh 72.7 94.3 96.8 6.8 Tamil Nadu 72.5 83.1 96.5 6.7 Goa 82.6 96.4 97.1 6.4 Maharashtra 69.5 86.0 93.5 6.1 Haryana 63.2 84.2 91.8 6.0 Punjab 78.8 92.3 94.3 5.6 West Bengal 73.1 81.8 92.1 5.4 Karnataka 67.8 82.1 90.5 5.4 New Delhi 89.2 95.3 96.7 5.3 Assam 73.0 84.9 91.8 5.3 Arunachal Pradesh 68.4 87.2 89.0 5.0 Manipur 74.0 89.5 90.5 4.9 Gujarat 67.6 77.3 88.1 4.9 Andhra Pradesh 63.5 74.4 85.0 4.5 Orissa 60.0 77.4 83.5 4.5 Uttar Pradesh 49.1 62.2 76.0 4.1 Madhya Pradesh 53.8 66.9 76.7 3.8 All India 71.1 77.8 83.6 3.3 Jammu 69.8 72.0 81.6 3.0 Rajasthan 41.2 52.9 63.5 2.9

Bihar 47.7 57.3 66.8 2.8

Source: Data Computed from NFHS 1, 2 & 3.

28

Chapter 2: Progress in selected indicators of MDGs in India and states Table 2.10: Actual annual rate of progress in levels of under five mortality rate in

India and major states, 1992-05 Goal 4: Reduce Child Mortality Indicator: Under five Mortality rate Base Year: 1992-93 Current Level: 2005-06 = -2/3 Required rate of Annual Progress: -2.89

Child Mortality Actual Annual Rate

of Progress

Major states 1992-1993 1998-1999 2005-2006 1992-2005

Tamil Nadu 86.5 63.3 35.5 4.54

Kerala 32.0 18.8 16.3 3.77

Haryana 98.7 76.8 52.3 3.62

Gujarat 104.0 85.1 60.9 3.19

Assam 142.2 89.5 85.0 3.09

West Bengal 99.3 67.6 59.6 3.08

Karnataka 87.3 69.8 54.7 2.87

Maharashtra 70.3 58.1 46.7 2.58

Bihar 127.5 105.1 84.8 2.58

All India 109.3 94.9 74.3 2.46

Uttar Pradesh 141.3 122.5 96.4 2.44

Orissa 131.0 104.4 90.6 2.37

Andhra Pradesh 91.2 85.5 63.2 2.36

Madhya Pradesh 130.3 137.6 94.2 2.13

Punjab 68.0 72.1 52.0 1.81

Rajasthan 102.6 114.9 85.4 1.29

Source: Data obtained from NFHS1 National report, page-221, NFHS2 National report, page-195 &

NFHS3 National report, page-187.

29

Progress and Prospects of Millennium Development Goals in India Table 2.11: Actual annual rate of progress in levels of Infant Mortality Rate in

India and states, 1990-06 Goal 4: Reduce Child Mortality Indicator: Infant Mortality rate Base Year: 1990 Current Level: 2006 µ = -2/3 Required rate of Annual Progress: 2.67

Infant Mortality Rate

Actual Annual Rate

of Progress

States/India 1990 2002 2006 1990-2006

Manipur 29 14 11 3.88

Arunachal Pradesh 75 37 40 2.92

Orissa 122 87 73 2.51

West Bengal 63 49 38 2.48

Maharashtra 58 45 35 2.48

Tamil Nadu 59 44 37 2.33

Sikkim 51 34 33 2.21

Madhya Pradesh 111 85 74 2.08

Karnataka 70 55 48 1.96

India 80 63 57 1.80

Goa 21 17 15 1.79

Uttar Pradesh 99 80 71 1.77

Punjab 61 51 44 1.74

Himachal Pradesh 68 52 50 1.65

Gujarat 72 60 53 1.65

Tripura 46 34 36 1.36

Rajasthan 84 78 67 1.26

Bihar 75 61 60 1.25

Andhra Pradesh 70 62 56 1.25

Haryana 69 62 57 1.09

Assam 76 70 67 0.74

Kerala 17 10 15 0.74

Source: Data obtained from Sample Registration System, Annual Volumes.

30

Chapter 2: Progress in selected indicators of MDGs in India and states

Table 2.12: Actual annual rate of progress in percentage of children immunized against

measles in India and states, 1992-05 Goal 4: Reduce Child Mortality Target 15: Proportion of 1 year old Children immunized against measles Base Year: 1992-93 Current Level: 2005-06 Required rate of Annual Progress: 4.35

Coverage of measles during Actual Annual Rate of Progress

India/States 1992-1993 1998-1999 2005-2006 1992-2005

Meghalaya 13.2 17.7 43.8 17.83

Bihar 14.6 16.6 40.4 13.59 Nagaland 10.0 19.6 27.3 13.31 West Bengal 42.5 52.4 74.7 5.83 Orissa 40.2 54.0 66.5 5.03 Madhya Pradesh 40.7 35.5 61.4 3.91 Assam 25.8 24.6 37.4 3.46 Uttar Pradesh 26.3 34.6 37.7 3.33

Manipur 37.0 45.8 52.8 3.28 All India 42.2 50.7 58.8 3.03 Arunachal Pradesh 27.5 33.6 38.3 3.02 Rajasthan 31.2 27.1 42.7 2.84 Kerala 60.5 84.6 82.1 2.75 Karnataka 54.9 67.3 72.0 2.40 Tamil Nadu 71.6 90.2 92.5 2.25 Andhra Pradesh 53.8 64.7 69.4 2.23 Haryana 60.9 72.2 75.5 1.84 Himachal Pradesh 71.5 89.1 86.3 1.59 Maharashtra 70.2 84.3 84.7 1.59 Punjab 64.8 76.5 78.0 1.57

Gujarat 55.9 63.6 65.7 1.35 Goa 77.8 84.3 91.2 1.32 Jammu & Kashmir 69.1 68.9 78.3 1.02 Delhi 69.6 77.5 78.2 0.95

Mizoram 65.5 71.0 69.5 0.47

Source: Data obtained from NFHS1 National report, page-252, NFHS2 National report, page-209 & NFHS3 National report, page-231.

31

Progress and Prospects of Millennium Development Goals in India Table 2.13: Actual annual rate of progress in percentage of births assisted by skilled

health professionals in India and states, 1992-05 Goal 5: Improve Maternal Health: Indicator 17: Proportion of Births attended by skilled health Professionals Base Year: 1992-93 Current Level: 2005-06 = 1 Required rate of Annual Progress: 3.26

Medical assistance at Delivery

Actual Annual Rate

of Progress

India/States 1992-1993 1998-1999 2005-2006 1992-2005

Orissa 20.5 33.4 44.0 8.82

Rajasthan 21.8 35.8 41.0 6.77 Himachal Pradesh 25.6 40.2 47.8 6.67 Jammu & Kashmir 31.2 42.4 56.5 6.24 Assam 17.9 21.4 31.0 5.63 Haryana 30.3 42.0 48.9 4.72 Uttar Pradesh 17.2 22.4 27.2 4.47 Bihar 19.0 23.4 29.3 4.17 Andhra Pradesh 49.3 65.2 74.9 3.99 Gujarat 42.5 53.5 63.0 3.71 Manipur 40.4 53.9 59.0 3.54 Tripura 33.5 - 48.8 3.51 West Bengal 33.0 44.2 47.6 3.40 Arunachal Pradesh 21.3 31.9 30.2 3.21 Punjab 48.3 62.6 68.2 3.17 Karnataka 50.9 59.1 69.7 2.84 India 34.2 42.3 46.6 2.79 Maharashtra 53.2 59.4 68.7 2.24 Tamil Nadu 71.2 83.8 90.6 2.10 New Delhi 53.0 65.9 64.1 1.61 Nagaland 22.2 32.8 24.7 0.87 Kerala 89.7 94.0 99.4 0.83 Madhya Pradesh 30.0 29.7 32.7 0.69 Mizoram 61.5 67.5 65.4 0.49 Goa 88.4 90.8 94.0 0.49

Meghalaya 36.9 20.6 31.1 -1.21

Source: Data obtained from NFHS 1 National Report, Page-242, NFHS2 National Report, Page-305 &

NFHS 3 National Report, Page-220.

32

Chapter 2 : Progress in selected indicators of MDGs in India and states Table 2.14: Actual annual rate of progress in percentage of households covered with

safe drinking water in India and states, 1991-01 Safe Drinking Water Proportion of Population with access to safe drinking water (Indicator 30). Required annual rate of progress = 2.08

State/India

Census of India,

2001

Census of India,

1991

Actual Annual

Rate of Progress

Uttar Pradesh 87.8 62.2 2.8

Bihar 86.6 58.8 2.8

Punjab 97.6 92.7 2.8

Andhra Pradesh 80.2 55.1 2.3

Tamil Nadu 85.6 67.4 2.3

Himachal Pradesh 88.6 77.3 2.1

Slow Progress (Actual Rate of Progress is lower than Required Rate of Progress)

Haryana 86.6 74.3 2.0 Gujarat 84.1 69.8 2.0 Goa 70.1 43.4 2.0 Karnataka 84.6 71.7 1.9 All India 77.9 62.3 1.7 Orissa 64.2 39.1 1.7 West Bengal 88.5 82.0 1.5 Maharashtra 79.8 68.5 1.5 Madhya Pradesh 68.4 53.4 1.3 Arunachal Pradesh 77.5 70.0 1.0 Tripura 52.5 37.2 1.0 Assam 58.8 45.9 1.0 Mizoram 36.0 16.2 1.0 Rajasthan 68.2 59.0 0.9 Kerala 23.4 18.9 0.2

Meghalaya 39.0 36.2 0.2

Source: National Human Development Report 2001, Page 175 Housing and Amenities, Paper 2 of 1993; Table 3.1, Page 44, Census of India, 1991,

Census of India 2001

33

CHAPTER III

TRENDS AND PROSPECTS OF INFANT MORTALITY, CHILD MORTALITY AND MATERNAL MORTALITY

IN INDIA AND STATES 3.1. Introduction In the absence of morbidity data, mortality indicators such as crude death rate, infant mortality rate,

child mortality rate and maternal mortality are used to understand the health status of a population in

most of the developing countries. Data on these indicators are expected from civil registration system

at all level of administrative units but in many countries including India the quality of data still suffers

from coverage and completeness and not been used for estimating mortality level. In India, these

estimates are obtained from the sample registration system. We focus mainly on Infant mortality rate

(IMR) and under five child mortality rate (U5MR). The exercise is carried out for India and major

states covering nearly 95 per cent of India’s population and wherever possible separately for rural

and urban areas. Also, a review of methodology of estimating the maternal mortality is also described. In the earlier chapter we have already examined changes that have taken place during 1990-2000

and have indicated whether the changes are in tune with the required rate of change needed to

achieve the MDG. On analyzing the trend in selected indicators in the 1990s, it is found that the

country has made some progress in reduction of mortality but the changes are very skewed across

the states. The pace of decline of infant mortality was much lower in 1990s compared to 1980s

across the states. The successive rounds of National and Family Health Survey had shown the

increase in Ante Natal Care and institutional deliveries in the country but the IMR has not reduced

much. However, there are growing interstate disparities in reduction of infant mortality as well as the

utilization of health services in the states of India. Research indicated that the achievement of MDG

depends on the performance of poor performing states in the country.

