Infant Mortality

Social Entrepreneurship Project

2/18/2012 Institute of Management Nirma University Group 14

Table of Contents
Mini Case .................................................................................................................3 Three Reasons for selecting the sector: ......................................................................5 What is Infant Mortality? ..........................................................................................6 Statistics ..................................................................................................................7 India vs. World Status ...........................................................................................7 Indias Infant Mortality over the Years ..................................................................10 State-wise data ...................................................................................................11 Stage-wise Infant Mortality Rates .........................................................................13 Role of Government ................................................................................................ 14 National Rural Health Mission .............................................................................14 Anganwadi ..........................................................................................................15 Home Based New Born Scheme............................................................................16 Role of NGOs ..........................................................................................................18 AYAUSKAM .........................................................................................................19 Care in Bihar ......................................................................................................19 Bihar Family Health Initiatives..........................................................................19 Laxmi .................................................................................................................20 Corporate Role .......................................................................................................21 DHL in Maharashtra ...........................................................................................21 Glenmark Foundation .........................................................................................22 Jindal Steel & Power............................................................................................23 Ranbaxy Laboratories ..........................................................................................24 Vedanta Aluminum .............................................................................................25 International Organizations in India ........................................................................26 UNICEF ..............................................................................................................26 Impact ...................................................................................................................27 Our View on the Impact ..........................................................................................29 References Exhaustive .........................................................................................30

Mini Case
Is Shining India turning a Blind Eye towards its Infants? Badal Das had come with his one-and-a-half-year-old son Anik, who was admitted on January 28. Doctors said he needed to be under observation. Doctors had conducted a blood test and said my son needed to be admitted because of some deficiency in his cells. They made us sign a bond that the baby was admitted in critical condition in spite of the fact that he showed no sign of ailment and one of the nurses, after having a look at the blood report, said the baby was perfectly fine, Das said, adding that his sons condition had been deteriorating since then and that he wanted to take his son to some other place. My childs condition has grown worse. Now I want him out of here. The news of rampant death of kids is petrifying, he said. A father of another two-month-old, on condition of anonymity, said his baby did not show any visible signs of a serious ailment and that the medical officer in Nadia, where he had come from, said the child had lost body fluid and saline water needed to be administered. He had had an upset stomach and was suffering from loose motions. I was made to sign a bond that my child was brought in a serious condition, he said, adding that it was probably done to save them from a lot of disgrace and embarrassment since the number of crib death cases was mounting. Negligence in duty and rude behaviour of nurses were also alleged. Rina Singhs 34-day-old daughter Jaya, from Gaighata, 24 Parganas North, was admitted on Sunday. While Jaya was having problem in breathing, Rina alleged that the nurse on duty did not pay any attention to her. I kept on asking her to have a look at my child last night when she was gasping for breath but she did not. My daughter died this morning, she said. The father of Mahrufa Khatoon, who gave birth to twins, said, We have come from Nadia. I am staying here in open air, within the hospital premises. Nurses here have very bad behaviour. They behave as if we are unwanted creatures. Besides, the OPD is a scene of filth and squalor. Dogs and cats roam freely here and often lick babies, he said.

Lack of security at the hospital campus was clearly visible in spite of the recent case of child thefts in Chittaranjan Hospital. All it takes to reach the wards, beyond visiting hours, is a pink card, a tiffin carrier and Rs 30. This correspondent borrowed a visitors card from a patients family member, a tiffin carrier from another and went through the side gate which had no police personnel at the gate. One uniformed guard stopped him near the stairs. I will go up to the second floor, give the food to my sister and rush back in 5 minutess, he said and shoved three 10-rupee notes in his hand. The guard was too busy counting his money, and therefore let him go without further hassle. The correspondent went into every ward, including the emergency ward, talked to patients and even took pictures. No one, including the nurses in the wards, bothered to ask him anything. At most they gave him a cold stare. Each of the beds, meant for one child, was occupied by four persons - two kids and their mothers. We sleep on these beds, half hanging. I have grown a severe pain in my waist and legs, said the mother of an ailing child in Ward 6. One of the mothers was holding the oxygen pipe in place because it wouldnt stay steady or the child sleeping next, on the same bed, would pull it off. I not only have to keep the other child away from this pipe, but also hold it steady, for as long as it is administered, she said. None of the hospital authorities, wanted to comment. (Article adapted from Indian Express)1

Note by the report writers: Behind the glistening steel and glass structures of a growing Kolkata, the rot in the our system shines through with the recent report of the multitude deaths of infants within days. An estimated 34 infants died in West Bengal in a single week of heavy winter due to negligence on part of the hospitals as well as a complete lack of proper healthcare. This very case describes the problem in its deepest sense for India. We are not being responsible towards our infants.

Three Reasons for selecting the sector:

a. India is one of the most affected countries in the world in area of infant mortality & deaths during various natal stages. Due to lack of various healthcare facilities and other reasons, countless innocent lives are lost without reason. So much so that sometimes our healthcare system, or lack thereof, is the cause of the death of hundreds of babies born every year. b. A poor family incurs a lot of expense in child bearing and rearing. And when this results into complication, the family is further pushed into poverty by way of spending on private hospitals. c. A society is defined by the way in which it treats its weak. And Indias poor healthcare system is not exactly designed to suit the needs of its poor. More needs to be done and this report can help to identify the source of this problem and target the same accordingly.

