Infant mortality rate is an immense problem in India. Far from the millennium development goals level of 29, the IMR rate is presently at 40 (as per 2013 estimates). Further, even this mean number can be misleading as there is wide dispersion across states in India. This dispersion has led to what the literature calls, a ‘north-south’ divide.

In the northern states of India - such as Punjab, Haryana, Uttar Pradesh and Madhya Pradesh - IMR rates are regularly much higher than in the southern states -- Kerala, Tamil Nadu, Andhra Pradesh and Karnataka. The difference is so distinct that while states like Kerala have achieved an IMR of 12, comparable with middle income countries, Madhya Pradesh has an IMR of 59, comparable with some of the least developed countries in the world. This highlights the uselessness of the mean IMR number mentioned above.

What is the government doing about this? The flagship programme of the State to deal with the crisis of IMR is the ICDS, the Integrated Child Development Scheme. It works in all states of India to provide antenatal and postnatal care to mothers, supplementary nutrition to children, and raises awareness about the proper treatment of women during pregnancy and beyond. Unfortunately, the scheme has proven largely ineffective in tackling the existing conditions.

One of the main concerns related to the ICDS is the treatment of personnel. The scheme employs hundreds of anganwadi workers, asha workers and midwives to ensure the proper provision of maternal and child care is provided in each village and town in the country. Yet, those who are entrusted with this enormous responsibility are treated quite poorly by the State. 

For starters, ICDS healthcare workers are not even recognised as salaried employees by the government. In some states they receive as little as Rs 1000 a month as remuneration - a far cry from what is needed to run a household in India - and even this is not paid regularly. Not only does this provide little incentive to carry out duties, it also makes it nigh impossible to work full time as an ICDS healthcare worker.

Caste also complicates the matter here. In many villages and towns, people refuse to avail the benefits of or take advice from ICDS healthcare workers as they belong to lower caste groups. This goes the other way around as well, with ICDS healthcare workers simply neglecting those who belong to lower castes than themselves.

The ICDS is then faced with challenges both from within and without. In order to overcome these challenges the State has decided to… look the other way. The ICDS is a failing scheme which is quickly losing State support without any alternate approach on the horizon. What then can be said about India’s IMR rate?

The current position is likely to continue for the years to come. Without targeted intervention in these matters, there is little chance that the IMR will reach MDG levels. Further, even if it does, it is likely to be due to pressures exerted on it by southern states without much improvement in the north. The need of the hour is direct action against infant mortality which takes into account the vast regional disparity in the country. Let us hope the Indian government doesn’t wait around for this to become a crisis.