34

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states

3.2. Prospects on Reduction in Infant Mortality and Child Mortality in

India

The infant mortality rate is projected using three sets of regression models. In all the models the infant

mortality rate is regressed against time. The data are obtained from the Sample Registration System

for the period 1971-2003. However, in the regression a three-year moving average of infant mortality

rate is used rather than single year estimates. For example, the data of the year 1991 refers to the

average of 1990-92 and so on. In each model a different lower limit is assumed. The lower limit or

minimum level of infant mortality rate assumed in the first model is 15. This minimum limit is fixed

based on the observed level of infant mortality rate in the state of Kerala in the recent past. In the

second model, a minimum level of infant mortality rate of 26 is assumed. This lower limit is fixed by

taking into account the targets in the millennium development goals to be achieved by the year 2015.

The third model is a simpler one without taking into account the minimum level of infant mortality rate.

In this model there are chances that infant mortality rate may reach an unreasonably low level, especially

in the case of long term forecasting whereas this will not be so in the first two models. The results of

regression equation obtained from these three alternative models are given in Table 3.1.

The description of the variables used in the regression model is given below.

Unit: India Data Source: Sample Registration System

Period: 1972-2001

Method: Ordinary Least Square

Model 1: ln (IMR-15) = a + bt

Model 2: ln (IMR-26) = a+bt

Model 3: IMR = a+ b t

Where, IMR is the infant mortality rate and t is the time. The value of t is 1 for 1972, 2 for 1973

and 30 for 2001. Model 1 and model 2 assume modified exponential relation in infant mortality

rate over time.

35

Progress and Prospects of Millennium Development Goals in India Table 3. 1: Results of Ordinary Least Square with Infant Mortality Rate as

dependent variable and time as independent variable under alternative models, India

Parameters Model 1 Model 2 Model 3

Regression coefficient -0.0345 -0.0399 -2.97

T statistics of regression coefficient -36.03 -34.14 -38.36

Intercept 4.90 4.83 142.02

R 2 98.5 98.1 98.5

No of observation 30 30 30

Projected IMR for the year 2010 52 54

Projected IMR for the year 2015 46 49

The regression coefficients in all the three model are statistically significant. The R2 value is 0.98 indicating that 98 percent variation is explained in the models. Model 1 and Model 2 are almost similar. On average, it is required a decline of 3 to 4 percentage point in IMR annually to achieve the target of MDG. Similar coefficients are also developed for rural and urban India separately.

36

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Fig 3.1 shows the trends and prospects of infant mortality rate for the country. The estimates until

2001 are taken from SRS while that of 2010 and 2015 are projected under the minimum infant

mortality rate of 15 as observed for the state of Kerala in the recent past. The IMR of India has

declined from 134 in 1971 to 110 in 1981, 80 in 1991 and to 66 in 2001. Based on the trends, the

projected IMR is 52 for the year 2010 and 46 for the year 2015. It may be mentioned that in 2006

the estimated value of IMR was 57 (RGI, 2006). The target is to bring Infant mortality rate to below

27 for the year 2015 so as to realize the goals of MDG. The projected value of infant mortality rate

does not vary much even by keeping the minimum level of infant mortality rate of 26. There is a long

way to reach the goal set in the millennium summit as well as what has been described in our National

Population Policy Document i.e. reaching infant mortality rate of below 30 per thousand live births

by 2010. These prospects of infant mortality rate must be seen in view of maternal and child health

care. There is not very encouraging progress in ante natal care, institutional care, and immunization.

In fact, during the last 5 to 6 years, coverage of children under vaccination has either stagnated or has

37

Progress and Prospects of Millennium Development Goals in India

declined and this decline has been more pronounced in poor performing states and underprivileged

social groups. The trend of infant mortality rate varies largely by place of residence. The infant

mortality rate of rural areas is usually higher than that of urban areas. The trends in infant mortality rate for

rural and urban India are shown in Fig 3.2. The infant mortality rate for rural India has declined from

144 in1971 to 119 in 1981, 86 in 1991 and 72 by 2001. The projected estimates of infant

mortality rate is 56 in 2010 and 50 in 2015 under the assumption of a minimum infant mortality rate

of 15.

by place of residence 1971-2015

In case of urban India, the infant mortality rate has declined from 85 in 1971, 64 in

1981, 52 in 1991 and 42 per 1000 live births by 2001. The IMR is projected at 36 per 1000

live births for the year 2010 and 32 for the year 2015 for urban India. Even urban India has not

moved faster towards the goal and there is a need for greater efforts in urban areas, especially

in slum localities.

38

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Under Five Mortality rate The under five mortality rates are estimated from SRS based abridged life tables. The under five

mortality rate is the probability of not surviving till age five. This is derived as follows. In the

first step, the probability of surviving till age one is multiplied with the probability of surviving

from age 1 to age 4. The resulting figure is subtracted to estimate the probability of death and

multiplied with 1000 to derive the under five mortality rate. Further, the regression equation is

estimated by taking under five mortality rates as the dependent variable against the time trend.

The estimates are also provided with a minimum value of 17 of under-five mortality rate. The

estimates are carried out separately for males and females. Based on the trends, the estimated

figure of under five mortality rate is likely to be 67 by 2010 and 58 by 2015.

39

Progress and Prospects of Millennium Development Goals in India

The estimated regression for India and major states are shown in appendix 3.8-3.10. The

progress has not been very encouraging and a lot needs to be done. In terms of goal, under-five

mortality rate has to reach below 40 by 2015 but it will be about 58 if the current trend continues.

However, the gender gap has narrowed down over time. In 1990, female child mortality was

around 11 per cent higher than male mortality and female mortality has comparatively improved

faster and by 2015 it will be 7 per cent higher (if the same trend continues). This is encouraging

but not satisfactory and in order to bridge the gap at earliest there is need for special attention

for the female children that are probably being neglected due to a decline in desired number of

total children but not in preference for sons.

40

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states 3.3. Prospects on Reduction of Infant Mortality and Child Mortality

in states of India There are large variations in the current level of IMR across the states of India. Moreover, the

pace of decline in IMR varies largely among the states of India. The success of achieving the

MDG in reducing the infant mortality rate depends on reducing regional disparities in the level of

infant mortality rate. Like at the national level, we have used the same methodology for projecting

the IMR in states of India. Two sets of regression equations, model 1 and model 2 as discussed

before these are used. The state level estimates of infant mortality rate and under-five child

mortality of SRS form the basis of analysis. For each state, the estimated infant mortality rate

(time trend) is regressed against time. The resulting regression coefficients and predicted IMR

are shown in the table 3.2- 3.7. The estimated IMR for the year 2015 is shown in fig 3.5. None

of the major states will be reaching an infant mortality rate of below 30 by 2015 except that of

Kerala. In fact, the level of infant mortality rate for some states like Uttar Pradesh Bihar, Madhya

Pradesh, Rajasthan and Orissa are well above 50 with the highest of 77 is observed in Orissa.

With the current trends of IMR, none of the states of India except Kerala are expected to reach

the required level of IMR as desired in the MDG. Based on the estimated IMR, the states are

classified as follows. Expected Range of infant mortality rate for 2015

States with infant mortality rate more than 50: Uttar Pradesh, Bihar, Madhya Pradesh,

Rajasthan and Orissa States with infant mortality rate between 40-50: Andhra Pradesh, West Bengal, Karnataka

Assam and Haryana

States with infant mortality rate less than 40: Kerala, Tamil Nadu, Maharashtra and

Gujarat

41

Progress and Prospects of Millennium Development Goals in India

Fig 3.5 shows the trends of infant mortality rate in selected states of India. The IMR for the state of

Uttar Pradesh has declined from 167 in 1971 to 150 in 1981 and 82 per 1000 live births in 2001. It

is projected at 51 per 1000 live births for the year 2015. Similarly, for the states of Orissa, the

projected IMR will be highest among all the states. Table 3.8 provides the estimate of under-five

mortality rate for 2015. On the basis of this, the states are classified as follows: a. States with under five mortality of less than 40 2010- Kerala

2015- Andhra Pradesh, Gujarat, Himachal Pradesh, Kerala

b. States with under five mortality between 40-60 2010- Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka and Punjab

2015- Karnataka, Maharashtra, Punjab, Rajasthan.