What is Infant Mortality?

In the field of public health, infant mortality is a commonly used statistical measure that is defined as the ratio of infant deaths to live births. The most widely used definition of Infant mortality rate (IMR) is the number of deaths of babies under one year of age per 1,000 live births. The rate in a given region, therefore, is the total number of newborns dying under one year of age divided by the total number of live births during the year, then all multiplied by 1,000. The infant mortality rate is also called the infant death rate (per 1,000 live births).2 General Nature of the Problem For the world, and for both Less Developed Countries (LDCs) and More Developed Countries (MDCs), IMR declined significantly between 1960 and 2001. According to the Save the Children State of the World's Mothers report, the world infant mortality rate declined from 126 in 1960 to 57 in 2001. However, IMR was, and remains, higher in LDCs. In 2001, the Infant Mortality Rate for Less Developed Countries (91) was about 10 times as large as it was for More Developed Countries (8). For Least Developed Countries, the Infant Mortality Rate is 17 times as high as it is for More Developed Countries. Also, while both LDCs and MDCs made dramatic reductions in infant mortality rates, reductions among less developed countries are, on average, much less than those among the more developed countries.2

Statistics
India vs. World Status
The infant mortality rate of the world is 49.4 according to the United Nations and 42.09 according to the CIA World Factbook. India has an infant mortality rate of 60.82 which is way above average according to the UN study.3 The top 10 countries in the world with respect to lowest infant mortality3 are:

Rank

Country or territory

Infant

mortality

rate

(deaths/1,000 live births)

Singapore

2.31

Bermuda

2.46

Sweden

2.75

Japan

2.79

Hong Kong

2.92

Macau

3.22

Iceland

3.23

France

3.33

Rank

Country or territory

Infant

mortality

rate

(deaths/1,000 live births)

Finland

3.47

10

Anguilla

3.52

Whereas the bottom 103 are given by:

215

Guinea-Bissau

99.82

216

Zambia

101.20

217

Mali

102.05

218

Mozambique

105.80

219

Somalia

109.19

220

Niger

116.66

221

Liberia

138.24

222

Afghanistan

151.95

223

Sierra Leone

154.43

224

Angola

180.21

It is no surprise that majority of poor-infant mortality record nations are third world countries with poor healthcare and infrastructure. The following picture 3 proves this fact:

India comes in the lower half of the table of world infant mortality rank.

147

Peru

28.62

148

Maldives

29.53

149

Guyana

29.65

150

Trinidad and Tobago

29.93

151

Indonesia

29.97

152

India

30.15

153

Kyrgyzstan

31.26

154

Zimbabwe

32.31

As shown above, India ranks below countries such as Peru, Indonesia and Maldives. All world statistics source Wikipedia page.2

Indias Infant Mortality over the Years

The following brief table gives an overview of infant mortality in India4:
Projected Infant Mortality Rate (IMR) in India
(2001-2005, 2006-2010, 2011-2015, 2016-2020 and 2021-2025) Year 2001-2005 2006-2010 2011-2015 2016-2020 2021-2025 Infant Mortality Rate (IMR) 61.3 54.3 49.2 44 40 Source : Ministry of Health & Family Welfare, Govt. of India. (11509)

The following graph5 shows the position of India over the years from 1950s to the present situation.

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This shows that from the 60s when mortality was as high as 160 per 1000 it has come down significantly to about 50 due to progress in healthcare, better technology and communications. But still compared to first world countries where infant mortality is a ridiculous 2 per 1000 births, we still have a long way to go.

State-wise data
Infant mortality can be directly linked to education as well as a progressive society. So unsurprisingly, Kerala has the lowest infant mortality in India. Even rural areas of Kerala state have an IMR of 12 which is at par with first world countries. The following table gives a state wise picture4 of the infant mortality statistic:

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State-wise Estimated Infant Mortality Rate by Residence in India

