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GOVERNMENT OF INDIA
MINISTRY OF WOMEN AND CHILD DEVELOPMENT
LOK SABHA
UNSTARRED QUESTION NO: 855
ANSWERED ON:  14.12.2018
Child Sex Ratio
MANOJ RAJORIA
RAMSINH PATALYABHAI RATHWA
Will the Minister of



WOMEN AND CHILD DEVELOPMENT be pleased to state:-



(a) whether the Government is aware that Scheduled Tribe population particularly children and mothers in India suffers from high degree of malnutrition, if so, the details thereof during the last three years, State/UT-wise;
(b) the steps taken by the Government to tackle this situation;
(c) whether the Government has accorded priority to provide better healthcare facilities especially to the tribal women and children in the country and if so, the details thereof and if not, the reasons therefor; and
(d) the steps taken by the Government for improving the Maternal Mortality Rate due to malnutrition and declining Child Sex Ratio in respect of the tribal population?


ANSWER
MINISTER OF STATE IN THE MINISTRY OF WOMEN AND CHILD DEVELOPMENT
(DR. VIRENDRA KUMAR)

(a): As per the recent report of National Family Health Survey (NFHS) – 4 conducted by Ministry of Health and Family Welfare in 2015-16, 45.3% Scheduled Tribe children under 5 years of age are underweight, 43.8% are stunted and 76.8% are anaemic. Further, 31.7% Scheduled Tribe women (15-49 years of age) have chronic energy deficiency (BMI less than 18.5) and 59.8% are anaemic. The State-wise details are at Annexure-I & II.

(b): This Ministry is implementing several schemes and programs like Anganwadi Services, Scheme for Adolescent Girls and Pradhan Mantri Matru Vandana Yojna under the Umbrella Integrated Child Development Services Scheme as direct targeted interventions to address the problem of malnutrition throughout the country including for Tribal population. Government has also set up POSHAN Abhiyaan, which aims to prevent and reduce prevalence of stunting, underweight and anaemia among children (0-6 years), prevalence of anaemia among women (15-49 years) and reduction in prevalence of low birth weight in the country in a time bound manner.

(c): The National Health Mission (NHM) framework provides for a separate chapter for Health in tribal areas. The Framework allows innovative approaches and differential norms for Tribal areas.

• All tribal districts whose composite health index is below the State average have been identified as high priority districts and receive more resources per capita under the NHM as compared to the rest of the districts in the State.
• State governments have been advised to provide higher allocation to the high priority districts in the ratio of 1:1.3 per unit of population.
• All Aspirational Districts have been included into high priority districts and out of 256 identified new high priority district, 101 are tribal districts.


(d): Under the National Health Mission (NHM), following are some of the important steps taken to reduce maternal deaths in the country:

• Janani Suraksha Yojana (JSY), a demand promotion and conditional cash transfer scheme is implemented with the objective of reducing Maternal and Infant Mortality by encouraging institutional deliveries.
• Under Janani Shishu Suraksha Karyakram (JSSK), every pregnant woman is entitled to free delivery, including caesarean section in public health institutions. This also includes free transport, diagnostics, medicines, other consumables, food and blood, if required.
• Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) has been launched to provide fixed-day assured comprehensive and quality antenatal care universally to all pregnant women on the 9th of every month. While antenatal care is routinely provided to pregnant women, special ANC services are provided by OBGY specialists/ Radiologist/ Physicians at government health facilities under PMSMA.
• ''LaQshya - Labor room Quality improvement Initiative'' launched on 11th Dec 2017.
• Special provision of birth waiting homes under NHM in tribal areas.
• Maternal Death Surveillance and Response (MDSR) is implemented to take corrective action for averting maternal deaths.
• Funds are provided for strengthening of ‘Delivery Points’ for provision of comprehensive Reproductive, Maternal, New Born Child Health and Adolescent (RMNCH+A) services. Placing quality emergency obstetric care services at “Delivery Points” is a priority area.
• Maternal and Child Health (MCH) Wings are established at high caseload facilities.
• Operationalization of Comprehensive Abortion Care Services and services for Reproductive Tract Infections and Sexually Transmitted Infections (RTI/STI.
• Mother and Child Tracking System (MCTS) and Mother and Child Tracking Facilitation Centre (MCTFC), a name-based web-enabled system to track every pregnant women and child.
• Operational guidelines for Universal screening of Gestational Diabetes Mellitus, screening for hypothyroidism for high risk group during pregnancy, training of General Surgeons for performing Caesarean Section, calcium supplementation & de-worming during pregnancy and promotion of birth companion during delivery have been disseminated.
• Monthly Village Health and Nutrition Days (VHND) are organized as an outreach activity at Anganwadi centres for provision of maternal and child care including nutrition.
• Over 10 lakhs Accredited Social Health Activists (ASHAs) have been engaged to facilitate access of health care services by the community, particularly pregnant women.
• Under the National Iron+ Initiative, iron and folic acid supplementation is given across life stages including pregnant, lactating women and adolescent girls.
• Regular IEC/BCC is conducted.