42

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states c. States with under five mortality of more than 60 2010- Assam, Bihar, Haryana, Madhya Pradesh, Orissa, Maharashtra, Rajasthan, Uttar Pradesh

and West Bengal. 2015- Assam, Bihar, Haryana, Madhya Pradesh, Orissa and West Bengal. 3.3.1 Rural and Urban Differentials in IMR in Major States of India We have also attempted to project the IMR in rural and urban areas of the major states. Fig 3.6

indicates the variation of IMR across the states in rural areas. It may be observed that in 2001 there

were a number of states like Orissa, Rajasthan, Madhya Pradesh and Uttar Pradesh where the

IMR was above 80 and the predicted values indicate that these states are nowhere close to the

target outlined in MDGs. The states like Maharashtra, Punjab, Tamil Nadu and Gujarat may

attain the targets but for other states it will be difficult to reach a level of below 50. In the case of

urban areas, the progress has not been very encouraging. It may be noted that urban areas of states

like Orissa, Rajasthan, Madhya Pradesh and Uttar Pradesh have a long way to go in order to reach

the desired goal. Service coverage for mother and child in urban areas of these states is not better

than in the rural areas.

43

Progress and Prospects of Millennium Development Goals in India

44

Chapter 3: Trends and prospects of infant mortality, child mortality and maternal mortality in India and states 3.4: Maternal Mortality in India and states The World Health Organization (WHO) definition of maternal mortality includes all deaths among

pregnant and recently pregnant women except for deaths from “accidental or incidental causes”

(Graham et. al., 1989). As recently as 1985, maternal mortality in developing countries was referred

to as “a neglected tragedy” (Rosenfield and Maine, 1985). Although accurate data on maternal

mortality is not available, estimates shows that 500,000 women in developing countries die each

year from the complications of pregnancy, unsafe abortions, and childbirth (WHO, 1986). In many

of these countries, maternal mortality is the leading cause of death among women in the reproductive

ages. Further, the discrepancy between the maternal mortality rates in developing and developed

countries is greater than that of any other demographic indicator. The number of maternal deaths

among women of reproductive ages in India is about 100 times the number in the United States.

Infant mortality, by contrast, is about 10 to 15 times greater in India (United Nation Population

Division, 1988). In recent years increased attention has been focused on the disparity between

developed and the developing countries in the levels of infant and child mortality. However, much

less attention has been paid to a second area of comparable or even greater inequality – the differential

between such countries in mortality risks to women associated with pregnancy and childbearing. Of

the one- half million annual maternal deaths worldwide, it has been estimated that developing countries

account for 98 percent of all such deaths.

The problem of maternal mortality in case of India can be assessed by the continuing high rates of

mortality and morbidity related to pregnancy and childbirth. India’s maternal mortality ratio, estimated at

400 to 570 per 100,000 live births, is fifty times higher than that of many developed countries and six

times higher than that of neighboring Sri Lanka. Measures such as maternal, fetal, perinatal, and

neonatal mortality are undoubtly the most extreme manifestations of poor maternal health and are no

more than “the tip of the iceberg” of poor maternal health. Because Indian women are denied the

benefits of modern maternal health care, millions more- between 4 and 5 million – suffer from ill

health associated with childbearing (Jejeebhoy, 1997). A large proportion of these deaths and the

episodes of ill health are preventable, given proper health care and the obstetric care facilities.

45

Progress and Prospects of Millennium Development Goals in India

Beyond the immediate loss of life, maternal mortality exerts a devastating burden on the family of the

deceased. Most of the times, infant and maternal deaths occur simultaneously. Prevention of a maternal

death can in many cases, prevent the death of an infant. The study by Chen et. al., (1974) has

revealed that of the children born live to the mothers who died after child birth, 95 per cent died

within a year. It has been estimated that for every mother who dies, on average, two children are left

motherless. Priority has always been given to child survival and mother’s health has remained relatively

neglected. This neglect is all the more regrettable in view of the well-known linkages between mother’s

and child’s health and the difficulty of ensuring the health and survival of a child without adequately

safe guarding the health of the mother. An effort to reduce maternal mortality thus complements the

growing concern about infant and childhood mortality (Goldstone, 1986).

Available data suggests that maternal mortality levels in India remain highest in the world. Estimates

range from a maternal mortality ratio of 437 per 100,000 live births to 568 per 100,000 births.

Regional disparities are wide: the maternal mortality ratio in the four northern states is estimated to be

almost twice as high as in the rest of India. It is estimated that India accounted for 19 percent of all

live births worldwide, and as much as 27 percent of all maternal deaths.

In the absence of good vital registration in India, the role of the Sample Registration System in

providing data on vital events is highly valuable. The Sample Registration System has estimated a

maternal mortality ratio of 408 and 407 per 100,000 live births for 1997 and 1998 respectively

(Registrar General of India, 1999 and 2000). While the suggested level seems to be plausible at the

all- India level, the state level estimates by the Sample Registration System seem to be severely

distorted by sampling as well as non sampling errors. Therefore, the policy initiatives are very much

affected by the absence of reliable and consistent estimates of maternal mortality in India. 3.4.1. Methodology of Estimation of MMR Until the early 70s, there were no efforts to estimate maternal mortality ratio. While analyzing the

causes of death, Preston (1976) obtained a linear relationship between the maternal mortality rate (MMR) and the overall mortality rate (M) i.e. crude death rate. The relation is given by

MMR = 0.0197*M – 0.0001, R2 =0 .89

46

Chapter 3: Trends and prospects of infant mortality, child mortality and maternal mortality in India and states

From the above equation one can very easily estimate the maternal mortality rate and thereby maternal

mortality ratio using the relation MM Ratio = (MMR*TF)/ (CBR*TP)

Where, MMR: Maternal Mortality Ratio TF: Total female population, TP: Total Population, and

CBR: Crude birth rate.

Boerma (1987) used a similar methodology and fitted the equation of the form

MMRatio = 3.067 + 0.055*X, R2 =0 .89 (N= 23)

Where X is the percent of female deaths in age group15-49 due to maternal causes. It may be noted that the values on the variable X are generally not available for the developing

countries. Therefore, the application of the above regression equations is very limited in the case of

developing countries. However, he has suggested some other variables that can be considered for

estimating maternal mortality. These variables are

General mortality in the population

The health status of women, and

The fertility level As direct computation of maternal mortality indicators requires large samples, several indirect methods

have been proposed to estimate the level of maternal mortality. The sisterhood method proposed by

Graham et. al. (1989) is one of them. In order to calculate the number of sisters dying of maternal

causes, Graham et. al. suggested asking four questions in a sample survey. The four questions are

1. How many sisters have you ever had who were ever married (including those who are now

dead)?

2. How many of these ever-married sisters are alive now?

3. How many of these ever-married sisters are dead? 4. How many of these dead sisters died while they were pregnant, or during childbirth, or

during the six weeks after the end of pregnancy.

This procedure cuts down the required sample size to a great extent because women generally in

developing countries have several sisters who might have been exposed to the risk of mortality each

time they were pregnant. It has been debated that the above questions should be asked to all the

surviving sisters to reduce the sampling bias (Trussel and Rodriguez, 1990). The relation used to

estimate maternal mortality is given by

47

Progress and Prospects of Millennium Development Goals in India MMR = (1- PS) (1/TFR)

where, PS is the probability of survival and TFR is the total fertility rate. There are a few serious

problems with this procedure.

1. The reference period for the estimated maternal mortality rate is not well defined. 2. The procedure does not provide current estimates. The usual question that can be asked

at this point is about the utility of an estimate which relates to a point 10 to 20 years

back.

3. Again, use is made of model life tables, which can be a serious problem. 4. Maternal mortality rate is more sensitive to the changes in total fertility rate than in probability

of survival, which in any case will not change much. Therefore, it will be difficult to use

the estimates obtained from this procedure in studying trends and differentials in maternal

mortality.

Another procedure for estimating maternal mortality indirectly is given by Blum and Fargues (1990).

This estimation procedure does not require any survey or any special question to be asked in a survey. It is based on the estimation of theoretical i(x) = mf(x)/ mm(x), where mf(x) is the female age

specific death rate and mm(x) is the male age specific death rate. It is assumed that in the age group

15-49 there is no excess mortality of females than males except due to maternal causes. So, the deviation of the observed i(x) from a ‘theoretical’ i’(x) at these ages may be attributed to maternal mortality. Maternal mortality rates are thus estimated as

MMR = mf(x) – i’(x) * mm(x) Provided there is no excess mortality of males specific to this age group, i(x) may be approximated by linear interpolation between values of i(x) observed just before (10-14 age group) and just after the child bearing period (50-54 or a longer interval, e.g. 50-64). In a country like India, where socio cultural discrimination against female children is quite common, the estimated values based on interpolation may be very misleading. The assumptions regarding the method are likely to be highly violated in a country like India.

Bhat et. al (1992) proposed an econometric regression model to estimate the maternal mortality rate

as well as ratio and applied the same to the Indian data. They, however, made four assumptions. The

assumptions are: (1) data on age specific death rates from all causes are available separately for males and females (i.e. dxm and dxf); (2) data on age specific fertility rates are available (i.e. fx); (3) the

48

Chapter 3: Trends and prospects of infant mortality, child mortality and maternal mortality in India and states ratio of maternal mortality at different age intervals to that at the age interval 20-24 is either available or can be “borrowed” from another population (i.e., the age pattern of maternal mortality is known and is denoted by wx); and (4) the age pattern of the sex-ratios of death rates in the absence of maternal mortality can be expressed either as a smooth or a kinked function of age (gx) with only a few unknown parameters. The level of maternal mortality can be obtained by using the following equation

d xf = g x d xm

+ ⎤ w x f x + ∑

x d xm

The above equation contains two unknowns namely; ⎤, the level of maternal mortality at the 20-24 age interval, and the parameters of the function gx. If one assumes that for women of reproductive ages the sex ratio of death rates in the absence of maternal mortality would be a linear function of age

(x), then the estimating equation can be set up as

Rx = a + bX + ⎤Z x

d R = xf = wx f x Where x

d xm and Z x d xm

From the ordinary regression techniques, the parameters a, b, and ⎤ can be easily estimated. After the estimation of ⎤, the implied level of overall maternal mortality ratio can be obtained by using equations derived by the authors.