(2007 to 2010) 2007 States/UTs Bigger States Andhra Pradesh Assam Bihar Chhattisgarh Delhi Gujarat Haryana Jammu & Kashmir Jharkhand Karnataka Kerala Madhya Pradesh Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Pradesh West Bengal Smaller States Arunachal Pradesh Goa Himachal Pradesh Manipur Meghalaya Mizoram Nagaland Sikkim Tripura Uttarakhand Union Territories Andaman & Nicobar Islands Chandigarh Dadra & Nagar Haveli Daman & Diu Lakshadweep Puducherry India 34 27 34 27 24 25 55 38 25 38 29 25 31 61 23 28 18 23 23 22 37 31 28 34 31 31 25 53 35 22 38 29 28 31 58 23 29 20 36 35 22 36 27 25 37 24 25 22 50 31 25 41 21 22 28 55 20 25 24 30 28 19 34 25 22 38 23 25 22 47 29 20 43 19 23 25 51 18 23 22 29 27 21 31 37 13 47 12 56 23 21 34 39 48 41 11 49 13 57 27 18 36 40 52 15 13 25 9 46 16 29 20 32 25 32 10 44 14 58 37 26 33 34 44 34 10 45 16 60 45 25 35 36 48 19 11 27 8 43 24 28 19 26 24 32 11 45 16 59 36 26 34 31 41 35 11 46 18 61 45 27 36 33 44 14 10 28 11 40 19 23 21 20 27 31 10 40 14 55 37 23 30 27 38 34 10 41 15 58 47 24 31 29 41 12 10 29 9 37 21 20 19 19 25 54 66 58 59 36 52 55 51 48 47 13 72 34 71 43 65 35 69 37 60 68 59 61 41 60 60 53 51 52 14 77 41 73 47 72 38 72 39 37 41 44 49 35 36 44 38 31 35 10 50 24 52 35 40 31 51 29 52 64 56 57 35 50 54 49 46 45 12 70 33 69 41 63 31 67 35 58 66 57 59 40 58 58 51 49 50 12 75 40 71 45 69 34 70 37 36 39 42 48 34 35 43 37 32 33 10 48 23 49 33 38 28 49 29 49 61 52 54 33 48 51 45 44 41 12 67 31 65 38 59 28 63 33 54 64 53 55 40 55 54 48 46 47 12 72 37 68 42 65 30 66 34 35 37 40 47 31 33 41 34 30 31 11 45 22 46 31 35 26 47 27 46 58 48 51 30 44 48 43 42 38 13 62 28 61 34 55 24 61 31 51 60 49 52 37 51 51 45 44 43 14 67 34 63 37 61 25 64 32 33 36 38 44 29 30 38 32 30 28 10 42 20 43 28 31 22 44 25 2008 2009 2010 Total Rural Urban Total Rural Urban Total Rural Urban Total Rural Urban

Note : Infant mortality rates for smaller States and Union Territories are based on three-years period 2008-10. Source : Ministry of Health & Family Welfare, Govt. of India.

As said above, literacy is negatively correlated to infant mortality. Similarly, states which are traditionally known as masculine oriented (such as Himachal Pradesh) have a higher infant mortality rate of females; whereas this figure is insignificant for states like Kerala. 4

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Projected Levels of Infant Mortality Rate

(1996-2016) States Andhra Pradesh Assam Bihar Gujarat Haryana Karnataka Kerala Madhya Pradesh Maharashtra Orissa Punjab Rajasthan Tamil Nadu Uttar Pradesh West Bengal India (Pooled) India 19962001 65 64 54 46 54 76 13 99 46 106 44 64 46 64 54 60 63 Males 20012006 59 53 43 34 46 76 10 91 39 97 39 53 38 49 46 50 53 20062011 53 44 35 26 39 76 9 83 33 89 34 44 31 37 40 42 45 20112016 48 36 28 21 34 75 9 76 29 81 30 37 26 29 35 35 38 19962001 56 61 55 44 57 67 9 101 46 105 51 65 43 74 56 61 64 Females 200620012006 2011 50 51 44 33 46 66 8 94 40 98 45 52 34 57 51 51 54 44 43 35 25 38 65 8 88 34 93 40 43 28 45 47 43 45 20112016 39 36 28 19 31 64 8 83 30 87 36 35 23 36 43 36 39

Source : Population Projection for India and States 1996-2016, Registrar General, Ministry of Home Affairs.

Stage-wise Infant Mortality Rates

The stage at which death of the infant occurs is also an important factor in the nature of infrastructure lack in the country. For example, more deaths in prematernal stage indicate lack of testing and mother protection, whereas deaths during the 1st year indicate lack of vaccination. 4
Child and Infant Mortality Indicators in India
-1999 Indicators Child (below 5 years) mortality rate Infant mortality rate Neo-natal mortality rate Early neo-natal mortality rate Late neo-natal mortality rate Post neo-natal mortality rate Peri-natal mortality rate Still birth rate Source : Registrar General of India. Total 20 70 45 34 11 24 44 10 Rural 23 75 49 37 12 26 47 11 Urban 12 44 28 22 6 16 30 8

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Role of Government
National Rural Health Mission
National Rural Health Mission of India (NRHM) is a program and scheme run by the ministry of health under government of India. The mission was launched on 5 April 2005 for period of 7 years (20052012). The mission helps and seeks to improve the health care delivery system. This mission is operational in whole of India with special focus on 18 states Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh, Jharkhand, Jammu and Kashmir,Manipur, Mizoram, Meghalaya, Madhya Pradesh, Nagaland, Orissa, Rajasthan,Sikkim, Tripura, Uttarkhand and Uttar Pradesh. It is undoubtedly the most ambitious rural health initiative ever been implemented in the country focusing on the above states which are poor and populous. The primary aim of this mission is to provide accessible, accountable, affordable, effective and reliable health care service to the people of India residing in villages. It also aims proper hygiene and sanitation system and to make a synergistic approach by integrating other health programs and other Indian system of medicine. The creation of a Village health worker known as Accredited Social Health Activist(ASHA) to bring the primary health care and basic health care to the people. A diverse set of factors are thought to be associated with maternal mortality: factors that influence delays in deciding to seek medical care, in reaching a place where care is available, and in receiving appropriate care. The tenth plan document of India has targeted to reduce the IMR to 45 per 1000 live births by 2007 and 28 per 1000 live births by 2012. The main causes of high MMR being socioeconomic status of women, inadequate antenatal care, the low proportion of institutional deliveries|birth, and the non-availability of skilled birth attendants in two-thirds of cases.6 The goals of the NHRM include:7 Reduction in Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR) Universal access to public health services such as Womens health, child health, water, sanitation & hygiene, immunization, and Nutrition. Prevention and control of communicable and non-communicable diseases, including locally endemic diseases Access to integrated comprehensive primary healthcare
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 Population stabilization, gender and demographic balance. Revitalize local health traditions and mainstream AYUSH Promotion of healthy life styles

