Tripura & Gujarat: A Comparison of Child Health

Tripura, which will go to polls on 18 February, has been ruled by a Left Front govt. continuously since 1993, and under the same chief minister Manik Sarkar since 1998. Two other states with similar long periods of rule by the same party – the BJP - are Gujarat and Madhya Pradesh. Gujarat has had a BJP govt. practically since 1993 except for a one and quarter years of a splinter party rule in 1996-98. MP has been ruled by BJP since 2003.

These long periods of rule are sufficient for effect of govt. policies to be reflected in measurable data. Let us look at one key indicator of how much these govts. care for the well being of people. It is children’s health. Data is from the National Family & Health Survey (NFHS) 4 conducted in 2015-16.

First, early childhood mortality. Death rates of newborns indicate whether modern support systems were available for the birth, and subsequent death rates show how much medical care and nutritional support was given to the child. High death rates mean lack of medical support and low nutritional status.

Neonatal mortality rate (death before newborn reaches one month of age) in Tripura is half of Gujarat and one third of MP. (see table below) Infant mortality (death before child reaches one year age) in Tripura is less than Gujarat and half of that in MP. And, child mortality (death before reaching five years age) is a quarter less than Gujarat and about half of that in MP.

Clearly, Tripura’s govt. is paying far more attention to child health and survival than both Gujarat and MP. The first NFHS was conducted in 1992-93. At that time, Tripura was worse than Gujarat in all three childhood mortality markers, though better than MP.

Why this dramatic improvement in Tripura which propelled it beyond such a rich state as Gujarat? The answer lies in expansion of govt. run healthcare system, to reach even remote tribal hamlets, ensuring that pregnant women get skilled care, and such necessities as iron-folic acid tablets, ensuring that labour rooms are functional and attention to small details such as setting up of special rooms attached to healthcare centres (called ‘Mayer Ghar’) where about-to-deliver women (with one relative) can come and stay a week before due date so that she doesn’t have to travel from remote villages when in labour. Food is provided free of cost in this facility. Gujarat and MP both suffer from severe lack of public health facilities and personnel. Both have given more priority to private healthcare, starving the public system and leaving vast numbers of poorer sections, especially tribals in remote areas without any healthcare.

It is not just that Tripura is looking after its newborns better than ‘model’ Gujarat. The general status of health of children in Tripura is better than in Gujarat. Underweight children make up 18% of all newborns in Tripura compared to 19% in Gujarat and 22% in MP.

And, anaemia was found to exist in 48% children in Tripura while this share was 63% in Gujarat and 69% in MP. Low weight at birth and anaemia (haemoglobin count less than 11 g/dl) are indicators of undernutrition, which in turn is primarily caused by poverty, but also lack of access to information and education for mothers.

It is stunning that an advanced state like Gujarat with a high per capita income, high urbanization, high industrialization and high profile (propagated by no less than the PM himself) should be lagging behind a remote, inaccessible, forested state like Tripura with 31% tribal population.

These figures can be taken to mean that Tripura’s Left Front govt. has done exemplary work in children’s health, or that Gujarat’s and MP’s BJP govts. have done very poorly on this count.

Or, it can mean both.