Ram (1995) in his study of maternal mortality proposed the following regression model for estimating

MMR:

MMR 1: 654.81 – 6.4878 * IB

MMR 2: 366.49-5.0698* IB + 41.5612 *TFR where IB is the Institutional Birth and TFR is the total fertility rate

The log linear regression model is quite useful in estimation of MMR at the state level. The regression model used was

Ln (MMR) = 8.845- 0.721 ln (safe deliveries).

The correlation of safe deliveries and MMR is found to be –0.823. The estimated maternal mortality

ratio is shown in table 3.10.

49

Progress and Prospects of Millennium Development Goals in India Table 3.2: Estimated trends of IMR (2010-15) in states of India assuming minimum

level of IMR of 15 Unit: States of India

Model –1: ln (IMR –15) =a+ b*t

Regression Results

Projected IMR for

2 N 2010 2015State b

0 b1 R

Andhra Pradesh

Assam

Bihar*

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan Tamil

Nadu Uttar

Pradesh West

Bengal** INDIA

4.6578 4.8351 4.9638 4.9907 4.6134 4.3280 4.0148 4.9819 4.5308 4.9516 4.6158 4.7366 4.7112 5.2866 4.6625 4.8841

-0.0290 -0.0297 -0.0389 -0.0431 -0.0243 -0.0195 -0.0980 -0.0223 -0.0379 -0.0187 -0.0392 -0.0208 -0.0413 -0.0387 -0.0374 -0.0328

0.886 30 49 44 0.841 30 55 49 0.913 20 61 53 0.942 30 42 37 0.875 30 54 50 0.806 30 50 47 0.961 18 16 16 0.961 30 76 70 0.990 30 36 33 0.901 30 83 77 0.939 30 37 33 0.724 30 66 61 0.977 30 37 33 0.960 30 59 51 0.984 20 51 45 0.985 30 52 46

Note: * Bihar –Data of Three year moving average from 1981-83 to 2000-2002

* * West Bengal - Data of Three year moving average from 1981-83 to 2000-2002

50

Chapter 3: Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Table 3.3: Estimated trends of IMR (2010-15) in states of India assuming

minimum level of IMR of 26 Model-2: ln (IMR-26) = a+ bt

Regression Results Projected IMR for

2

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan

Tamil Nadu

Uttar Pradesh

West Bengal

INDIA

b0 4.5574 4.7556 4.9332 4.9388 4.5076 4.1475 3.8524 4.9095 4.4397 4.8754 4.5255 4.6374 4.6415 5.2437 4.6277 4.8116

b1 -0.0346 -0.0347 -0.0468 -0.0509 -0.0290 -0.0208 -0.1502 -0.0251 -0.0488 -0.0210 -0.0490 -0.0238 -0.0514 -0.0433 -0.0485 -0.0382

R2 N 2010 2015 0.893 30 51 47 0.821 30 56 51 0.917 20 62 54 0.939 30 45 41 0.877 30 55 51 0.681 25 54 51 0.920 11 26 26 0.959 30 77 71 0.991 30 39 36 0.899 30 84 78 0.947 30 40 37 0.729 30 67 62 0.976 30 40 37 0.958 30 61 54 0.984 20 51 46 0.985 30 54 49

Source: Sample Registration System (1971-73 to 2000-2002)

Note:

Bihar – Data of Three year moving average from 1981-83 to 2000-2002

West Bengal – Data of Three year moving average from 1981-83 to 2000-2002

51

Progress and Prospects of Millennium Development Goals in India Table 3.4: Estimated trends of IMR (2010-15) in states of India (Rural) assuming

minimum level of IMR of 15 Major States (Rural)

Model –1: ln (IMR –15) =a+ b*t

Regression Results Projected IMR for

State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan

Tamil Nadu

Uttar Pradesh

West Bengal

INDIA

4.7257 4.8470 5.0122 5.0724 4.7045 4.4210 4.0792 5.0489 4.6240 4.9874 4.6946 4.9331 4.8526 5.3359 4.7837 4.9686

-0.0269 -0.0287 -0.0398 -0.0410 -0.0259 -0.0155 -0.0964 -0.0221 -0.0324 -0.0184 -0.0385 -0.0264 -0.0402 -0.0383 -0.0389 -0.0323

0.849 30 55 50 0.831 30 57 51 0.920 20 62 54 0.919 30 47 41 0.858 30 55 50 0.762 30 60 57 0.966 18 15 15 0.952 30 81 74 0.980 30 44 39 0.894 30 87 80 0.945 30 39 35 0.911 30 65 58 0.980 30 42 37 0.951 30 62 54 0.976 20 54 47 0.983 30 56 50

Source: Sample Registration System (1971-73 to 2000-2002)

Note:

Bihar – Data of Three year moving average from 1981-83 to 2000-2002.

West Bengal –Data of Three year moving average from 1981-83 to 2000-2002.

52

Chapter 3: Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Table 3.5: Estimated trends of IMR (2010-15) in states of India (Rural) assuming

minimum level of IMR of 26 Model 2: Ln (IMR-26)=a+bt

Regression Results Projected IMR for

State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan

Tamil Nadu

Uttar Pradesh

West Bengal

INDIA

4.6291 4.7669 4.9859 5.0215 4.6102 4.2662 3.9185 4.9813 4.5286 4.9138 4.6104 4.8564 4.7910 5.2951 4.7579 4.9016

-0.0314 -0.0333 -0.0477 -0.0475 -0.0306 -0.0168 -0.1416 -0.0246 -0.0396 -0.0205 -0.0471 -0.0299 -0.0485 -0.0426 -0.0493 -0.0371

0.855 30 56 52 0.814 30 58 53 0.924 20 63 55 0.916 30 50 45 0.860 30 56 52 0.624 25 63 60 0.920 11 26 26 0.950 30 82 75 0.982 30 46 42 0.892 30 87 81 0.952 30 42 39 0.915 30 66 60 0.977 30 44 40 0.949 30 64 57 0.977 20 54 48 0.983 30 58 52

Source: Sample Registration System (1971-73 to 2000-2002)

Note:

Bihar – Data of Three year moving average from 1981-83 to 2000-2002.

West Bengal –Data of Three year moving average from 1981-83 to 2000-2002.

53

Progress and Prospects of Millennium Development Goals in India Table 3.6: Estimated trends of IMR (2010-15) in states of India (Urban) assuming

minimum level of IMR of 15 Model 1: ln (IMR-15) =a+bt

Regression Results Projected IMR for

State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan

Tamil Nadu

Uttar Pradesh

West Bengal

INDIA

4.1393 4.5973 4.1922 4.6586 3.8533 4.0691 3.7351 4.4486 4.2189 4.2304 4.2226 4.0794 4.1692 4.7607 3.8317 4.3001

-0.0330 -0.0497 -0.0220 -0.0473 -0.0037 -0.0511 -0.1180 -0.0246 -0.0507 -0.0113 -0.0410 -0.0120 -0.0381 -0.0327 -0.0224 -0.0327

0.780 30 32 30 0.799 30 29 26 0.471 20 50 46 0.959 30 32 28 0.116 30 56 55 0.753 30 23 21 0.838 18 15 15 0.915 30 48 44 0.970 30 24 22 0.631 30 59 57 0.904 30 29 26 0.402 30 52 50 0.946 30 30 27 0.968 30 48 43 0.727 20 39 37 0.964 30 36 32

Source: Sample Registration System (1971-73 to 2000-2002)

Note:

Bihar – Data of Three year moving average from 1981-83 to 2000-2002.

West Bengal –Data of Three year moving average from 1981-83 to 2000-2002.

54

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Table 3.7: Estimated trends of IMR (2010-15) in states of India (Urban) assuming

minimum level of IMR of 26 Model 2: ln (IMR-26) =a+bt

Regression Results Projected IMR for State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Karnataka

Kerala

Madhya Pradesh

Maharashtra

Orissa

Punjab

Rajasthan

Tamil Nadu

Uttar Pradesh

West Bengal

INDIA

4.0054 4.5959 4.0306 4.6028 3.5855 3.6526 3.4870 4.3278 4.2182 4.0583 4.1119 3.8695 4.0441 4.6766 3.6367 4.1746

-0.0489 -0.0717 -0.0293 -0.0616 -0.0048 -0.0475 -0.2290 -0.0308 -0.0858 -0.0139 -0.0603 -0.0152 -0.0562 -0.0389 -0.0365 -0.0442

0.778 30 34 32 0.765 30 32 30 0.452 20 50 47 0.962 30 35 33 0.113 30 56 55 0.665 25 32 31 0.916 11 26 26 0.908 30 49 46 0.947 30 28 28 0.633 30 60 57 0.909 30 32 30 0.391 30 52 51 0.945 30 32 31 0.971 30 50 45 0.720 20 39 37 0.959 30 38 35

Source: Sample Registration System (1971-73 to 2000-2002)

Note:

Bihar – Data of Three year moving average from 1981-83 to 2000-2002.

West Bengal –Data of Three year moving average from 1981-83 to 2000-2002.

55

Progress and Prospects of Millennium Development Goals in India Table 3.8 (a): Estimated trends of U5MR (2010-15) in states of India assuming

minimum level of U5MR of 17 Model: ln (U5MR-17) = a+ b*t

Regression Results Projected U5MR for

State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Himachal Pradesh

Karnataka

Kerala

Madhya Pradesh

Orissa

Maharashtra

Punjab Rajasthan

West Bengal

Uttar Pradesh

INDIA

4.5428 4.9275 4.8446 4.7946 4.528

4.4513 4.6594 3.3412 5.234

5.0696 4.4869 4.3238 5.0861

4.66 4.9323 4.8095

-0.0566 -0.0337 -0.0367 -0.0654 -0.0177 -0.0498 -0.0567 -0.3944 -0.039

-0.0367 -0.0321 -0.0412 -0.0567 -0.0267 -0.0292 -0.0407

93.9 8 88.1 8 63.5 8 94.2 8 50.6 8 97.4 8 96.9 8 95.4 6 98.7 8 94.7 8 94.5 8 92.4 8 92.8 8 97.5 8 97.8 5 95.5 8

44 37 83 73 74 64 46 38 80 74 46 39 47 40 17 17 97 82 88 76 61 54 47 42 63 52 76 68 97 86 67 58

2010- Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka, Punjab 2015- Karnataka, Maharashtra, Punjab, Rajasthan.

