Regarding mortality, Figure 2 shows trends in rural infant mortality rates for the two states as compared with the all-India figures. Both states had lower IMRs than the country average in the late 1970s and 1980s. The IMR in Andhra improved at a faster rate than the country average between 1977 and 1983, before actually worsening slightly in the latter part of the 1980s.
Figure 2. RURAL INFANT MORTALITY RATES - Per 1,000 live births
SOURCE: SRSNutrition trends are provided by data from the NNMB which show a decline in combined moderate and severe nutrition grades (Gomez classification, less than 75% of NCHS weight-forage standards) in the states of Andhra Pradesh and Tamil Nadu over the last fifteen years (Figure 3a). The order of the decline is similar to that observed in the country as a whole - lower than that observed in Kerala or Maharashtra, but higher than in Orissa, Madhya Pradesh or Karnataka. The increase in the numbers of preschool children classified as normal (above 90% standard) has, however, been relatively modest (NIN 1991) in both Andhra Pradesh and Tamil Nadu.
Figure 3A. Underweight Prevalences - 1-5 year olds, by state
The NNMB repeat surveys for rural areas showed that the prevalence of severely underweight 1-5 year olds (i.e. below 60% NCHS median weight-for-age) dropped from 15.4% in 1975-79 to 7.5% in 1988-90 - i.e. at a faster rate than the all-India improvement of 15.0% to 8.7% in the same period. As with the all-India trend, there was little change in the prevalence of moderately underweight (remaining around 45%). Figure 3b shows that the major part of the improvement occurred in the late 1970s/early 1980s.
Figure 3B - PREVALENCE OF SEVERELY UNDERWEIGHT - PERCENT 1-5 YEAR OLDS
SOURCE: NNMB (NCHS standards)The repeat surveys also suggested that during 1975-79 more preschool (1-5 year old) boys (65.9%) than girls (56.8%) were below 75% NCHS median weight-for-age - an observation similar to the above using local standards. However, this difference had disappeared by 1988-90, when equal proportions of boys and girls (about 52% each) were in this category.
Comparing urban and rural areas, a 1984 NNMB study has shown that children living in slums exhibit the highest prevalence (46.1%) of underweight (using local Hyderabad standards), close to the rural figure of 44.5%. In each of the three other urban socio-economic classes, prevalences were lower and the proportion of severely underweight children was also minimal.
The rural infant mortality rate decreased from 136 in 1976 to 87 in 1988, as compared to the all-India IMR decrease from 139 to 102 (see Figure 2). The urban IMR in 1988 was 63. A comparison of the ratio of deaths among children 0-4 years to total deaths shows that Andhra Pradesh, at 32.4% (in 1987) is better-off than most states (the all-India average was 42.0%) with respect to the survival prospects of young children relative to the rest of the population (UNICEF p 16, 17, 19, 132).
The NNMB repeat surveys for rural areas showed that the prevalence of severely underweight 1-5 year olds (i.e. below 60% NCHS median weight-for-age) dropped from 12.6% in 1975-79 to 4.2% in 1988-90 - i.e. at a faster rate than the all-India improvement of 15.0% to 8.7% in the same period. As with the all-India trend, there was little change in the prevalence of moderately underweight (remaining around 45%). The prevalence below 75% median weight-for-age overall dropped from 59.6% to 50.0%. Figure 3b shows that the major part of the improvement occurred in the mid to late 1980s, with no real change between 1977-83. There was little gender difference in the proportions of children, in either 1975-79 or 1988-90, that were below 75% NCHS median weight-for-age.
According to rural and urban NNMB surveys between 1975-80 (data pooled for these years), the prevalences of underweight children (severe and moderate degrees, Gomez classification) in the urban middle-income group (28.9%) and the industrial labour group (34.8%) were much less than those in the low-income group (45.2%) and the slums (38.6%). The rural picture tended to be worse than the urban slums but better than the urban low-income group, which had the highest prevalence of underweight children. The pattern thus seen in the city of Madras (Tamil Nadu) was slightly different from that observed in the city of Hyderabad (Andhra Pradesh) and also all the other main cities of states covered by NNMB, where highest prevalences were seen in slums.
A district-wise analysis in Tamil Nadu, shows a relatively greater reduction in the numbers of children below 75% of NCHS standards in districts between 1979 and 1990 where the Tamil Nadu Integrated Nutrition Project (TINP-I) has been operating since 1980 (NIN 1991b), as shown in Table 6.
The rural infant mortality rate decreased from 121 in 1976 to 84 in 1988, as compared to the all-India IMR decrease from 139 to 102 (see Figure 2). A comparison of the ratio of deaths among children 0-4 years to total deaths shows that Tamil Nadu at 25.2% (in 1987) is second only to Kerala (13.3%) (with the all-India average was 42.0%) with respect to the survival prospects of young children relative to the rest of the population.