Anganwadi
The word Anganwadi is derived from the Hindi word Angan which refers to the courtyard of a house. In rural areas an Angan is where people get together to discuss, greet, and socialize. The angan is also used occasionally to cook food or for household members to sleep in the open air. This part of the house is seen as the heart of the house. It is perceived as a sacred place. Thus the significance that this part of the house enjoys is how the worker who works in an angan and visits other angans to perform the indispensable duty of helping with health care issues among other things came to be known as the Anganwadi worker. They are after all the most important link between the rural poor and good healthcare.8 The basic work of Anganwadi workers is extremely important and needs to be carried out in the most efficient manner possible.They need to provide care for newborn babies as well as ensure that all children below the age of 6 are immunized or in other words have received vaccinations. They are also expected to provide antenatal care for pregnant women and ensuring that they are immunized against tetanus. In addition to this they must also provide post natal care to nursing mothers. Since they primarily focus on poor and malnourished groups it becomes necessary to provide supplementary nutrition to both children below the age of 6 as well as nursing and pregnant women. Consistently they need to ensure that regular health and medical check ups of women who fall between the age group of 15 to 49 years take place and that all women and children have access to these check ups. They also need to work towards providing pre school education to children who are between 3 to 5 years old. The Ministry of Women and Child Development has laid down certain guidelines as to what are the responsibilities of Anganwadi Workers (AWW). Some of them are as follows. These include showing community support and active participation in executing this programme, to conduct regular quick surveys of all families, organize pre-school activities, provide health and nutritional education to families especially pregnant women as to how to breastfeeding practices etc., motivating families to adopt family planning, educating parents about child growth and development, assist in the implementation and execution of Kishori Shakti Yojana (KSY) to educate
15

teenage girls and parents by organizing social awareness programmes etc., identify disabilities in children and so on. The Anganwadi system is mainly managed by the Anganwadi worker. She is a health worker chosen from the community and given 4 months training in health, nutrition and child-care. She is incharge of an Anganwadi which covers a population of 1000.About 10 Anganwadi workers are supervised by a Supervisor called Mukhyasevika. 4 Mukhyasevikas are headed by a Child Development Projects Officer (CDPO). There are an estimated 1.053 million anganwadi centers employing 1.8 million mostly-female workers and helpers across the country. They provide outreach services to poor families in need of immunization, healthy food, clean water, clean toilets and a learning environment for infants, toddlers and preschoolers. They also provide similar services for expectant and nursing mothers. According to government figures, anganwadis reach about 58.1 million children and 10.23 million pregnant or lactating women. Anganwadis are India's primary tool against the scourges of child malnourishment, infant mortality and curbing preventable diseases such as polio. While infant mortality has declined in recent years, India has the world's largest population of malnourished or under-nourished children. It is estimated that about 47% of children aged 03 are under-nourished as per international standards. Every 10 Anganwadi workers are supervised by the Mukhya Sevika. They provide on the job training to these workers. In addition to performing the responsibilities along with the anganwadi workers they have other duties such as keeping a check as to who are benefitting from the programme from low economic status specifically those who belong to the malnourished category, guide the Anganwadi workers in assessing the correct age of children, weight of children and how to plot their weights on charts, demonstrate to these workers as to how everything can be done using effective methods for example in providing education to mothers regarding health and nutrition, and also maintain statistics of anganwadis and the workers assigned there so as to determine what can be improved. The Mukhya Sevika then reports to the Child development Projects Officer (CDPO).

Home Based New Born Scheme

India's pioneering "Home-based New Born Scheme" has shown the world a new way to cut down on neonatal mortality (within 28 days of birth).9 Almost 13 years after Dr Abhay Bang demonstrated a 62% reduction in neonatal mortality through multiple home visits in Maharashtra, the World
16

Health Organization(WHO) has touted it as a global policy. In a neonatal health meeting held in Geneva last week, the WHO praised India's leadership in rolling out the scheme and asked all countries recording high neonatal mortality to introduce similar interventions. For the first time, India last year rolled the home-based newborn care scheme under the country's National Rural Health Mission. Under this scheme, Accredited Social Health Activists (ASHAs) will have to visit new mothers six times in 42 days to encourage safe newborn care practices and early detection and free referral of sick newborn babies. The ASHAs are being paid Rs 250 for every home visit but get the money only after the completion of 42 days. Within this timeframe, the ASHAs will have to record the birth weight of the child in the maternal and child protection cards (MCP), immunize newborns with BCG vaccine and administer the first dose of oral polio and DPT vaccine. They will also have to register the births and both the mother and child will have to be safe at the end of the 42nd day to get the money.