States with under 5 mortality >60

2010- Assam, Bihar, Haryana, Madhya Pradesh, Orissa, Maharashtra, Rajasthan, Uttar Pradesh, West

Bengal.

2015- Assam, Bihar, Haryana, Madhya Pradesh, Orissa, West Bengal.

56

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Table 3.8 (b): Estimated trends of U5MR (2010-15) in states of India (male) assuming

minimum level of U5MR of 17 Model: ln (U5MR-17) =a+ b*t

Regression Results Projected IMR for

5State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Himachal Pradesh

Karnataka

Kerala

Madhya Pradesh

Orissa

Maharashtra

Punjab Rajasthan

Uttar Pradesh

West Bengal

4.5412 4.9307 4.7617 4.7128 4.3792 4.3488 4.6482 3.1469 5.14989 5.0575 4.3123 4.1995 4.9505 4.8176 4.4872

-0.0468 -0.0348 -0.0372 -0.0585 -0.0177 -0.0354 -0.0539 -0.2378 -0.0309 -0.0369 -0.047 -0.0444 -0.0463 -0.0294 -0.0348

89.8 8 78.9 8 63.3 8 99.3 8 66.5 8 86.5 8 87.4 8 94.5 6 96.5 8 97.9 8 94.9 8 96.9 8 92.6 8 96.8 5 98.6 8

51 44 81 71 69 60 48 40 71 66 53 47 49 41 17 17 104 92 87 75 44 38 42 37 68 57 84 69 58 52

2015- Andhra Pradesh, Gujarat, Himachal Pradesh, Kerala

States with under 5 mortality 40-60

2010- Andhra Pradesh, Gujarat, Himachal Pradesh, Karnataka, Punjab

2015- Karnataka, Maharashtra, Punjab, Rajasthan.

States with under 5 mortality >60

2010- Assam, Bihar, Haryana, Madhya Pradesh, Orissa, Maharashtra, Rajasthan, Uttar Pradesh, West Bengal.

2015- Assam, Bihar, Haryana, Madhya Pradesh, Orissa, West Bengal.

57

Progress and Prospects of Millennium Development Goals in India Table 3.8 (c): Estimated trends of U5MR (2010-15) in states of India (female) assuming

minimum level of U5MR of 17 Model: ln (U5MR-17) =a+b*t

Regression Results Projected U5MR for

State b0 b1 R2 N 2010 2015

Andhra Pradesh

Assam

Bihar

Gujarat

Haryana

Himachal Pradesh

Karnataka

Kerala

Madhya Pradesh

Orissa

Maharashtra

Punjab Rajasthan

West Bengal

Uttar Pradesh

INDIA

4.5572 5.7019 4.9476 4.8317 4.6831 4.5785 4.6041 3.6358 5.2789 5.089

4.2983 4.4325 5.1697 4.4917 5.0923 4.8567

-0.0684 -0.1621 -0.0381 -0.0569 -0.0196 -0.0673 -0.0484 -0.6371 -0.0402 -0.0375 -0.0448 -0.0351 -0.057

-0.031

-0.0469 -0.0387

94.6 8 43.0 8 63.3 8 92.3 8 38.8 8 91.5 8 93.4 8 94.3 6 96.8 8 82.7 8 88.8 8 84.1 8 90.8 8 93.0 8 90.2 5 96.3 8

38 32 25 21 78 67 53 44 87 81 39 33 51 44 17 17 98 83 88 76 44 39 56 50 67 55 62 56 88 78 72 62

58

Chapter 3 : Trends and prospects of infant mortality, child mortality and maternal mortality in India and states Table 3.9: Estimates of under five mortality rates for India and states using SRS Data

Under Five Mortality Rates

States Year 1986-1990 1987-1991 1988-1992 1989-1993 1990-1994 1991-1995 1992-1996 1993-1997

Mid-Year 1988 1989 1990 1991 1992 1993 1994 1995 India Male 126 125 119 112 109 108 105 102

Female 142 138 132 124 120 119 116 113 Person 137 132 125 118 114 113 111 107

Andhra Pradesh Male 110 105 97 89 90 88 85 84 Female 109 101 96 87 80 79 77 75 Person 108 103 97 88 84 84 81 79

Assam Male 145 145 143 139 141 136 121 117 Female 657 146 140 135 133 137 124 123 Person 150 145 141 137 134 138 123 120

Bihar Male 142 127 117 109 107 109 111 110 Female 168 147 139 129 123 126 131 128 Person 152 136 128 119 115 114 121 119

Gujarat Male 124 116 110 104 99 95 91 88 Female 140 131 123 113 106 103 103 101 Person 134 123 116 108 102 99 89 94

Haryana Male 97 96 93 88 87 88 88 89 Female 133 122 115 110 110 110 113 117 Person 111 110 104 98 98 98 100 102

Hl Pradesh Male 94 88 87 80 82 83 77 75 Female 109 101 100 94 82 77 79 77 Person 101 94 91 86 82 80 78 76

Karnataka Male 108 111 110 105 100 95 87 81 Female 107 109 105 103 96 93 87 83 Person 114 110 107 104 98 94 87 82

Kerala Male 34 32 30 26 23 23 21 19 Female 33 29 25 20 18 18 17 17 Person 34 31 27 23 20 20 19 18

Madhya Pradesh Male 181 179 177 169 166 163 154 150 Female 199 201 194 185 178 173 164 157 Person 195 192 185 176 172 168 159 153

Orissa Male 171 164 154 152 147 144 138 135 Female 171 170 159 155 150 159 142 131 Person 170 170 167 153 150 150 140 133

Maharashtra Male 88 87 83 76 74 74 71 69 Female 92 82 80 75 76 75 72 68 Person 87 84 81 75 75 590 71 69

Punjab Male 81 78 76 73 68 69 66 64 Female 103 95 92 87 85 84 83 84 Person 92 86 84 80 75 76 74 73

Rajasthan Male 151 150 144 128 125 124 121 116 Female 181 182 172 149 142 139 137 133 Person 173 165 157 138 133 130 128 124

Tamil Nadu Male 92 85 . 73 67 65 61 58 Female 105 90 . 75 68 67 64 62 Person 670 87 . 74 67 66 63 60

Uttar Pradesh Male 169 155 . 136 134 131 127 123 Female 203 189 . 171 164 160 157 142 Person 185 171 . 152 147 145 141 136

West Bengal Male 104 100 97 93 91 89 87 85 Female 105 101 97 93 95 93 89 86 Person 42 100 97 93 93 91 88 85

59

Progress and Prospects of Millennium Development Goals in India Table3.10: Estimates of Maternal Mortality Ratio for 15 major states of India,

1992-93, 1998-99, and 2003-04.

Sl. No. State 1992-1993 1998-1999 2003-2004 SRS 2003

1 Andhra Pradesh 417 341 164 195

2 Assam 867 762 ** 490

3 Bihar 830 714 460 371

4 Gujarat 464 393 158 172

5 Haryana 593 468 293 162

6 Karnataka 408 364 195 228

7 Kerala 271 262 20 110

8 Madhya Pradesh 597 601 179 379

9 Maharashtra 395 365 349 149

10 Orissa 786 552 352 358

11 Punjab 423 351 98 178

12 Rajasthan 752 526 354 445

13 Tamil Nadu 320 284 53 134

14 Uttar Pradesh 892 737 437 517

15 West Bengal 557 451 358 194

16 India 5 4 3 4 6 6 304 301

Note: Estimates of MMR for India and its major States were derived by putting the

values of percentage safe deliveries in 1992-93 (NFHS-1) 1998-99 (NFHS-2) and RCH –Phase 2

(2003-04) in the following regression equation: ln (MMR)= 8.845 - 0.721 ln (safe delivery).

** Data was not available for estimation.

60

CHAPTER IV

LEVELS AND TRENDS IN POVERTY RATIO IN INDIA AND MAJOR STATES

4.1. Introduction The millennium declaration set the target to reduce the levels of poverty and hunger to half by 2015

from the levels observed in 1990. The corresponding indicators for quantifying the goal are percentage

of population living below the poverty line, proportion of the population with income less than one

dollar a day and the poverty gap ratio. In India, there are a number of organizations, institutions and

individuals that have estimated the poverty level for the country and its major states. Of these estimates,

the Planning Commission estimates are official, periodic and derived by using the consumption

expenditure data collected by National Sample Survey Organization. According to these estimates,

the reduction in the poverty level has been quite substantial during 1973-74 to 2004-05 for the

country as a whole. For example, the percentage of population living below the poverty line for India

has declined from 55% in 1973-74 to 26% by 1999-2000 and further 22% by 2004-05 based on

Mixed Recall Period. The pace of decline was not uniform across the states of India as some states

experienced a more rapid decline while others had stagnated. In this chapter we have examined the

levels and trends in the poverty estimates in India and its major states and have also attempted to

project the future scenario. Accordingly, we have estimated the percentage of population below

poverty line for the periods 2004-05, 2009-10 and 2014-15. Further, we have also estimated the

absolute numbers of the poor population in the country and states for the respective periods. 4.2. Methodology We have used the regression approach for deriving the future poverty estimates. For this, the poverty

estimates for the years 1983, 1987-88, 1993-94 and 1999-2000 are used to obtain regression

coefficients. Based on these coefficients we have projected the levels for successive years. Separate

regression equations have been derived for each of the major states of India. In the regression

61

Progress and Prospects of Millennium Development Goals in India

equation, we have assumed five percent as the minimum level poverty at any point of time. This is

assumed as the state of Punjab has recorded the lowest poverty level of 6.16 per cent for the year

1999-00. The regression equation used in projecting poverty is given in chapter 1. In order to arrive

at the absolute population below the poverty line, the projected population by the Registrar General

of India (RGI, 1996) for the respective years has been used. It may be pointed out that the population

used for the years 2004-05, 2009-10 and 2014-15 refers to population as of 1st March of the

respective years. 4.3. Levels and trends in poverty estimates: India The trends in poverty levels for the period 1973-74 to 2014-15 are given in table 4.1. Based on the

trends, a reduction by almost 20 points is observed in last two decades. In other words, the percentage

of population below poverty line had declined by almost one point annually in the seventies and

eighties. The nineties exhibited a much faster decline in the poverty levels for India as the levels

reduced from 36% to 26% by 1999-2000 (on 30 day recall basis), a 10 point decline in just 6 years.

