A Comparative Study of Infant and Under 5 Mortality Rate and Institutional Births of EAG States with Reference to SDG-3 (Target -2): An Analysis of the NFHS (2019-20)

Children and maternal health are the supreme assets of a nation. Because mothers are reproductive or fertile women and children are the future of the nation. Therefore, both play a vital role for the future of the nation. The increase in economic productivity depends upon the health of the residents of any area. As we know that in 1980s, the social development indicators were included in the development indicators. The social development indicator includes health, education, sanitation, hygiene, etc.; in which health and education play a vital role in economic development. Sustainable Development has 17 goals in which SDG- Goal-3 is related to Health and Well-being. SDG-3 have 13 targets and 28 indicators defined by United Nations like MMR, U5MR, IMR, HIV, suicide rates, life expectancy, etc. in which Out of 13 target, this study is based on SDG Goal – 3.2 (By 2030, end of preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce IMR to at least as low as 12 per 1000 live births instead of NNMR and Under -5 mortality to at least as low as 25 per 1000 live births) and Institutional birth of EAG States. The EAG states mainly consist of Uttar Pradesh, Uttarakhand, Bihar, Orissa, Jharkhand, Chhattisgarh, Rajasthan and Madhya Pradesh. This study is focused upon the comparative study among EAG states in terms of Infant and child mortality rate and institutional birth with the help of NFHS.


Introduction
Children and maternal health are the supreme assets of a nation. Because mothers are reproductive or fertile women and children are the future of the nation. Therefore, both play a vital role for the future of the nation. Health is the states of a person's mental, social and physical condition. It is very necessary for every human being, if a person's body is healthy, then the mind and brain will be healthy and efficiency will increase, only then by making proper efforts, he will move towards development. That's why, it is very important for a person to be healthy for economic development. The increases in economics productivity dependupon the health of the residents of any area. As we know that in 1980s, the social development indicators are included inthe development indicators. The social development indicator includes health, education, sanitation, hygiene, etc.; in which health and education play a vital role in economic development.
After the end of Cold War (1990s), the whole world was focussed and concerned with social development. Thereafter there was a World Summit on Social Development in 1995 conducted which resolved Copenhagen Declaration on Social Development that consists of 6 international developmental goals with the aims Shaping The 21 1st Century. These 6 international developmental goals have been carried forward in the form of "Millennium Development Goals 2000-2015" which is further carried out as "Sustainable Development Goals 2015-2030". Sustainable Development Goals are 17, in which SDG-Goal-3 is related Health and Well-being. SDG-3 have 13 targets and 28 indicators defined by United Nations like MMR, U5MR, IMR, HIV, suicide rates, life expectancy, etc. in which this study is based on U5MR,IMR, and INSTITUTIONAL BIRTH for EAG states . EAG states stand for empowered action group states is also known as BIMAROU (backward socioeconomic states) which consist of 8 bigger populated states of India which have a population of 49.5 percent of total India's population. These EAG states mainly consist of Uttar Pradesh, Uttarakhand, Bihar, Orissa, Jharkhand, Chhattisgarh, Rajasthan and Madhya Pradesh.The research problem of this study is to know the status of EAG states in terms of Infant and child mortality rate and institutional birth with the help of NFHS.

Objectives
The objectives of this study are as following:  To study the comparative analysis of Infant and Under 5 mortality rate of EAG states;  To analyse the institutional births of EAG states;  To examine the correlation between NMR and U5MR with institutional births of EAG states;  To examine whether EAG states achieved the target of SDG-3 by 2030 related to NMR/IMR and U5MR.

Methodology
This study is mainly Analytical and Descriptive research in nature.The study is based upon the secondary data. The secondary data are collected from NFHS and also from various books, journals, articles, magazines and govt publications. NFHS  It is necessary to compare the (Health indicators) IMR, U5MR and IB of EAG states. In EAG states consists of eight states i.e. Rajasthan, U.P, Uttarkhand, Bihar, Jharkhand, M.P, Chhattisgarh and Orissa. With the help of status index, the comparative analysis of IMR, U5MR and IB of these statesis analyzed in Table 1.

