Overall, there was a 6% rise in dependence on public healthcare for out-patients and 7% for in-patients over the decade ending 2014, said the Brookings report, which analysed National Sample Survey Office (NSSO) data over this period.
 
An in-patient is formally admitted for at least one night to a hospital, while an out-patient visits a hospital, clinic, or associated facility for diagnosis or treatment.
 
For out-patient care, 74.9% of ailing patients (who sought care) exclusively accessed a private facility in 2014, compared to 79.7% in 2004. The biggest decrease was seen among rural women, as we said. While 78.2% of them sought private care in 2004, 70.4% did in 2014.
 

Source: Brookings India, based on National Sample Survey Office data
 
In-patients depend less on the private sector than do out-patients, the data reveal.
 
The percentage of in-patients seeking public care increased from 42.3% in 2004 to 45.4% in 2014;  the percentage of rural women accessing public care rose from 45.1% in 2004 to 56.1% in 2014.
 

Source: Brookings India, based on National Sample Survey Office data
 
“The number of people seeking private healthcare, however, might be an underestimation, as NSSO surveyors are instructed to mark all those who went to both government and private facilities as “only going to government facilities,” said the Brookings report.
 
Indians spend eight times more in a private hospital than a government hospital, according to this analysis of National Health Accounts (NHA) 2013-14 data by The Hindu.
 
Quality of care biggest constraint for not accessing public hospitals
 
Despite the decline in exclusive dependence on private care, 29 of every 1,000 Indians pointed to the unsatisfactory quality of healthcare, the most commonly cited reason for not accessing a public hospital.
 
Long waiting periods at government health services appears to be an increasing bottleneck in seeking public care. In 2004, 6.8 of every 1,000 cited this as a reason for not using a public hospital; it rose to 18.6 in 2014.
 
Of 930,000 doctors in India, 11.4% (106,000) work for the government. This means there is one government doctor for every 11,528 people, according to the National Health Profile 2015, IndiaSpend reported in November 2016.
 
Public-health centers across India’s rural areas–25,308 in 29 states and seven union territories–are short of more than 3,000 doctors, the scarcity rising 200% (or tripling) over 10 years, IndiaSpend reported in February 2016.

Source: Brookings India
 
More people required medical care over a decade
 
The number of people not using medical services fell from 15.1 in every 1,000 in 2004 to 12.4 in 2014, which implies an 18% increase in Indians seeking some form of healthcare.
 
There was an increase, however, in the proportion of people not seeking services, as they felt their ailment wasn’t serious enough, and more women than men report not using healthcare due to the same reason–the gender gap has widened over the decade.
 
More Indian men are likely to be admitted to hospital during the last moments of life than women–62.5% to 37.5%, IndiaSpend reported in November 2016. For every 1,000 men whose death is certified by medical professionals, the corresponding figure for women is 600.

Source: Brookings India
 
The number of people not using healthcare due to financial reasons reduced from four of every 1,000 in 2004 to 0.7 in 2014, said the Brookings report, possibly a result of rising incomes or use of publicly funded health-insurance schemes implemented over the last 10 years by the central and state governments.
 
About 12% of the urban and 13% of the rural population got health insurance through the Rashtriya Swasthya Bima Yojana (National Health Insurance Scheme) or similar plans, IndiaSpend reported in July 2015.
 
(Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex.)

This article was firs published on India Spend
 
 

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A health worker weighs an infant at a hospital in Agartala, Tripura. Of all infants in India who died before they completed 29 days post-birth, 48.1% suffered from low birth weight and prematurity.
 
Neo-natal mortality is defined as death during the first 28 days of life. And India reports the highest numbers in the world: As many as 700,000 newborns die in India each year–29 per 1,000 births.
 
This accounts for 26% of neo-natal deaths in the world, according to the United Nations Children’s Fund (UNICEF). Thirteen African countries have better infant mortality rates (IMR) than India, IndiaSpend reported in May 2016.
 
The figures for child mortality, 0-5 years of age, are equally high: Between 1990 and 2015, more children in this age group died in India than anywhere in the world. Despite a 62% reduction in child mortality over these years, the number stands at 1.3 million every year.
 
The deadly 28 post-birth days 
 
An infant is said to have LBW when she is under 2.5 kg (5.5 pounds) at birth. A premature or preterm baby is one born alive before the completion of 37 weeks of pregnancy, according to the World Health Organization (WHO).
 
In India, of all infants who died before they completed 29 days post-birth, 48.1% suffered from LBW and premature birth, according to the Causes of Death Statistics, 2010-13 report by the census office. This figure was 35.9% for children under one year of age, and 29.8% for those in the 0-4 age group.
 
These two causes led to the most deaths of children between 0-4 years of age. But between 1 and 4 years, they did not even figure in the top 10 factors, indicating that 0-1 year is the most vulnerable period in childhood.

 
Source: Causes of Death Statistics, 2010-13
 
Poor maternal health
 
LBW is a complex syndrome caused by two factors–preterm birth and a foetus too small for his/her gestational age. However, the overlap between these two situations has the worst outcomes.
 
There are three underlying reasons for LBW, all traceable to the mother: Poor nutritional status before conception, short stature (mostly due to under-nutrition and infections during childhood) and poor nutrition during pregnancy, Narayan Ramachandran, chairman, InKlude Labs, which helps state governments implement large-scale school-based deworming in India, wrote in the Mint.
 