The projected levels shows that the levels are expected to come down to about 8 per cent by the

year 2014-15 (a level much lower than stipulated in the MDG). The country would achieve the

target of poverty reduction if the trends continued. In terms of absolute numbers, at the beginning of

the present century there were about 255 million persons living below the poverty line which is

expected to decline to about 139 million by 2009-10 and further to 95 million by 2014-15. The

implication is that more programmatic interventions are required in order to eradicate poverty from

the country.

The Planning commission, Government of India has estimated poverty levels for India and the states

for the year 2006-07. It has estimated that the poverty levels by taking into account per capita

income of the state, agricultural yield, per capita plan expenditure incurred by the state and the

poverty line of the state. According to Planning Commission projections, during 2006-07, a little

over 19 percent of the India’s population is expected to live below poverty line (Planning commission 2003). Our estimate is quite close to the one given by the planning commission (at 18 percent).

62

Chapter 4 : Levels and trends in poverty ratio in India and major states

Note: 1. Figures for the years 1973-73 to 1999-00 are taken from Planning Commission 2. Figures for the years 2004-05, 2009-10 and 2014-2015 are projected using time trends.

4.4. Levels and trends in poverty estimates: Inter-state variations

Table 4.2 provides poverty levels for major states of India along with the absolute number of population below the poverty line for the period 1973-74 through 2014-15. We have arranged the states in the ascending order of poverty levels of the year 2014-15. It is evident that the levels as well as changes in the poverty ratios vary substantially across the states of India. According to 1999-00 estimates based on the 30 days recall period, Orissa recorded the highest percentage of population below the poverty line (over 47 per cent) followed by Bihar (nearly 43 per cent) and Madhya Pradesh (over 37 percent). Punjab and Haryana, on the other hand, have a much less percentage of the population living below the poverty line (6 and 9 per cent respectively). The projected levels reveal that the percentages of population living below the poverty line would come down to 16 per cent or less for all states except Assam by the year 2014-15. In fact, for the states of Punjab, Kerala, Haryana, Gujarat, Rajasthan, Tamil Nadu, Andhra Pradesh, Karnataka and West Bengal, the poverty levels

63

Progress and Prospects of Millennium Development Goals in India

are expected to come down in the range of 5 to 6 per cent by the year 2014-2015. For Maharashtra and Uttar Pradesh, these estimates are expected to reach the levels of 7 and 11 per cent respectively. On the other hand, the poverty levels are expected to be in the range of 15 to 16 per cent in Orissa, Bihar and Madhya Pradesh. It needs to be emphasized here that all these states are expected to lag behind what is desired in the millennium development goals (col. 8 in table 4.2). Assam is the only state where the percentage of population below the poverty line is expected to be in the range of over 29 per cent by 2014-15 (a level far above the MDG goal). Our estimates show that during 2014-15, about half of the country’s total population below the poverty line would be living in the states of Uttar Pradesh and Bihar.

4.5. Poverty and Hunger: India and States Poverty levels have been closely associated with the nutritional status of the population. Besides, populations with higher incidence of poverty are also likely to have higher levels of underweight children (an indicator of hunger). In the Indian context, with poverty estimates given by the planning commission and weight for age data (as the indicator of nutrition) from the National Family and Health Survey, it is observed that the states having higher incidence of poverty have higher prevalence of underweight children of aged three years. At the same time states that have exhibited relatively lower levels of poverty too have higher incidence of underweight children. This indicates that the reduction in poverty level does not necessarily guarantee reduction in the extent of hunger.

Using the data in table 4.2 and Table 2.4, we have plotted the poverty ratios for the period 1993-94 and underweight children aged three years of 1992-93 and the poverty ratio of 1999-2000 with underweight children aged three years of 1998-99. The pattern is quite similar for both the periods

(i.e., 1992-93 and 1998-99). The proportion of underweight children is substantially higher for states with higher levels of poverty. At the same time, it is also high in many of the states where poverty levels are relatively lower. For example, the states of Orissa, Madhya Pradesh and Bihar have higher levels of both poverty and hunger, whereas in the states of Haryana, Punjab, Maharashtra and Gujarat the extent of hunger is high despite relatively lower levels of poverty ratios. From this we can say that reduction in poverty levels alone would not necessary yield a reduction in the incidence of hunger. In order to bring down the incidence of hunger, the program has to focus beyond targeting poverty reduction.

64

Chapter 4 : Levels and trends in poverty ratio in India and major states

Fig : Poverty Ratio and Underweight of Children in India, 1999 -2000

Fig : Poverty Ratio and Underweight of Children in India, 1992 -1993

65

Progress and Prospects of Millennium Development Goals in India Table 4.1: Trends in the Percentage of Population below Poverty line and absolute

number of poor in India, 1973-74 to 2014-15

Percentage of population Population below poverty line Year

1973-74

1977-78

1983

1987-88

1993-94

Planning commission estimates

54.9

51.3

44.5

38.9

36.0

321.3

328.9 322.9 307.1 320.3

Projected percentage and number of population below poverty line

2004-05

2009-10

2014-15

23.69

11.98 7.61

255.11

139.23 94.76

Table 4.2: Levels and Trends in Percentage of Population below Poverty Line

Poverty

Annual

Poverty

Annual

Combined

Reduction Reduction Reduction Reduction in 6 years in Poverty in 6 years in Poverty

States / India

1973-74 1983 1987-88 93-94 99-00 1987-88&1993-94 1993-94 & 1999-00

1 2 3 4 5 6 7 8 9

10 11 12 13 14 15

Andhra P. Assam Bihar Gujarat Haryana Karnataka Kerala Madhya P. Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar P. West Bengal

48.86 51.21 61.91 48.15 35.36 54.47 59.79 61.78 53.24 66.18 28.15 46.14 54.94 57.07 63.43

28.91 40.47 62.22 32.79 21.37 38.24 40.42 49.78 43.44 65.29 16.18 34.46 51.66 47.07 54.85

25.9 36.2 52.1 31.5 16.6 37.5 31.8 43.1 40.4 55.6 13.2 35.2 43.4 41.5 44.7

22.19 40.86 54.96 24.21 25.05 33.16 25.43 42.52 36.86 48.56 11.77 27.41 35.03 40.85 35.66

15.77 36.09 42.6 14.07 8.74 20.04 12.72 37.43 25.02 47.15 6.16 15.28 21.12 31.15 27.02

3.71 -4.66 -2.86 7.29 -8.45 4.34 6.37 0.58 3.54 7.04 1.43 7.79 8.37 0.65 9.04

0.62 -0.78 -0.48 1.22 -1.41 0.72 1.06 0.10 0.59 1.17 0.24 1.30 1.40 0.11 1.51

6.42 4.77 12.36 10.14 16.31 13.12 12.71 5.09 11.84 1.41 5.61 12.13 13.91 9.7 8.64

1.07 0.79 2.06 1.69 2.72 2.19 2.12 0.85 1.97 0.24 0.94 2.02 2.32 1.62 1.44

16 All India 54.88 44.48 38.9 35.97 26.1 2.93 0.49 9.87 1.65

Source: Planning commission, Govt of India.

66

Chapter 4: Levels and trends in poverty ratio in India and major states Table 4.3: Projected trends in the percentage of population below poverty line for major

states of India, 2000-15.

* Estimates by Planning commission, Govt. of India.

Major State/

Regression

Base

Projected Percentage of Popula-

Target

Projected Absolute Population

India Co-efficient Level * tion Below Poverty Line MDG below Poverty Line (in Lakhs)

Col 1

Punjab Kerala Haryana Gujarat Rajasthan Tamil Nadu Andhra P. Karnataka West Bengal Maharashtra Uttar P. Orissa

Bihar

Madhya P.

Assam

India

Col 2

A 3.392 4.1896 3.3614 3.8608 3.9219 4.2769 3.5058 3.889 4.2037 3.9341 3.9061 4.1905 4.1595 3.8823 3.5705 3.9129

Col 3

B

-0.6989 -0.4842 -0.3882 -0.3681 -0.3457 -0.3434 -0.2588 -0.2522 -0.271 -0.2062 -0.1444 -0.1224 -0.1201 -0.0983 -0.0256 -0.197

Col 4

1999-00

6.16

12.72

8.74

14.07

15.28

21.12

15.77

20.04

27.02

25.02

31.15

47.15

42.6

37.43

36.09

26.1

Col 5

2004-05

5.90 10.86

9.14

12.54

13.97

17.93

14.13

18.85

22.27

23.23

29.15

40.82

40.13

34.69

36.27

23.69

Col 6

2009-10

5.03

5.52

5.59

6.20

6.59

7.32

7.50

8.92

9.45 11.50

16.73

24.42

24.27

23.16

32.51

11.98

Col 7

2014-15

5.00

5.05

5.09

5.19

5.28

5.42

5.69

6.11

6.15

7.32

10.70

15.53

15.57

16.11

29.20

7.61

Col 8

By 2015

5.89

12.72

12.10

27.48

13.71

17.52

17.98

16.58

17.83

18.43

20.43

24.28

20.43

21.46

11.09

12.53

Col 9

2004-05

15

37

20

65

82

115

113

104

187

223

554

153

438

302

101

2551

Col 10 2009-10

13

20

13

34

42

49

63

53

85

117

355

96

289

220

98

1392

Col 11 2014-15

14

18

13

30

37

38

50

38

58

78

254

63

202

167

94

948

Note: 1. The regression coefficients have been derived using poverty estimates of the Planning Commission

for the years 1983, 1987, 1993-94 and 1999-2000.