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Role of NGOs
In recent years there has been a growth of Non-Government Organisations (NGOs) in India. NGOs have been successful in reaching the poor and reducing mortality and fertility. As innovators and experimenters, NGOs have the potential to help operationalize the reproductive amid child health (RCH) Programme. A growing interest among government and donors in health and development initiatives of the non-government sector reflect to a considerable degree, a growing disenchantment with the public system. A vigorous nongovernment sector, as is present in India, is indicative of the acknowledgement on the part of government that some social functions are outside its legitimate control. Over the years, NGOs have performed several functions to foster pluralism in India. In the field of health, there has been a significant growth of NGOs in the country over the past two decades. The 1970s witnessed the emergence of a new breed of NGOs -- several of whom took on the challenge of translating the concepts of equity, social justice, community participation, and integrated development, embodied within the primary health care concept. Through community-based, people-oriented programmes targeted to the poor, NGOs were able to demonstrate the feasibility and effectiveness of alternative health care models that were successful in reaching the unreached and serving the unserved. As the government moves forward to operationalize the Reproductive and Child Health Programme in India, the need to work in partnership with NGOs will enhance. New modalities for working as allies must, therefore, be developed by government, NGOs, and donors. NGOs have the responsibility, as innovators and experimenters, to field test new strategies -- an urgent need for operationalizing reproductive health services. Maternal and child health services form an integral part of reproductive health programmes. In the past, several NGOs have focussed their efforts on designing services targetted to women and children. Although Maternal and Child Health (MCH) services form an integral part of the government's Family Welfare Programme, so far efforts have focussed primarily on improving child survival. Maternal health has suffered from relative neglect in this programme. There is, therefore, an urgent need to strengthen maternity care services. The government's relatively recent initiative, the Child Survival Safe Motherhood (CSSM) Programme, an effort to redress this neglect, should receive strong emphasis. The safe motherhood programme has a three-fold focus: (1) to strengthen community-based maternal health care; (2) to organize referral facilities for the treatment of complicated deliveries; and (3) to institute an alarm and transport system to promptly transfer women who need emergency care to a referral
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facility for effective treatment.

AYAUSKAM
Operational Area: 30 Gram Panchayats of four blocks in the district of Nuapada. AYAUSKAM has been working with the people of Nuapada district, which is known for poverty, starvation, death, migration, drought and all the classic symptoms of poverty. As a doctor heads the organization, its basic thrust of activities is directed at issues of infant mortality, maternal mortality, HIV/AIDS and reproductive health care. They have been trying to link these issues with the panchayats to generate greater awareness and make the people responsible towards solving them in the context of their social milieu. AYAUSKAM has been accepted as a district-level member of the NRHM. A number of their SHG leaders and traditional birth attendants (TBAs) are working as ASHA workers at the village level. They have also taken-up leadership building activities among women and linked it with the health and nutrition program. During the last panchayat election, their organization was actively involved in the PEVAC drive. As a result of their sincere and hard application, the percentage of women representation could be raised to 52 percent in Nuapada District.10

Care in Bihar
Bihar Family Health Initiatives Location: Bihar Bihar, one of the poorest states in India, is poised to significantly improve maternal, newborn and child health outcomes by 2015. Strong government leadership, movement toward integration and system strengthening through the Bihar Health Sector Reform Programme (BHSRP), and increased resources create a unique opportunity for progress. In this context, the Family Health Initiative in Bihar, with support from the Bill and Melinda Gates Foundation, catalyses a dynamic process of developing, testing, and scaling-up innovative solutions that transform frontline and first level facility family health services, dramatically increasing coverage and quality of life-saving interventions, improving survival and health for women, newborns and children throughout the state.11 Project goals include: 1) Increasing the consistent availability of high impact and cost-effective family health interventions 2) Improving the quality of key family health services and delivery processes
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3) Increasing utilization of key services and uptake of health promoting behaviors 4) Facilitating identification and consistent adoption of successful approaches concurrently at state level and nationally. By the end of the 5-year project period, significant reductions in maternal, neonatal and infant mortality consistent with government of Bihar targets and in malnutrition will have been achieved. This will result from improved health behaviors and increased coverage of services known to be associated with mortality and nutritional impacts: increased contraceptive prevalence rate, skilled birth attendance, emergency obstetric care, immediate newborn care, asphyxia management, prevention and management of newborn sepsis, early and exclusive breastfeeding, appropriate complementary feeding, and complete immunization. In concert with the other Foundation grantees in Bihar as well as other stakeholders, CARE will increase equity in the receipt of health services by ensuring that all families are mapped and included by frontline workers; equity is monitored and addressed by supervisors and managers; and accountability mechanisms benefit all population groups. Documentation of effectiveness of strategies, tools and innovations that can benefit family health throughout India and globally will also be produced from project learnings.

