What gets measured, gets managed

Introduction : Maternal And Child Health Care

The status of women in UP leaves much to be desired. The sex ratio as per the 1991 census was 879 females per 1,000 males as compared to 927 in the country as a whole. The mortality estimates for the period 1990-94 indicate that the expectation of life for females is lower than that of males. The maternal mortality ratio, which measures the extent of women dying due to maternal causes within 6 weeks of delivery, is the highest among all states. In 1997, there were an estimated 707 maternal deaths per 100,000 live births (SRS, 1998), almost eight times that in Kerala and 70 percent higher than the national average (436). Overall, 34 percent of women in the state are mildly anaemic, 14 percent are moderately anaemic and 2 percent are severely anaemic. However, of the children under three years of age having any degree of iron-deficiency anaemia, a lower proportion of female children (69 percent) compared to male children (73 percent) are anaemic (NFHS-II).

ANC services reach only half of the total pregnant women in UP. Percentage given two or more doses of tetanus toxoid (TT) injections increased from 37 percent in 1992-93 to 51 percent in 1998-99 (NFHS-II). The efforts made by the state government to reach more women with TT services using a special campaign approach covering the entire state has resulted in a substantial increase in the proportion of pregnant women receiving two doses of TT injections. The proportion of pregnant women given TT injections increased from 46 percent in 1998 to 68 percent in 1999, and pregnant women who received two or more doses of TT injections increased from 42 percent to 59 percent (SO2-IS). The percentage of women who received iron and folic acid tablets increased only marginally from 30 percent in 1992-93 to 32 percent in 1998-99 due to constant disruptions in the supply chain (NFHS-II).

Another important aspect of maternal and child health is institutional deliveries and deliveries conducted by trained attendants. Institutional deliveries increased from 11 percent in 1992-93 to 17 percent in 1998 (NFHS-II). Trained personnel provide assistance to less than one-fourth of the total deliveries in the state (RCHS). More than three-fourths of deliveries are attended by untrained personnel in unhygienic conditions at home. Substantial efforts are required to improve the quality of maternal and child health care.

Fully immunized children increased substantially from 20 percent in 1992-93 (NFHS-I) to 42 percent in 1998 (RCHS) and at the same time, children not getting any vaccination declined from 43 percent to 30 percent. Deaths due to acute diarrhoea are a significant proportion of all deaths among children. Nearly all dehydration-related deaths can be prevented by prompt administration of rehydration solutions (ORS). Only 21 percent of mothers have ever used ORS packets or recommended home solutions to overcome problems of dehydration in 1992-93 (NFHS-I), and this has increased to 36 percent in 1998 (RCHS). Nearly 71 percent of all children under three years of age have iron-deficiency anaemia.

Nearly one-third of currently married women in the 15 to 44 age group have symptoms of reproductive tract infections and sexually transmitted infections (RTIs/STIs) as compared to only 21 percent of men aged 20-54 (RCHS). Awareness of AIDS and HIV is extremely low both among men (47 percent) and women (21 percent). UP has 166 AIDS cases and urgent steps need to be taken to prevent further spread of AIDS.

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