Worlds apart 1: Tamil Nadu and Madhya Pradesh. Madhya Pradesh. High fertility scars India's largest state
Chhabra, R.
People and the Planet 3(3): 21-23
1994
ISSN/ISBN: 0968-1655 PMID: 12345834 Document Number: 198850
The Indian government targeted 90 districts, which had poor demographic indicators and poor infrastructure, for provision of health services. Targeted areas were identified as having a birth rate of over 39, low female literacy, low age at marriage, and generally poor economic conditions. Many (23) targeted districts were in India's largest state, Madhya Pradesh (MP). Estimates of infrastructure cost indicated that, in MP, the minimum cost would be $320 million or Rs. 10,000 million for minimum national standards and an additional Rs. 200 million annually for operational expenses. However, the current operating budget was only Rs. 400 million. Some small communities, such as in Dhar, have voluntarily contributed supplies and labor to improve health facilities. The vast size of the territory in MP (149 persons per km) creates coverage difficulties for health workers (with a potential radius of 33.5 km per worker). 34,000 of the 71,000 inhabited villages were more than 6 kilometers from the nearest paved road. No additional funding has been provided nationally for districts with larger geographic areas or for inaccessible areas. Literacy was particularly low in MP, which also had 40% of the tribal population in all of India (25% of MP population). Female literacy in 1991 was only 28.8%. Many positive social initiatives have been undertaken to increase use of the IUD, to reach women with only two children, to prevent early marriage, to build community support and improve health skills, and to coordinate delivery of health services for multiple needs, including maternal and child health and family planning. Delivery of services is but one focus of family planning; another equally important focus is attitudinal change about such beliefs as son preference. MP had the highest growth rate in India (26.8%), a total 1991 population of 66 million, and total fertility of 4.6. Infant mortality in MP was the second highest at 117/1000.