Laxmi
CORE ISSUES LAXMI adopts programs that address the need for comprehensive development of women and children, and hence its programs are focused on following nine issues that impact the development of women and children most: 1. Environment, Hygiene and Sanitation, including Solid Waste Management 2. Sexual and Reproductive Health 3. Child Rights 4. HIV/AIDS 5. Gender 6. Women Empowerment 7. Non-Formal Education 8. Tenure and Housing Rights 9. Livelihood and Economic self-reliance.12

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Corporate Role
In India, majority of social initiatives of corporates are part of a plan to create a good CSR paragraph in the annual shareholder statement. Traditionally Indian corporates have left the job of social work to the NGOs and government whilst being happy by providing funds. But there are several companies which work extensively towards creating better societies around them. Amongst these, some corporate social initiatives toward infant mortality are shown below:

DHL in Maharashtra
DHL, the worlds leading express and logistics company, has a partnership with UNICEF and the Government of India in support of efforts to reduce malnutrition and infant mortality in the Nandurbar District of Maharashtra, India. DHLs grant will fund a three-year UNICEF project to empower communities to improve child survival rates in 1,000 villages in Maharashtra.

DHLs parent company Deutsche Post World Net (DPWN) supports UNICEF projects in three regions around the world to reduce child mortality. The target for 2009 is to raise sufficient funds to vaccinate 50,000 children against the six major preventable child killer diseases. In India, funding by DHL will help accelerate UNICEFs work with the Government to achieve the Millennium Development Goals to reduce the districts under five mortality rate to 41 per 1000 live births by 2015.
Working together with the Government of India, the Government of Maharashtra, NGOs and other partners, UNICEF will use the US$650,000 DHL grant to educate villagers on the prevention and treatment of common communicable diseases, provide immunizations and micronutrients to infants and young children while strengthening the districts health infrastructure. The grant from DHL will be used jointly with communities and government functionaries to develop and implement village health and nutrition plans, setting up village information posts, training workers, midwives and setting up computer equipment for staff training and support. The programme is an extension of DHLs global partnership with UNICEF. Globally, DHLs parent company Deutsche Post World Net (DPWN) supports UNICEF projects in three regions around the world to reduce child mortality. The target for 2009 is to raise sufficient funds to vaccinate 50,000 children against the six major preventable child killer diseases. In India, funding by DHL will help accelerate UNICEFs work with the Government to achieve the Millennium Development Goals to reduce the districts under five mortality rate to 41 per 1000 live births by 2015. In addition to the grant, DHL will also develop an employee volunteer program to enable staff from across the region to contribute their time and efforts to support 21

UNICEFs program in the Nandurbar District. Working alongside UNICEF, a number of volunteer programs are being planned to improve physical infrastructures or build capacity of local groups to improve quality of life among villagers in the Nandurbar District.13

According to the Population Foundation of India (2008), the infant mortality rates in Nandurbar District, Maharashtra was at a high of 68/1,000 live births in 2001. Maternal mortality is estimated to be above 300 per 100,000 live births. UNICEF aims to reduce malnutrition among children below three years of age from 58 percent to 30 percent. Similarly, the project aims at reducing infant mortality to 30 per 1000 live births, while reducing maternal mortality by 30 percent.
UNICEF, in conjunction with the Government of India, will develop community-led, cost- effective village action plans to improve health conditions and promote child survival. According to the Population Foundation of India (2008), the infant mortality rates in Nandurbar District, Maharashtra was at a high of 68/1,000 live births in 2001. Maternal mortality is estimated to be above 300 per 100,000 live births. UNICEF aims to reduce malnutrition among children below three years of age from 58 percent to 30 percent. Similarly, the project aims at reducing infant mortality to 30 per 1000 live births, while reducing maternal mortality by 30 percent. At the request of the Chief Minister of the State in 2003, UNICEF and the District administration began their work in the Nandurbar District. UNICEF has initiated community planning sessions around childrens issues in each of the 1,000 villages and 1,437 hamlets of the District. About 4,000 youth volunteers have been trained on maximizing community participation in this program.

Glenmark Foundation
Glenmark Foundation, the Corporate Social Responsibility (CSR) arm of Glenmark Pharmaceuticals has announced the launch of its flagship programme, Project Kavach Healthy Children, Healthier World in the state of Rajasthan. The campaign addresses the important issue of high Infant and Child Mortality by focusing on 3 key agendas reducing malnutrition, increasing immunization and promoting good hygiene practices among pregnant mothers and caregivers. 15 Glenmark Foundation has announced that will adopt over 150 villages near Jaipur in the initial phase of Project Kavach. For expanding its reach, the Foundation has also tied with a local NGO called SIDART (Society for Integrated Developmental

Activities Research and Training).

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The launch of Project Kavach in Rajasthan was preceded by the successful rollout of this child health campaign by Glenmark Foundation in Madhya Pradesh, India in the month of June, 2011.