These points are corroborated by a research involving 350 mothers–conducted by the Rohilkhand Medical College in Uttar Pradesh–to find the epidemiological factors associated with LBW among institutional deliveries.
 
The study revealed the following: 40% of expectant mothers delivered LBW babies and 76.5% of them had a gestational age lower than 37 weeks; 58.5% of these mothers were less than 20 years of age and 76.1% of them weighed less than 50 kg.
 
Incidence of LBW highest in S Asia, India second highest in the world
 
In 2013, as many as 22 million newborns–an estimated 16% of babies born globally–had LBW, according to the UNICEF.
 
In terms of regional variations, South Asia had the highest incidence of LBW, with 28% newborns weighing less than 2.5 kg. This region also had the highest percentage of infants (66%) not weighed at birth. Sub-Saharan Africa’s incidence of LBW among newborns is estimated to be 13%; and 54% newborns are not weighed at birth.
 
At 28%, India had the third highest percentage of LBW newborns, behind only Mauritania (35%), Pakistan and Yemen (32% each). Except for Pakistan, India performed worse than all its South Asian neighbours. UNICEF, however, has cautioned that the data maybe inaccurate because of under-reporting.

 
India has most preterm births in the world
 
There are an estimated 15 million preterm births across the world each year, according to latest available data released by the WHO in 2012. Over 60% of preterm births occur in Africa and South Asia. At 3.5 million, India accounted for the most preterm births in the world, followed by China (1.17 million) and Nigeria (0.77 million).

 
India’s Newborn Action Plan and how it works
 
The India Newborn Action Plan (INAP) was launched in September 2014 with the aim of ending preventable newborn deaths and stillbirths by 2030. The plan aims to attain single-digit neonatal mortality and stillbirth rate by 2030.
 

Source: India Newborn Action Plan
KMC Coverage: Newborn with low birthweight or rpematurity managed with Kangaroo Mother Care at facility (In %)
 
INAP’s main strategy is called Kangaroo Mother Care (KMC). It creates a womb-like environment for the newborn that provides the four basic needs of the baby–Warmth, food, love and protection–and significantly benefits all newborns, especially those who are preterm or suffer from LBW.
 
Generally, KMC is advocated for all newborns weighing less than 2.5 kg at birth. However, in India, because of the huge burden of LBW, INAP has recommended facility-based KMC for newborns with birth weight less than 2 kg on priority basis.
 
Note: In September 2016, KMC was introduced in Veerangana Avanti Bai Women’s Hospital in Lucknow. It will also be launched in all the 79 Sick Newborn Care Units (SNCUs) across Uttar Pradesh

 
India has already cut neonatal tetanus mortality by 99.76% and was declared as maternal and neonatal tetanus-free by the WHO, as IndiaSpend reported in October 2015.
 
(Saha is an MA Gender and Development student at Institute of Development Studies, University of Sussex.)
 
This article was first published on India Spend

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Nearly 12 million Indian children were married before the age of 10 years–84% of them Hindu and 11% Muslim–reveals an IndiaSpend analysis of recently released census data.
 
To put it in context, this number is equivalent to Jammu & Kashmir’s population.
 
As many of 7.84 million (65%) married children were female, reinforcing the fact that girls are significantly more disadvantaged; eight in 10 illiterate children who were married were also girls.

 

Source: Census India
 
The data further reveal that 72% of all Hindu girls married before 10 were in rural areas, as compared to 58.5% Muslim girls, with higher levels of education correlating with later marriage.
 
Jain women marry latest (at a median age of 20.8 years), followed by Christian women (20.6 years) and Sikh women (19.9 years). Hindu and Muslim women have the lowest median age at first marriage (16.7 years), IndiaSpend reported earlier based on a seven-state report from Nirantar, a Delhi-based advocacy.
 
Women from urban areas, on average, marry more than two years later than their rural counterparts, IndiaSpend reported earlier.
 
The report also noted that the level of teenage pregnancy and motherhood is nine times higher among women with no education than among women with 12 or more years of education.
 

Source: Census India
 
80% of illiterate children married before 10 are girls
 
As many as 5.4 million (44%) married children under 10 were illiterate–80% of them female–indicating how lower levels of education correlate with early marriage.
 
As many as 1,403 females have never attended any educational institution for every 1,000 males who have not, IndiaSpend reported earlier.
 
In developing countries, girls with less access to quality education are more likely to marry early, argued Quentin Wodon, an advisor with the World Bank’s education department.
 
Better and safer job opportunities for girls may also reduce child marriage, as might better access to basic infrastructure (water, electricity), which frees up time spent on domestic chores for schooling, wrote Wodon.
 

Source: Census India
 
30% girls, 42% boys married before legal ages
 
The Prohibition of Child Marriage Act states that a girl in India cannot marry before age 18, a boy before 21.
 
A Muslim girl can marry when she attains puberty or completes 15 years of age, according to Muslim Personal Law, the Gujarat High Court and Delhi High Court noted in different judgments.
 
As many as 102 million girls (30% of female population) were married before 18 in 2011; the number was 119 million in 2001 (44% of female population), a decrease of 14 percentage points over the decade.
 
Among boys, 125 million were married before 21 years of age (42% of male population) in 2011; the number was 120 million in 2001 (49% of male population), a decrease of 7 percentage points over the decade.
 

 

Source: Census India
 
(Saha is a freelance journalist based in New Delhi.)
 
Courtesy: IndiaSpend.com
 

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