2. The absolute population has been obtained by applying the projected proportion of population

below poverty lines on the projected population for States by the Expert Committee established by

the Registrar General of India, 1996.

67

CHAPTER V

RELATIVE ROLE OF SELECTED FACTORS IN REDUCING CHILD MORTALITY (SEQUENCING)

5.1. Introduction A number of strategies have been by central and state government to reduce infant mortality and child mortality in India. It is often discussed on how to priorities the investment needs due to limited resources. The government policy generally focus on different fronts such as mother’s education, mother and child health care (ante-natal care, safe delivery, post natal care, new born care, immunization of children etc) and increasing the purchasing power of the household. Empirical research suggests that infant death is affected by both exogenous and endogenous factors. The endogenous factors are mainly biological in nature and contribute to more than 60 per cent to infant mortality. The exogenous factors are social, cultural, economic as well as environmental factors and may be reduced fast. In addition, the utilization of health services does affect child survival to a larger extent. In this chapter, we are interested to see the relative contribution of various factors in reduction of infant and child mortality.

Accordingly, this chapter examines the role of different factors in reducing the infant mortality. The inter-relationship of child mortality and key variables is generally complex and it becomes very difficult to infer the key factor conclusively. We started by examining the simple linear regression between selected variables. We have conceptualized the relationship of infant mortality with a set of independent variables and use the following regression equations.

Model 1: IMR01 = a+ b Flit01

Model 2: IMR Model 3: IMR 01= a + bPov 99_00

01= a + b safedel 98_99

Model 4: IMR 01= a + b ANC 98_99 where

IMR 01: infant mortality rate in2001 (per 1000 live birth)

Flit01: female literacy in 2001 (percentage) Pov99-00: percentage of population living below the poverty line in 1999-2000 Safedel ANC 98_99: percentage of safe delivery in 1998-99

98_99: Antenatal care (at least three) in 1998-99 The unit of analysis is the state or union territories for which the estimates of IMR are available.

68

Chapter 5: Relative role of selected factors in reducing child mortality (Sequencing)

5.2. Result of Regression Models with one explanatory variable The fitted models given in the table 5.1 indicate that the female literacy is the critical variable in

explaining the IMR. In model 1, the coefficient is -1.17 and statistically significant. Moreover the

regression equation suggests that female literacy explains 56 percent variation in IMR. The second

equation includes only poverty as the explanatory variable of IMR. The relationship of infant mortality

and poverty is very weak. It only explains 17 percent variation in IMR. However, in case of safe

delivery the R2 value increases compared to poverty. There may be a number of questions as health

status and program utilization strongly related to standard of living of household measured in terms of

assets. These variations are subject to the measurement issues related to poverty and, secondly,

acute and chronic poverty may only lead to more deaths. Table 5.1: Result of OLS with IMR as dependent variable and poverty, female literacy,

safe delivery and ANC as explanatory variable

Parameters/characteristics Model 1 Model 2 Model 3 Model 4

Regression coefficient -1.17 0.7072 -.6955 -.6151

T stat of regression coefficient -6.45 2.488 -4.38 -4.278

Intercept 120.83 34.17 86.99 86.48

R 2 55.8 17.1 45.5 44.3

No of observation 35 32 25 25 5.3. Result of Regression models with more than one explanatory variable

In second step some more explanatory variables are added to examine the change in the predictability

of the model. In the first step, poverty is added to female literacy. Safe delivery is added in model 2

where as ANC is added in model 3. The regression equations are given below. Model 1: IMR01 = a+ b Flit01 + c Pov 99_00

Model 2: IMR01= a+ b Flit01 + c Pov 99_00 + d safedel 98_99

Model 3: IMR01= a+ b Flit01 + c Pov 99_00 +d safedel 98_99 + e ANC 98_99

69

Progress and Prospects of Millennium Development Goals in India Table 5.2: Result of OLS with IMR as dependent variable and poverty, female literacy,

safe delivery and ante natal care as explanatory variable

Parameters/characteristics Model 1 Model 2 Model 3

Regression coefficients b -1.114 -0.755. -.735 c 0.215 .00531 0.0476 d -0.333 -0.185 e 0.154 T statistic b -5.27 -2.16 -2.04 c 0.948 .168 .147 d -1.35 -.42 e -.41

Intercept (a) 112.5 112.61 112.66

R 2 57.7 55.5 55.9 No of observation 32 25 25

Due to a high correlation of female literacy and program utilization, an addition of a variable in the

regression model does not add to the power of prediction and one may say that female education

would be the key to bring about the changes in health status of children. We have also mentioned

about the complexity of the relationship that cannot be understood with areal data. Therefore we

have analyzed National Family and Health Survey 1 and 2 data to understand the relative importance.

The results are presented in tables 5.3 - 5.6. 5.4. Relative role of factors in reducing the Infant Mortality Rate In this section the NFHS data is used to examine the role of different factors in reducing the IMR.

Table 5.3 describes the child mortality (12-59 months) with the characteristics of women when all

the remaining variables are controlled at their average level. Although the probability of child mortality

decreases with increasing levels of education and also standard of living, it varies in magnitude. Child

mortality is above the average level (8.0 percent) among both illiterate (9.2 percent) and among low

standard of living (9.4 percent) women. With higher level of education ( middle school complete

compared to literate), the decline of 2.5 percent occurs in child mortality and the value reaches the

level of 6.7 percent, but in the case of low to medium standard of living, the decline is about 1.7

70

Chapter 5: Relative role of selected factors in reducing child mortality (Sequencing) Percent. It declines by 7.7 percent in case of high SLI. Further, the important finding is that if the

education of women enhanced up to middle school complete and increases the standard of living

from low to medium, the decline in child mortality from the average level occurs around 1.3 percent

and only around 0.3 percent respectively. It clearly indicates the positive role of education on the

decline in child mortality. Similarly, the decline among the high school and above educated women

occurs around 3.4 percent whereas around 2.8 percent decline occurs in the high standard of living

women from the average level. Further, it may be noted that the decline in child mortality is more as

standard of living increases from medium to high school complete. Overall, the conclusion is that

education of women contributes more towards a decline in child mortality compared to the standard

of living. Further, there is a threshold level when the impact is more visible.

71

Progress and Prospects of Millennium Development Goals in India

Table 5.3: Logit Estimates of the Probability of deaths of children aged 0-11 months and 12-59 months, India, 1992-93 and 1998-99

Explanatory Infant Deaths (0-11 months) Child mortality (12-59 months)

NFHS –1 NFHS –2 NFHS –1 NFHS –2

Region (North) Central East Northeast West South

Type of Residence (Rural) Urban Religion (Hindu) Others Education (Imitate) <=Middle school >= High School

Caste (Scheduled caste) Scheduled tribe Other

Birth Order (One) Two Three Four and above

Working Status (No) Yes

Standard of living (Low) Medium High

Place of Delivery (Other) Institutional Missing Intercept

B (1)

0.124 0.049 0.035 -0.038 -0.080

0.008 -0.301* -0.274*- 0.750*

-0.206 -0.063

-0.391*- 0.866*- 0.492*

0.207** -0.104- 0.521*

-0.394* 0.095

-2.091*

Exp (B) (2)

1.132 1.050 1.035 0.962 0.923

1.008

0.740

0.760 0.472

0.814 0.939

0.676 0.421 0.611

1.230

0.902 0.594

0.675* 1.099

0.124

B (3)

0.136 -0.129 -0.181 -0.295- 0.481*

-0.056

-0.040

-0.312 -0.266

-0.133 -0.146

0.262**

0.088 -0.073

0.558*

-0.126- 0.771*

0.256** 4.977*

-2.755*

Exp (B) (4)

1.146 0.879 0.834 0.744 0.618

0.945

0.961

0.876 0.766

0.876 0.864

1.300 1.092 0.930

1.746

0.882 0.462

1.291 145.038

0.064

B (1)

0.328* 0.262* 0.045-

0.156**- 0.206

-0.070 -0.185*

-0.396* -0.759*

-0.170* -0.101** -0.222* -0.239* -0.133*

0.076** -0.300* -0.434*

- -

-1.893*

Exp (B) (2)

0.388 0.299 0.146 0.856 0.813

0.932

0.831

0.673 0.468

0.844 0.904

0.801 0.787 0.875

1.079

0.741 0.648

- -

0.151

B (3)

0.202- 0.133**- 0.256*- 0.375*- 0.365*

-0.127*

-0.114** -0.352* - 0.793*

0.130** -0.025

0.08 -0.124** -0.185*

0.081** -0.221*- 0.657*

- -

-1.950*

Exp (B) (4)

1.224 0.875 0.774 0.688 0.694

0.881

0.892

0.703 0.453

1.139 0.975

1.083 0.884 0.831

1.085

0.802 0.519

- -

0.142

Note: - Reference category is shown in parentheses.

**P<=0.05 (two-tailed t-test).

*P<=0.01 (two-tailed t-test).

