Over 23 lakh “missing deliveries” have been reported in Madhya Pradesh between 2011 and 2016, which might have an impact on the skewed sex ratio of 52:48 at birth in the state, according to the report of the comptroller and auditor general (CAG) of India on the general and social sectors. The report was submitted in the state assembly on Friday.
Painting a grim picture of the status of MP’s healthcare, the report said that during the period, 93.7 lakh pregnant women were registered for antenatal care (ANC) but there were only 69.8 lakh deliveries. So what happened to the 23.8 lakh missing deliveries?
According to 2011 statistics, the sex ratio in the state was 912 females per 1000 males against the national ratio of 914. The skewed ratio was attributed to the declining ratio at birth and poor care-seeking for the girl child. Though the National Rural Health Mission (NHRM) seeks to address this challenge by regulating the pre-conception and pre-natal diagnostic techniques misused for sex selection, the data shows that between 2011-12 and 2015-16, 33.36 lakh female child births were reported compared to 35.89 lakh male child births in the same period.
Stressing that continued skewed sex ratio at birth in MP ought to have been reviewed, the report said the case of “missing deliveries” was being addressed by strengthening reporting mechanism from private hospitals and deliveries at home, according to the principal secretary health. “The reply (of the principal secretary) was not acceptable as there was no improvement in sex ratio from 2012 to 2015-2016. This large difference between pregnant women registered for ANC and total delivery cases indicated the lack of follow-up and tracking of registered ANCs by ground level health workers and other monitoring authorities,” the report said.
Amulya Nidhi from Jan Swasthya Abhiyan, an NGO that has been working in the health sector, said the report has exposed the tall claims of the state government with regard to improvement in healthcare. “What happened to 23 lakh pregnancies? Were they terminated for seeking more male children, as the data shows? Or the authorities just didn’t bother to follow once they registered pregnant women for ANC,” he said.
Talking about other shortcomings, the report said MP could not attain the goals for the infant and maternal mortality rates and it lagged far behind the achievements of other states. The IMR of the state was 51 per 1000 live births as against the national average of 40 per 1000 live births.
On status of maternal and childcare, the reports shows that out of 93.7 lakh pregnant women registered for antenatal care (ANC) during 2011-16, only 52.5 lakh (56 %) could be registered within first trimester of pregnancies and 19.4 lakh (21 %) could not be receive three ANC check-ups.
The report also emphasised that under Madhya Pradesh Swasthya Seva Guarantee Yojana, the government was committed to provide minimum essential drugs and laboratory services for all type of health facility centres. “However , none of the test checked health facilities had all the listed drugs and laboratory services categorised the yojana”, the report pointed out
Box: Other major findings of CAG in health sector
Maternal deaths showed an increasing in MP from 2012-13, when it was 571 to 1580 in 2015-16
HIV testing of 47.27 lakh and venereal disease research laboratory testing of 60 lakh pregnant women could not be conducted.
Targets for child immunization against seven vaccine preventable diseases could not be achieved during 2011-16 and the range of shortfall was 16 to 21 %.
A dose of Hepatitis B zero was to be provided up to 48 hours of birth. However, out of 69.2 lakh live births, only 39.30 lakh (57 percent) infants were provided Hepatitis B Zero due to unavailability of storage facility of vaccine at health centres.
Total fertility rate (TFR) improved since 2012, as it reduced from 2.9 to 2.3 in 2016, but the state could not achieve the target fixed under National Rural Health Mission frame work of implementation (2012-17) to reduce the TFR to 2.1.
The TFR could not be reduced due to low performance in family planning programme. Against 3.03 lakh vasectomy planned during 2011-16, only 0.83 lakh (27 %) male sterilization could be performed “, the report said.