Vulnerable children

Why has infant mortality risen in Mizoram even as it has fallen everywhere else?

The Mizoram government insists the data does not reflect the ground reality.

The fourth National Family Health Survey, conducted in between January 2015 and December 2016 shows that most public health metrics have improvement. For instance, the number of infants dying per thousand live births – a critical measure of human development index – has gone down sharply from 57 in 2005 to 41 in 2016.

Quite significantly, infant mortality rate has declined in all 15 states and union territories surveyed, except one: Mizoram. According to data released as part of the survey, the rate in Mizoram went up from 34 in 2006 to 40 in 2016, an increase of almost 18%.

Is this an indication that Mizoram is facing an impending public health? If so, what is fuelling it?

According to H Lhungdim of the Population Centre of India, who was part of the team that carried out the survey in the state, the primary reason behind the higher number was the use of district-level samples. “Since robust data samples from each of the districts were collected this time the poor performance of the southern districts, particularly Saiha, reflects in the state average,” he explains.

Lhungdim, however, insists that it may not be the best idea to compare the survey of 2006 and 2016 as there were no district-level samples taken in the former. Lhungdim’s explanation indicates that Mizoram’s high infant mortality rate may not be a new phenomenon but was not detected earlier because of bad data and poor representation from the historically backward and minority-populated southern districts.

The centralisation of health facilities in the state capital Aizawl, said Lhungdim, has led to people in the southern districts being deprived. “Most of Mizoram is rural and since the terrain is difficult, quality healthcare fails to reach these people,” he said.

A Scroll.in ground report from Saiha district in 2015 corroborates Lhugdim’s contention. Aizawl’s apathy has pushed Saiha to the margins and the neglect is all-pervasive in the area.

In neighbouring Manipur, almost all district headquarters are bustling centres with comparatively decent healthcare facilities, according to Lhugdim. Manipur has the lowest infant mortality rate in India.

State government in denial

The Mizoram state government, though, does not seem to think that there is a problem. The state’s coordinator for maternal and child health Dr Zochhuan Awmi told Scroll.in over the phone from Aizawl that the data was not accurate and it “depicted Mizoram in a bad light”.

“According to our own live data, the rate has been steadily coming down – it is 22 now,” said Awmi. “We are completely surprised at how they have arrived at these numbers. It seems they didn’t go to the field at all.” Awmi pointed out that even census data, released earlier this year, pointed towards a lower rate: 32.

The data Awmi is referring to is Sample Registration System data of the Registrar General of India. A two tier-approach is employed by the to collect these numbers. A local enumerator keeps record of all births and deaths in a sample set of villages or urban blocks and an independent supervisor carries out a survey every six months retrospectively. While Mizoram’s infant mortality rate was indeed 32 at the end of 2015, according to this data set, it has risen by more than 80% since 2000, when the rate was just 17.5.

A study from Mizoram University in 2015 diagnosed that the high infant mortality rate in Saiha was a direct consequence of food insecurity and malnutrition. The study showed that per capita calorie intake in the region was 1703 kilocalories. The recommended amount is 2400 kilocalories.

Awmi, however, contended that the situation was under control. “Since April 2015, we have been distributing Vitamin D supplements and we have seen deaths come down by almost 50%,” she said. “We refuse to accept the National Family Health Survey.”

Broken system

T Sundararaman, dean of the School of Health Systems Studies at the Tata Institute of Social Sciences in Mumbai, said the National Family Health Survey seemed fairly robust and believable. “State governments tend to underreport data for obvious reasons,” said Sundararaman, who was also till recently the executive director at the National Health Systems Resource Centre in New Delhi.

However, he added, infant mortality rates should always be understood in relation to other metrics like nutrition prevalence since better nutrition levels usually lead to low infant mortality rates.

“The data looks believable because it’s in the same range as the census data and the previous survey,” Sundararaman says. “What happens is simple interventions like women’s education, sanitation, nutrition, etc. can bring down infant mortality rates from say the 60s to the 30s, but to decrease it beyond that requires higher level scientific and medical interventions and special facilities. Since it is unlikely that Mizoram can afford such interventions, the number has probably stagnated or increased, but it has definitely not decreased.”

