Describe the regional variations of health indicators among the Indian States.

Categorizing States Based on Health Performance

Indian states can be broadly categorized into three groups based on their overall health performance, using a composite index of key indicators:

• High Performing States: Southern states (Kerala, Tamil Nadu, Karnataka) and some North-Eastern states (Nagaland, Mizoram) generally exhibit better health indicators.
• Medium Performing States: States like Maharashtra, Gujarat, Punjab, and Haryana fall into this category, showing moderate progress but with significant intra-state variations.
• Low Performing States: States in the Hindi heartland – Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan – consistently lag behind in most health indicators.

Regional Variations in Key Health Indicators

1. Infant Mortality Rate (IMR) & Maternal Mortality Ratio (MMR)

IMR and MMR demonstrate stark regional differences. According to SRS (Sample Registration System) data (2018), Kerala has an IMR of 6 per 1000 live births, while Uttar Pradesh has an IMR of 62. Similarly, Kerala’s MMR is 8 per 100,000 live births, compared to 197 in Uttar Pradesh. These differences are linked to:

• Access to Healthcare: Southern states have better healthcare infrastructure, including primary health centers (PHCs) and skilled birth attendants.
• Female Literacy & Empowerment: Higher female literacy rates in Southern states correlate with better maternal and child health outcomes.
• Socio-Economic Factors: Poverty, malnutrition, and lack of sanitation contribute to higher IMR and MMR in low-performing states.

2. Total Fertility Rate (TFR)

TFR, the average number of children born to a woman, also varies significantly. NFHS-5 data shows that Bihar has the highest TFR (3.0), while Kerala has the lowest (1.8). Factors influencing TFR include:

• Education Levels: Higher education levels, particularly among women, are associated with lower TFR.
• Awareness of Family Planning: Access to and awareness of family planning services are crucial in controlling TFR.
• Son Preference: In some states, a strong preference for sons leads to higher fertility rates as families continue to have children until they have a son.

3. Malnutrition & Anemia

Malnutrition, particularly among children and women, is a major health challenge in India. The prevalence of stunting, wasting, and underweight children is significantly higher in low-performing states. NFHS-5 reveals that anemia prevalence among women (15-49 years) is highest in Bihar (67.1%) and lowest in Kerala (23.1%). Contributing factors include:

• Food Security: Access to adequate and nutritious food is limited in many parts of the country.
• Sanitation & Hygiene: Poor sanitation and hygiene practices contribute to malnutrition and anemia.
• Intra-Household Food Distribution: Unequal distribution of food within households, often favoring male members, exacerbates malnutrition among women and girls.

4. Disease Prevalence

The prevalence of communicable and non-communicable diseases also exhibits regional variations. For example:

• Vector-borne diseases (Malaria, Dengue): Higher prevalence in states with tropical climates and poor sanitation.
• Non-Communicable Diseases (Diabetes, Cardiovascular Diseases): Increasing prevalence in urban areas and states with changing lifestyles.
• Tuberculosis: Higher incidence in states with high population density and poverty.

Factors Contributing to Regional Variations

Several factors contribute to these regional disparities:

• Socio-Economic Development: States with higher per capita income and better infrastructure generally have better health indicators.
• Governance & Public Health Spending: Effective governance and adequate public health spending are crucial for improving health outcomes.
• Geographical Factors: Remote and inaccessible areas often lack adequate healthcare facilities.
• Social Determinants of Health: Caste, gender, and other social factors influence access to healthcare and health outcomes.