During 2018-20, Telangana achieved a further reduction in MMR to 43, which made the State among the few in India to achieve the SDG target
By Sujit Kumar Mishra, Anudeep Gujjeti, Mohammad Sajid
The fifth round of the National Family Health Survey (NFHS) (2019-21) showed considerable improvement in the sex ratio of Telangana to 1,049 (1,070 for rural and 1,015 for urban). This was 1,007 (1,035 for rural and 977 for urban) in the fourth round. The sex ratio is higher in rural areas in both periods of NFHS. It is also worth pointing out that except for Hyderabad, Adilabad, Medchal-Malkajgiri and Vikarabad, all other districts have a sex ratio of more than 1,000. According to the latest round, NFHS-5, the lowest sex ratio can be found in Hyderabad, the most urbanised district of Telangana.
Sex ratio is defined as the ratio of females to males in the total population or total number of females to 1,000 males in a given set of population.
Social Progress
The improvement over these two periods (2015-16 to 2019-21) is an indication of social progress. However, despite a favourable sex ratio in the total population, the child sex ratio in the State is not sound (894 in NFHS-5 as against 872 in NFHS-4). For rural, it is 907 (864 in NFHS-4), but in the urban space, it saw a decline to 873 in NFHS-5 from 880 in NFHS-4. A look at the child sex ratio through the socio-economic indicators provides an even more nuanced picture of the State. While the child sex ratio among the Other Backward Classes stood at 906 in the NFHS-5, it is just 887 within the Scheduled Caste community, and is even lower at 847 among the Scheduled Tribe.
Religion-wise analysis shows that the Hindu community is lagging in the last five years with 874, whereas the Christian community has a ratio of 980 and the Muslim community 989.
District-wise data also points to huge variations. Mahabubnagar (789), Adilabad (785), Vikarabad (775), Nagarkurnool (771) and Warangal Rural (698) are the districts in the bottom five positions with respect to child sex ratio in the State. This raises a pertinent question: why the State has huge variations across regional and socioeconomic categories?
Impact of Schemes
A combination of schemes like KCR Kits, Amma Vodi and Kalyana Lakshmi/Shaadi Mubarak, directly and indirectly, impact the overall sex ratio other than improving the health profile among women in the State. These schemes were started recognising the fact that the welfare of society lies in the welfare of mother and child. KCR Kits was launched in June 2017. Under the scheme, after the delivery, a woman receives Rs 12,000 as compensation for her wage loss during pregnancy and in the case of a female child, gets Rs 1,000 extra. The scheme has been a success since its inception.
According to the Socio-Economic Outlook 2023 of Telangana, the beneficiaries of KCR Kits increased from 4.6 lakh in 2017-18 to 6.1 lakh in 2021-22. During the same period, public institutional deliveries increased from 2.3 lakh to 2.9 lakh. In 2021-22, around 2.3 lakh KCR Kits were distributed across the State.
The proportion of institutional deliveries positively impacts the Neonatal Mortality Rate (NNMR) as well. In the NFHS-4, institutional births stood at 91.5%, while it increased to 97% in NFHS-5. According to the Telangana Socio-Economic Outlook 2023, the deliveries at government hospitals increased to 61% in 2022 from 30.5% in 2015-16. Needless to say, the Telangana government is striving to increase the number significantly. At the same time, the NNMR reduced from 21.9 during NFHS-4 to 16.8 in NFHS-5.
Another scheme which positively impacted the health outcome was Amma Vodi, an exclusive ambulance service launched in 2018. This provides free transport facilities for pregnant women to hospitals for regular checkups before and after delivery. Aarogya Lakshmi provides pregnant and breastfeeding women with supplementary nutrition. All these directly help in the baby’s healthy growth, thereby curtailing the NNMR and indirectly improving the child sex ratio.
One more flagship scheme of the government that has impacted child health is Kalyana Lakshmi/Shaadi Mubarak. Though envisaged to reduce child marriages and the financial burden related to marriages, the scheme indirectly helped improve the State’s health outcomes, especially related to women and child’s health. It can only be availed if the girl is 18 years or above, which means that the average conceiving age of women also increases, which positively affects the health of women and the child thereby decreasing the Maternal Mortality Ratio and NNMR. According to the Socio-Economic Outlook 2023 of Telangana, 5.9 lakh BC, 2.4 lakh SC, 1.5 lakh ST and 2.4 lakh Minority families benefited from the scheme until January 2023. The total disbursed amount stood at Rs 10,558.79 crore.
All these schemes were started in the last 5-6 years and need time to reflect on the State’s statistics. However, there is scope for improvement. These schemes have positively impacted the Maternal Mortality Ratio (MMR) in Telangana. As per the report on ‘Special Bulletin on Maternal Mortality in India, Sample Registration System,’ the MMR reduced from 81 in 2014-16 to 63 in 2016-18, which was on track to the Sustainable Development Goals (SDG), which requires the MMR go less than 70 per 1,00,000 live births.
Creating Awareness
During 2018-20, Telangana achieved a further reduction in MMR to 43, which made the State among the few in India to achieve the SDG target. The focus now must shift to the child sex ratio. Though the above mentioned schemes are running successfully, the variation in the child sex ratio in the State in several categories leaves room for nuanced and focused implementation.
For example, increasing awareness of the benefits of delivering at an institution apart from dietary and hygiene. Most importantly, awareness of the benefits of having a girl child must be raised by disseminating information on policies and schemes which help girls in their education and empowerment.
In terms of educational attainment, it is evident that 12 or more years of education indicated an impact in tackling the child sex ratio. According to NFHS-5, among women with no education, the child sex ratio is 881 whereas the same is 908 among women with 12 or more years of complete education. It proves that there is a positive impact of the number of years of schooling on the child sex ratio as well. Hence, there is a need to formulate policies and interventions that contribute to girls’ higher education, opportunities and investments. This can be achieved by identifying the worst performing categories and focused implementation.