72

Chapter 5: Relative role of selected factors in reducing child mortality (Sequencing) Table 5.4: Decomposition of changes in mortality of children aged 0-11 months, India,

1992-93 and 1998-99

Explanatory Variables

Proportion of overall change due to change in composition, Composition Propensity Interaction

Region of Residence 0.01 -1.41 0.04 Type of Residence -0.001 -0.17 0.01 Religion -0.03 0.64 0.03 Education -0.31 1.02 0.19 Caste 0.003 -0.52 0.07 Birth Order -0.25 4.64 0.56 Working Status 0.04 0.83 0.07 Standard of living -0.48 -0.38 -0.19 Place of Delivery -1.07 25.36 -22.90 Intercept -6.79 Total -2.10 23.21 -22.12 Percentage of Absolute Change 0.044 0.49 0.47

Table 5.5: Decomposition of changes in mortality of children aged 12-59 months, India, 1992-93 and 1998-99

Explanatory Variables Proportion of overall change due to change in composition,

Composition Propensity Interaction

Region of Residence 0.004 -1.44 -0.01 Type of Residence 0.005 -0.12 0.005 Religion -0.03 0.14 0.01 Education -0.19 0.06 0.002 Caste 0.04 0.77 -0.001 Birth Order -0.10 0.63 0.22 Working Status 0.02 0.01 0.002 Standard of living -0.55 0.001 -0.02 Intercept -0.46 Total -0.79 -0.42 0.21 Percentage of Absolute Change 0.56 0.30 0.15

Table 5.6: Estimated child mortality (12-59 months) in percent, by selected individual characteristics, India, 1998-99

Variable Child mortality

(in percent) No change 8.0 Education 9.2 Illiterate 6.7 Middle School Complete High School complete 4.6 And above Standard of living Low 9.4 Medium 7.7 High 5.2

73

Progress and Prospects of Millennium Development Goals in India

References

Graham Wendy et.al (1989), “Estimating maternal mortality: The sisterhood method’, Studies in Family Planning, 20b (3): 125-136.

Jejeebhoy, Shireen (1997). “Maternal Mortality and morbidity in India: Prioritizing for social science research’, The Journal of Family Welfare, 43(2):31-52

Ministry of Finance, Govt of India, Economic Survey (1999).

Mohanty S.K and F. Ram (2004) Methodological Issues and Evidences on the State of Human Development in India, in Roy. T.K., M.Guruswamy and P.Arokiasamy (eds.), Population, Health and Development in India, Changing Perspectives, Rawat Publication, Jaipur.

National Human Development Report (2002). Planning Commission, Govt of India

RGI. 2002. Sample Registration System, Statistical Report 1999. New Delhi: RGI. RGI. 2007. SRS Base Abridged Life Table 2002-06 India, New Delhi: Office of the Registrar General and Census Commissioner.

RGI. 2007. SRS Bulletin, Volume 42, No.1, October 2007.

RGI. 2003. Maternal Mortality in India: 1997-2003 Trends, Causes and Risk Factors. Sample Registration System. Registrar General, India, New Delhi

Planning Commission, Govt of India (2003). India’s Five Year Plans, First five Year Plan to Tenth Five Year Plan, Academic Foundation, New Delhi

Planning Commission (2007). Poverty estimates for 2004-05, accessed on line: http:// planningcommission.nic.in/news/prmar07.pdf.

Rosenfield A and Maine D (1985). Maternal mortality – a neighborhood tragedy: Where is the M in MCH?’, Lancet, 2(8):83-85

Ram F (1995). “Maternal Mortality and its demographic Determinants”, Post Doctoral Thesis submitted to The Rockefeller Foundation, New York.

UN (2003), Indicators for Monitoring the Millennium Development Goals: Definitions, Rationale, Concepts and Sources.

UNDP (2005), Human Development Report, OUP

WHO (2000). Maternal Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA. Geneva: WHO.

WHO (1986), Bulletin of Regional Health Information, Delhi, WHO. Southeast Asia Regional Office.

74

Goal 1

Appendix 1.1 Data Source, Periodicity and constraints in Measuring MDG: India

Goal/Indicators Data Source

Eradicate extreme poverty & hunger

Target

1-2

Goal 2

Target 3

Goal 3

Target 4

Goal 4

Target 5

Goal 5

Target 6

Goal 6

Target 7

1. a. Proportion of population below $1 a day

1b. Poverty headcount ratio (% of population below poverty line)

2. Poverty gap ratio (incidence time’s depth of poverty)

3. Share of poorest quintile in national consumption

4. Prevalence of underweight in children

(under five years of age)

5. Proportion of population below minimum level of dietary energy consumption.

Achieve universal primary education 6. Net enrolment ratio in primary education.

7a. Proportion of pupils starting grade 1 who reach grade V

7b. Primary Completion Rate 8. Literacy rate of 15-24 year olds. Promote gender equality & empower women.

9. Ratio of girls to boys in primary, secondary, & tertiary education.

10. Ratio of literate females to males among

15 to 24 year olds.

11. Share of women in wage employment in the non-agricultural sector.

12. Proportion of seats held by women in national parliament.

Reduce child mortality. 13. Under-five mortality rate. 14. Infant mortality rate.

15. Proportion of 1 year-old children immunized against measles.

Improve maternal health. 16. Maternal mortality ratio.

17. Proportion of births attended by skilled health personnel

Combat HIV/AIDS, malaria, & other diseases

18. HIV prevalence among 15 to 24 year old pregnant women.

19a.Condom use rate of the contraceptive prevalence rate

World Bank estimates based on country data. Planning Commission, Govt of India estimates based on consumer expenditure data collected by NSSO. However, these estimates are often debated owning to reference period, fixed price level etc. Various rounds of National Family Health Surveys. Estimates by Food and Agricultural Organization as country level data are not available.

Various rounds of National Family Health Surveys and Selected rounds of National Sample Survey Selected educational statistics, ministry of human resources development, Govt. of India Various rounds of National Family Health Survey and Selected rounds of National Sample Survey

Various rounds of National Family Health Surveys. Efforts may be made to improve the methodology for indirect estimates. Data from published reports and records of election Sample Registration System and Various rounds of National Family Health Surveys. Various rounds of National Family Health Surveys.

Sample Registration System, indirect estimates.

Various rounds of National Family Health Surveys. National Family Health Survey 3 National Family Health Survey 3.

75

Appendix 1.1 continued

19b.Percentage of population aged 15-24 with comprehensive correct knowledge of HIV/ AIDS Contraceptive prevalence rate.

Target 8

Goal 7

Target 9

Target

10

Target

11

Goal 8

19c. Contraceptive prevalence rate

20. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14.

21. Prevalence & death rates associated with malaria.

22. Proportion of population in malaria risk areas using effective malaria prevention

& treatment measures.

23. Prevalence & death rated associated with tuberculosis.

24. Proportion of tuberculosis cases detected & cured under directly observed treatment, short course (DOTS)

Ensure environmental sustainability. 25. Proportion of land area covered by forest

26. Ratio of area protected to maintain biological diversity to surface area

27. Energy use (kg oil equivalent) per $1 GDP

(PPP)

28. Carbon dioxide emissions (per capita) and consumption of ozone-depleting CFCs (ODP tons).

29. Proportion of population using solid fuels

30. Proportion of population with sustainable access to an improved water source, urban and rural.

31. Proportion of urban and rural population with access to improved sanitations

32. Proportion of population with access to secure tenure

Develop a global partnership for development. Official development assistance (ODA)

33. Net ODA total and to LDCs as a percentage of OEDC/DAC donors’ to basic social service (basic education, primary health care, nutrition, safe drinking water and sanitation)

34. Proportion of ODA for basic social services (basic education, primary health care, nutrition, safe water, & sanitation).

35. Proportion of bilateral ODA for the environment in small island developing states.

36. Proportion of ODA for transport sector in landlocked countries.

Various rounds of National Family Health Surveys.

Not Available Cause of death statistics Indicator 25-26: Forest Statistics of India and Compendium of Environmental Statistics from Govt. of India. Indicator 27- 28: Pollution control Board. Various rounds of National Family Health Surveys and Census of India State government record Various departments of central government and World Bank publications

76

Appendix 1.1 continued

Target 16

Target 17 Target 18

Market access

38. Proportion of exports (by value, excluding arms) admitted free of duties & quotas.

39. Average tariffs & quotas on agricultural product textiles & clothing.

Domestic & export agricultural subsidies in OECD countries.

Proportion of ODA provided to help build trade capacity.

Debt sustainability

Proportion of official bilateral HIPC debt cancelled.

Debts service as a percentage of exports of goods & services.

Proportion of ODA provided as debt relief. Number of countries reaching HIPC decision & completion points Unemployment rate of 15 to 24 years old. Proportion of population with access to affordable, essential drugs on a sustainable basis.

Telephone line per 1000 people Personal computer per 1000 people

Various department of central government and World Bank publications

various rounds of National Sample Surveys

National Family and Health Survey 3

a. Some indications, particularly for goals 7 & 8, remain under discussion, additions or revisions to the list may be made in the future.

b. Only one form of contraception-condoms-is effective in reducing the spread of HIV. The Millennium Development Goals and targets come from the Millennium Declaration signed by 189 countries, including 147 Heads of State, in September 2000 (www.un.org/documents/ga/res/55/a55r002.pdf - A/RES/55/2). The goals and targets are inter-related and should be seen as a whole. They represent a partnership between the developed countries and the developing countries determined, as the Declaration states, “to create an environment – at the national and global levels alike – which is conducive to development and the elimination of poverty.” a for monitoring country poverty trends, where available indicators based on national poverty lines should be used. b Amongst contraceptive methods, only condoms are effective in preventing HIV transmission. The contraceptive prevalence rate is also useful in tracking progress in other health, gender and poverty goals. Because the condom use rate is only measured amongst women in union, it is supplemented by an indicator on condom use in high-risk situations (indicator 19a) and an indicator on HIV/AIDS knowledge (indicator 19b). c This indicator is defined as the percentage of population aged 15-24 who correctly identify the two major ways of preventing the sexual transmission of HIV (using condoms and limiting sex to one faithful, uninfected partner), who reject the two most common local misconceptions about HIV transmission, and who know that a healthy- looking person can transmit HIV. However, since there are currently not a sufficient number of surveys to be able to calculate the indicator as defined above, UNICEF, in collaboration with UNAIDS and WHO, produced two proxy indicators that represent two components of the actual indicator. They are the following: a) Percentage of women and men 15-24 who know that a person can protect herself from HIV infection by “consistent use of condom”. b) Percentage of women and men 15-24 who know a healthy-looking person can transmit HIV. Data for this year’s report are only available on women. d Prevention to be measured by the percentage of children under 5 sleeping under insecticide-treated bed nets; treatment to be measured by percentage of children under 5 who are appropriately treated. e An improved measure of the target is under development by ILO for future years.

77