Additionally, Ministry of Tribal affairs approves projects by the Project Appraisal Committee every year and funds are released under the “Special Central Assistance (SCA) to Tribal Sub Scheme (TSS)” and State Grants under Article 275(1) to the concerned State Governments for improvement of Health facilities among tribal people including tribal women. The concerned States have been instructed that at least one-third of the total beneficiaries should be women/ girls.

In order to address the declining Child Sex Ratio, Beti Bachao Beti Padhao Scheme (BBBP) is implemented, which addresses the issues of women empowerment and aims to change mindsets to value girl child. It is a tri-ministerial effort of Ministries of Women and Child Development, Health & Family Welfare and Human Resource Development. The key elements of the scheme include nation-wide awareness and advocacy campaign and multi-sectoral interventions, which include tighter enforcement of Pre-Conception & Pre-Natal Diagnostic Techniques (PC&PNDT) Act, Pre-Natal/ Post Natal care of mother, improve enrolment of girls in schools, construction of girl’s toilets, community engagement/ training etc. The Scheme is currently implemented in all 640 districts (as per census 2011) of the Country through Multi-sectoral intervention and alert District Media & Advocacy in 405 districts and alert District Media & Advocacy in 235 districts. The scheme is administered through District appropriate authority by providing 100% financial grant-in-aid to the selected districts and funds are directly transferred to the concerned districts.

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Annexure-I

Statement referred to in reply to Part (a) of Lok Sabha Unstarred Q. No. 855 to be for 14.12.2018

Prevalence of Malnutrition among Scheduled Tribe Children (under 5 years) as per NFHS-3 and 4