About Glenmark Foundation

Instituted with the mission of Enriching Lives; Glenmark Foundation is the Corporate Social Responsibility (CSR) arm of Glenmark. The Foundation has been implementing several projects for the benefit of the underprivileged sections of the society under 3 core areas: Sustainable Livelihoods Child Health Employee Volunteering

Jindal Steel & Power

To make medical facilities available to the common man, JSPL has set up many charitable clinics and hospitals in the Raigarh district. An ICU unit at the general hospital at Raigarh has been set up.15 World-class health facilities are provided to the people of Raigarh at the 100-bed multi-speciality Fortis O. P. Jindal Hospital & Research Centre. The disciplinary facilities include: medicine, surgery, gynaecology, orthopedics and pediatrics. The hospital has four well-equipped Operation Theatres, a Cardiac ICU, a Burn ICU and a Neo-natal ICU. It plans to launch a comprehensive pathological and other investigation facilities such as X-Ray lab, ECHO colour Doppler, Endoscopy, CTScan. Health Camps Regular and integrated medical camps with super specialisty doctors from eminent hospitals have benefited more than 40,000 people in the district. Women welfare programs are also organized regularly. Regular village medical camps are organised through mobile medical van services with specialist doctors in Patratu, Angul and Raigarh. Population control and family welfare is one of the important aspects of community welfare. JSPL has been organising family planning camps in the region since 1996. This initiative has resulted in bringing couples under family welfare coverage and has 23

ensured better health for the women and also contributed in controlling infant mortality rate in the community.

Ranbaxy Laboratories
In 1978, in the wake of the grim health scenario in India, Ranbaxy realised the urgency to reach out to the underprivileged sections of society that had little or no access to basic healthcare. The Company took a conscious decision to contribute towards the national objective Health For All. Towards this end, the Ranbaxy Rural Development Trust was set up and the first well equipped mobile healthcare van was introduced, in certain underserved areas of Punjab. As the programme grew, the Ranbaxy Community Healthcare Society (RCHS), an independent body, was created, that is devoted to the health of the disadvantaged. Today, multiple well equipped mobile healthcare vans and an urban family welfare centre, run by Ranbaxy, benefit over 2 lakh people, in certain identified areas in the states of Punjab, Haryana, Himachal Pradesh, Madhya Pradesh and Delhi. The programme is based on an integrated approach of preventive, promotive and curative services, covering areas of maternal child health, family planning, reproductive health, adolescent health, health education including AIDS awareness. 16 During 2009, maternal and infant mortality were the focus of particular attention and efforts in these areas were intensified in RCHS serviced areas. The results of these interventions have been most encouraging and the general health profile of the local community has shown further improvement in terms of coverage for immunisation, vitamin A deficiency and family planning. The problem of malnutrition has been addressed to a large extent and birth rates and infant mortality rates have declined substantially. Amongst women, the risk of mortality due to pregnancy or child birth has also been reduced when compared with the prevailing level of risk, in India and other developing countries. Ranbaxy has also dovetailed its CSR efforts in a manner that is synchronous with the larger health goals of the State and Central Government. RCHS continued to work actively on critical issues related to HIV/AIDS, tuberculosis, malaria, polio, noncommunicable chronic diseases and female foeticide. RCHS also continued its partnership with the Voluntary Health Association of Punjab for the project on Reproductive Child Health (RCH), in the districts of Nawanshahar and Fatehgarh Sahib, in Punjab and achieved the targets set under the RCH-II plan, of the Government of India. Ranbaxy entered into a Public Private Partnership (PPP) with the Punjab State Government, to deliver healthcare services in identified districts of Punjab. The programme will be rolled out in a phased manner. In order to encourage scientific endeavour in the country, Ranbaxy presented Research Awards and Ranbaxy Science Scholar Awards to 12 outstanding Indian scientists and 9 brilliant young scholars. Symposia and Round Table Conferences were also organised on topics related to women's health, immunogenomics of infectious diseases and pandemic influenza.

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Vedanta Aluminum
In Lanjigarh, Vedanta has already interested more than 70 crore rupees in last 3-4 years in CSR activities. the important projects undertaken by them are opening of 42 child care centers, support to more than one thousand Anganwadi centers for improving nutritional level of childrens, health services in more than 100 villages through mobile health unit, electrification in 11 villages , commercial vegetable cultivation for 700 farmers, strawberry cultivation, leaf plate making for nearly 300 Dongria Kondh tribals , construction of nearly 50 Km roads and opening of a high standard English medium school in Lanjigarh. Over and above they are taking special projects such as integrated child development program, wadi and watershed and cultural activities.17

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International Organizations in India

UNICEF
UNICEF has been working in India since 1949. The largest UN organisation in the country,UNICEF is fully committed to working with the Government of India to ensure that each child born in this vast and complex country gets the best start in life, thrives and develops to his or her full potential. UNICEF uses its community-level knowledge to develop innovative interventions to ensure that women and children are able to access basic services such as clean water, health visitors and educational facilities, and that these services are of high quality. At the same time, UNICEF reaches out directly to families to help them to understand what they must do to ensure their children thrive. UNICEFs work is centred on children from neonatal stages to adolescence. There is also a special focus on social inclusion in all these programmes, keeping in mind the fact that the Eleventh-Five-Year Plan emphasises on inclusive growth and recognises social exclusion and inequality as a constraint to the achievement of MDG goals.18 In addition to reducing infant mortality rates (IMR), the Reproductive and Child Health programme will also aim to reduce maternal mortality rates (MMR) from 301 to 100 per 100,000 live births. The main interventions will revolve around enhancing child survival and maternal care. Key results include: Reduction of IMR from 58 to 28 per 1,000 live births. Reduction of MMR from 301 to 100 per 100,000 live births. The Child Development and Nutrition programmewill stress on the nutritional status of the mother along with the child. UNICEF will focus on providing technical know-how to enhance ICDS functioning and delivery by supporting training of the field-level workers on the one hand and by conducting a nationwide awareness campaign on the issue with the purpose of influencing policy. Anticipated results include: Reduction in the level of malnutrition. Significant reduction in micronutrient deficiencies. Child Environment improving freshwater availability, its management, conservation and equitable allocation, as well as access to sanitation and adoption of critical hygiene practices.
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Impact
As depicted in the chart earlier, due to the effort of the various organizations, infant mortality rate has gone down in India but it is still significantly larger. Comparative to some of the countries which are similar to India in terms of socio-cultural development and recent financial success too, India is seen as staggering. Comparison with BRIC countries:

Over 400,000 newborns die within the first 24 hours of their birth every year, the highest anywhere in the world, a study by an international non-government organisation, Save the Children, has declared. According to the NGO, despite a decade of rapid economic growth, Indias record on child mortality at 72 per 1,000 live births is worse than that of neighbouring Bangladesh, one of the poorest countries in the world. Two million children under five years of age dieone every 15 secondseach year in India, also the highest anywhere in the world, it said. Of these more than half die in the first month of their birth. Moreover, one-third of all malnourished children live in India, 46 per cent of children under three are underweight in the country, and over two-thirds of
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infants die within the very first month of their birth. Ninety per cent of these deaths occur due to easily preventable causes like pneumonia and diarrhoea. Improved Health Care With the recent developments in Indias financial health and a robust economy, India has been able to develop health centers across the country. With this, programs such as Anganwadi have been able to transform rural maternal health care in the country. It is not possible for a country as large as India to have affordable health care everywhere. And thus programs such as Anganwadi go a long way in improving conditions for women.

But still as the figure shows, attendance of skilled health staff is relatively less.

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Our View on the Impact

Every child lost is an opportunity lost for the country. And we owe it to the unborn ones that we give them everything there is to assure them of a safe entry in this world. Clearly this is not happening. Even though there is a reasonable reduction in the overall IMR of India, it is still way above the world average. Whereas the world average is about 50, India hovers just above this rate. In fact, India rates below many third world countries such as Haiti in the IMR. This is a matter of shame for all of us. There are a lot of NGOs- Indian and international which do very good work for this issue. But they can only do so much. Indias problem is its size itself. Any program is extremely difficult to implement in a country this huge. Addressing the Issue As far as addressing the core of the issue, we are far off. As the problem lies not just in the deliveries and care thereafter, but the problem also lies in the care provided to women in the neonatal stage. Also with this the care provided in terms of vaccination and care during the first 1 year is also important. Initiatives of the government and NGOs have concentrated mostly on providing a safe delivery to women. But infant care includes pre-natal as well as post-natal care. And this is where impact is severally lacking. It is this care that we expect to see that will see India really rising up to its citizens and protecting them. Although the government expects the IMR to reduce significantly by 2025, it wont go out completely. But India would work well if we could separate the controllable and uncontrollable aspects of infant mortality, and then target the controllable ones and get that really under control.

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References Exhaustive
1. Indian Express article accessed on 16/2/2012. Linkhttp://www.indianexpress.com/news/critical-hospital/905957/0 2. Information about Infant mortality and its definitions derived from Wikipedia page accessed on 17/2/2012. Link- http://en.wikipedia.org/wiki/Infant_mortality 3. World statistics on world infant mortality derived from Wikipedia page accessed on 17/2/2012. Linkhttp://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate 4. All Indian statistics taken from India Stat organization website accessed on 17/2/2012. Link- www.indiastat.org 5. Google Public data based on statistics from World Bank accessed on 16/2/2012. Linkhttp://www.google.co.in/publicdata/explore?ds=d5bncppjof8f9_&met_y=sp_dyn_imrt_i n&idim=country:IND&dl=en&hl=en&q=infant+mortality+rate+in+india 6. Wikipedia page on National Rural Health Mission accessed on 17/2/2012. Linkhttp://en.wikipedia.org/wiki/National_Rural_Health_Mission_of_India 7. Goals of NHRM. Link- nhrm.nic.in 8. Anganwadi information on Wikipedia page accessed on 17/2/2012. Linkhttp://en.wikipedia.org/wiki/Anganwadi 9. Times of India article on Home based birth scheme. Linkhttp://timesofindia.indiatimes.com/india/WHO-lauds-Indian-scheme-to-reduceneonatal-mortality/articleshow/11904619.cms 10. NGO Ayauskum Link http://www.ayaskum.org/ 11. www.careindia.org 12. Laxmi Profilehttp://www.ngogateway.org/user_homepage/menus.php?id=392&field=profile 13. DHL corporate responsibility. Link- http://www.indiacsr.in/en/?p=2109 14. Glenmark. Link- http://www.indiacsr.in/en/?p=85 15. Jindal Steel & Power. Linkhttp://www.jindalsteelpower.com/sustainability/csr/healthcare.aspx 16. Ranbaxy link- http://www.ranbaxy.com/socialresposbility/socialcommitment.aspx 17. Vedanta Link- http://www.indiacsr.in/en/?p=85 18. Information on UNICEF Link-http://www.unicef.org/india/resources_4691.htm

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