Status of SDG Goal -3 (Target -2) of EAG States
Sustainable Development Goal 3 is regarding "Good Health and Well-being" is one of the 17 SDGs established by the united nations in 2015 and is broader including targets related to reduction of maternal mortality, infant and child mortality rate, fight communal diseases and promote mental health, reduce road injuries and deaths, access to sexual and reproductive care, family planning and education, etc. The official wording is: "to ensure healthy lives and promote well-being for all at ages". The UN has defined 13 targets and 28 indicators for SDG 3. The targets cover a wide range of issues including communal diseases and non-communal diseases. Out of 13 target, this study is based on SDG Goal -3.2 (By 2030, end of preventable deaths of newborns and children under 5 years of age, with all countries aimingto reduce IMR to at least as low as 12 per 1000 live births instead of NNMR and Under -5 mortality to at least as low as 25 per 1000 live births). Only 5 states out of 8 EAG states data are available related to IMR and U5MR. Due to lack of availability of data we can examine SDG goal 3.2 for only 5states that can be achieved target by 2030 or not.

Correlation between NNMR, IMR, and U5MR withInstitutional Birth of EAG States
It is known from many national and international level studies that NNMR, IMR and U5MR are found to be correlated with IB. Generally negative correlation found between NNMR, IMR and U5MR with IB. In the light of these studies, correlation status between NNMR, IMR and U5MR with IB of EAG states is analysed in this study. Correlation status between these health indicators is depicted by Table 5. On the basis of table 5.1, the correlation status is as follows:  The correlation between NNMR and Institutional Births is negatively moderate degree of correlation (r = -0.645) and having goodness of fit (r 2 ) is 0.416 which show that if delivery care is taken under health institutes then 41.6% of NNMR will be reduced while 58.4% of NNMR are affected from other factors rather than institutional births.  The correlation between IMR and Institutional Births is negatively moderate degree of correlation (r = -0.539) and having goodness of fit (r 2 ) is 0.291 which show that if delivery care is taken under health institutes then 29.1% of IMR will be reduced while 70.9% of IMR are affected from other factors rather than institutional births.  The correlation between U5MR and Institutional Births is negatively moderate degree of correlation (r = -0.569) and having goodness of fit (r 2 ) is 0.324 which show that if delivery care is taken under health institutes then 32.4% of U5MR will be reduced while 67.6% of U5MR are affected from other factors rather than institutional births. Suggestions For the improvement of health sector in EAG States, some suggestions for government, policy makers, researchers etc. are as follows:  Need to aware about policy regarding newborns baby at ground level (especially in rural area) as well as better implementation of policy (child development program) at ground level for preventable and reduce deaths of newborns and children less than 5 year of age.  According to Economic survey 2021-22, trends in social service expenditure by the government (combined centre and states) are 8.6 percent of GDP in which expenditure of health sector is only 2.1 percent of GDP. So, there is need for increases percentage share of GDP expenditure on health sector. The Government should be increases the expenditure on health sector for increasing Research and Development centre, labs, hospitals, doctors, midwives etc.  In present scenario, private sector has more contribution in health sector in India. So, below poverty line of people are not able to get proper treatments due to higher cost in private sector.
So, here the government should be gives treatment at minimum cost /free for basis treatment.

Conclusion
This study concludes that Rajasthan has better status and UP and Bihar have worst status in terms of IMR. In terms of U5MR, Orissa and Rajasthan have a better status while UP and Bihar have worst status in EAG States. Therefore, it is a need to imply an effective policy the betterment of UP and Bihar especially among the EAG States. In the context of SDG Goal 3.2 determined by the UN only Orissa of EAG States will achieve this target by 2030 while other EAG states are lacked behind achieving the Goal by 2030. For achieving SDG Goal 3.2 for EAG states especially UP & Bihar, Government should taken initiatives for awareness among the people (especially for rural areas) about policies, projects and programme i.e. Child Development Programme etc. conducted by the government to reduce and preventable of infant and child death as well as better implantation for the poor people of EAG States.
Since, previous budget expenditure on health sector is very low as per its requirement in EAG States, so the government allocate increases more funds in budget for health sector. Since, human development and economic development have positive correlation and human development increases the pace of economic development so it is necessary to take care of health variables to increase productivity, efficiency and well-being.