S. No. State Stunting Underweight Anaemia
NFHS-3 NFHS-4 NFHS-3 NFHS-4 NFHS-3 NFHS-4
1 Andaman & Nicobar -- -- -- -- - -
2 Andhra Pradesh 54.9 31.7 41.5 47.4 76.3 74.2
3 Arunachal Pradesh 44.3 30.5 29.6 18.1 51.4 47.5
4 Assam 38.1 28.2 18.2 18.5 77.2 37.4
5 Bihar -- 48.2 -- 46.8 - 68
6 Chandigarh -- -- -- --
7 Chhattisgarh 51.6 42.2 52.8 43.8 78 48.2
8 Delhi -- -- -- -- - -
9 Dadra Nagar Haveli -- -- -- -- - -
10 Daman & Diu -- -- -- -- - -
11 Goa 35.9 25.7 43.9 24.4 25.4 44.4
12 Gujarat 60.9 47.5 64.5 51.6 82.9 56.7
13 Haryana -- 32.5 -- 28.9 72.1
14 Himachal Pradesh 28.1 22.3 25 20.3 63.3 67
15 Jammu & Kashmir 39.5 32.3 35.7 26.3 61 49.4
16 Jharkhand 54.5 48.8 64.3 55.1 79.5 78.4
17 Karnataka 51 39.3 41.9 40.3 80.6 63.7
18 Kerala -- 23.9 -- 21.6 - 49.9
19 Lakshadweep -- -- -- -- - -
20 Madhya Pradesh 56.4 48.2 71.4 51.5 82.5 76.1
21 Maharashtra 57.8 45.4 53.2 49.4 67.6 59.4
22 Manipur 45.6 34.3 24.2 12.6 40 19.8
23 Meghalaya 55.4 44.3 48.5 28.6 65 40.1
24 Mizoram -- 27.2 -- 11.6 - 18.6
25 Nagaland 37.2 28.9 23 16.3 - 21.8
26 Odisha 57.2 45.5 54.4 48.5 80.1 58.4
27 Punjab -- -- -- -- -- --
28 Puducherry -- -- -- -- -- --
29 Rajasthan 48.8 49.3 46.8 52.1 73.7 74
30 Sikkim 45.2 29.6 18 14.2 59.9 58.3
31 Tamil Nadu -- 25.7 -- 33 - 45.9
32 Telangana -- 34.7 -- 35.4 - 66.5
33 Tripura 30.7 24.9 36.5 20.9 77.1 54.8
34 Uttar Pradesh 68.5 50.9 61.2 46 78.8 65.7
35 Uttarakhand 47.9 34.9 50.4 29.9 72.4 61.7
36 West Bengal 58.6 37.3 59.7 42 86.3 68.1
37 India 53.9 43.8 54.5 45.3 76.8 66.3


Annexure-II

Statement referred to in reply to Part (a) of Lok Sabha Unstarred Q. No. 855 to be for 14.12.2018

Prevalence of Malnutrition among Scheduled Tribe Women (15-49 years) as per NFHS-3 and 4

S. No. State Underweight Anaemia
NFHS-3 NFHS-4 NFHS-3 NFHS-4
1 Andaman & Nicobar - - - -
2 Andhra Pradesh 43.5 28.8 69.1 71.8
3 Arunachal Pradesh 12.7 6.4 41.6 35.8
4 Assam 20 14.4 74.1 48.5
5 Bihar - 29.2 64.4
6 Chandigarh - - - -
7 Chhattisgarh 50.3 34 74 55.9
8 Delhi 34.6 - 59.5 -
9 Dadra Nagar Haveli - - - -
10 Daman & Diu - - - -
11 Goa 41.2 26.7 39.5 33.6
12 Gujarat 61.6 40.6 74.2 59
13 Haryana - 24.4 - 64.8
14 Himachal Pradesh 29.3 15.6 54.6 58.9
15 Jammu & Kashmir 28.7 21 54.1 37.9
16 Jharkhand 47.2 34.9 85 75
17 Karnataka 48.7 23.6 56.8 46.8
18 Kerala 42.6 20.1 51.9 48
19 Lakshadweep - - - -
20 Madhya Pradesh 49.8 34.4 73.9 64
21 Maharashtra 51.6 38.3 58.9 53.9
22 Manipur 11.9 7.1 28.4 20
23 Meghalaya 12.1 11 47.9 50.8
24 Mizoram - 8.3 - 24.4
25 Nagaland 16.0 11.6 - 23
26 Odisha 51.3 36.5 73.8 63.3
27 Punjab - 10.7 69.2
28 Puducherry - - - -
29 Rajasthan 49.3 37.5 65 63
30 Sikkim 9.6 4 58.6 34.6
31 Tamil Nadu 60.2 18.2 36 54.9
32 Telangana - 29.2 - 66.2
33 Tripura 23.7 14.2 74 55.3
34 Uttar Pradesh 46.4 29.8 35.2 57.6
35 Uttarakhand 49.5 21.5 71.4 55.6
36 West Bengal 55.6 33.2 78 75.5
India 46.6 31.7 68.5 59.9



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