Mizoram has been on the verge of a health crisis for some time now, owing largely to its over-reliance on central funds in the absence of any other real source of revenue. Even the Janani Suraksha Yojana, a scheme to reduce neonatal and maternal deaths, has suffered major cutbacks due to non-availability of funds.

It is evident that Mizoram’s healthcare system, particularly its maternal and child health services, is broken and requires immediate attention. The government would do well to acknowledge it.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

Understanding the engineering behind race cars

Every little element in these machines is designed to achieve power and speed.

All racing cars including stock, rally or Formula 1 cars are specially built to push the limits of achievable speed. F1 cars can accelerate to 90 km/h in less than two seconds and touch top speeds of over 320 km/h. Stock cars also typically achieve over 300 km/h. So what makes these cars go so fast? A powerful engine is combined with several other components that are relentlessly optimized to contribute to the vehicle’s speed. All these components can be grouped under four crucial elements:

Aerodynamics 

The fastest cars are the most aerodynamic. A sleek, streamlined design is a head-turner, but its primary function is to limit wind resistance against the vehicle. If a car is built to cut through the wind rather than push against it, it will travel faster and also use less fuel in the process. To further improve the aerodynamic quality of the car, everything from the wheel arcs and lights to the door handles and side mirrors are integrated into the overall structure to reduce the drag - the friction and resistance of the wind. For some varieties of race cars, automobile designers also reduce the shape and size of the car rear by designing the back of the car so that it tapers. This design innovation is called a lift-back or Kammback. Since aerodynamics is crucial to the speed of cars, many sports cars are even tested in wind tunnels

Power

All race car engines are designed to provide more horsepower to the car and propel it further, faster. The engines are designed with carburetors to allow more air and fuel to flow into them. Many sports and racing cars also have a dual-shift gear system that allows drivers to change gears faster. The shift time—or the brief time interval between gear changes when power delivery is momentarily interrupted—can be as little as 8 milliseconds with this gear system. Faster gear shifts enable the car to travel at their fastest possible speeds in shorter times.

Control

The ability to turn corners at higher speeds is crucial while racing and racing cars are often designed so that their floors are flat to maximize the downforce. Downforce is a downwards thrust that is created in a vehicle when it is in motion. This force exerts more pressure on the tyres increasing their grip on the road, and thereby enabling the car to travel faster through corners. The downforce can be so strong that at around 175 km/h, even if the road surface were turned upside down, the car would stick to the surface. Many racing cars like the Volkswagen Polo R WRC are even equipped with a large rear wing that helps generate extra downforce.

Weight

The total weight of the car and its distribution is a critical part of race car design. All race cars are made of durable but extremely light material that reduces the weight of the vehicle. Every part of the vehicle is evaluated and components that are not strictly required in the race car—such as trunks or back seats—are eliminated. The weight distribution in these cars is carefully calibrated since at high speeds it proves crucial to car control. As a result, almost all racing cars have an RMR configuration or a Rear Mid-engine, Rear-wheel-drive layout where the engine is situated at around the middle of the car (but closer to the rear than the front), just behind the passenger compartment. This layout where the car is a little heavier towards the rear than the front allows for better control of the car at high speeds.

Only the most cutting edge technology is used to develop modern race cars and as a result, they are normally far more expensive to buy and more difficult to maintain than regular ones. But your dream of owning a race car does not need to remain a dream. The Volkswagen GTI, part of the award-winning VW GTI family, is now coming to India. Since 1979, these sporty and powerful cars have been dominating roads and rally race tracks.

With a sleek aerodynamic build, a great power-to-weight ratio and 7-speed dual-shift gears, the Volkswagen GTI is the most accessible race car experience available in India. Packed with 189 bhp/ 192 PS, the car is capable of doing 0-100 km/h in just 7.2 seconds and boasts a top speed of 233 km/h. And though the car is built to be quick and powerful, it is also strong on fuel economy with an outstanding mileage of 16.34 km/l. To experience what it is like to drive a race car, book a test drive now.

This article was produced by the Scroll marketing team on behalf of Volkswagen and not by the Scroll editorial team.