‘Pneumonia' the new villain as TN fights to save its girls

As Tamil Nadu observed yet another National Girl Child Day on January 24, taking out rallies and holding awareness camps, the fact that the State has been able to address the incidence of female infanticide and low sex ratio in several of its districts only marginally raises concern. 

On top of that is the suspicious deaths of otherwise healthy baby girls being reported from certain parts of the State.

According to medical reports, at least 60 per cent of the cases of infant mortality in some of the districts, including Theni, Madurai and Salem, is due to ‘improper handling’ of the newborn. 

While a large number of infant deaths due to improper handling of the child that causes pneumonia points at female infanticide, State Health Department officials say the trend is one of the main factors affecting sex ratio in most of the districts in Tamil Nadu.

As per official records, the State reported 17 deaths for every 1,000 live births in 2016. In 2010, it was 24 per 1,000 live births. The death rate out of total admissions in hospitals has reduced to 6.2 per cent in 2017 from 8.6 per cent in 2016. 

According to the data from the National Health Mission, the sex ratio in Tamil Nadu had improved over the last five years, from 918 in 2013-2014 to 931 in 2018-2019. However, the sex ratio in several districts has worsened over time.

Various districts, including Salem, Dharmapuri, Villupuram, Namakkal, Thanjavur, Tiruvarur, Pudukkottai and Cuddalore, have seen a dip in the sex ratio. The sex ratio at birth in Thanjavur dropped to 908 in 2019 from 950 in 2018, while Cuddalore had a sex ratio of 926 in 2018, but dropped to 917 in 2019. Villupuram recorded sex ratio at birth of 894 in 2018 which dropped to 881 in 2019. Ariyalur had a child sex ratio of 894 in 2018 which declined to 868 in 2019.

The officials in the Directorate of Medical Services admit that the cases of foeticide continue across the State due to sex-selective abortions, besides other suspicious deaths. “While the districts that used to record cases of foeticide such as Perambalur and Salem have recorded a lesser number of cases comparatively, there are new districts,  including Villupuram, Theni and Madurai, that are being named for cases of foeticide and sex-selective abortions,” says Dr M Kamalakannan, superintendent, Directorate of Medical Services.

The data from the Directorate of Medical Services reveal that there were 16 cases of foeticide and sex-selective abortions recorded across Tamil Nadu in 2018. Seven medical centres and scanning units were inspected and ordered to be shut down after investigations revealed that the doctors running those units were carrying out sex-selective abortions. Eight medical centres were closed down in 2019 on similar charges and 10 cases of sex-selective abortions were registered.

When it comes to infant mortality in the State, the five major causes are pneumonia, diarrhoea, malnutrition, measles and malaria, say senior officials from the State Neo-natal Coordination Committee. Tamil Nadu government runs public healthcare programmes to control deaths due to all these issues except pneumonia. This is crucial as pneumonia is the new villain in the block, claiming the highest number of infant deaths.

“Tamil Nadu government has Malaria Control and Eradication Programme under the Directorate of Public Health and Preventive Medicine, while a vaccination programme to prevent measles among newborns is already in place in the State. The intensified diarrhoeal control fortnight programme is keeping a check on the deaths due to severe diarrhoea in infants. 

The nutritional kits and supplements are being given to new mothers to check malnutrition in infants through Anganwadi centres. However, there is no public healthcare programme for pneumonia,” says Dr S Srinivasan, State Neonatal Intensive Care Unit coordinator.

Paediatricians say the main reason for the deaths due to pneumonia is bad child-rearing practices or that the child is immuno-suppressant. The healthcare staff at a primary health centre in Cuddalore – one of the districts where the girl child number has taken a plunge – said on condition of anonymity that a large number of female infant deaths are due to bad child-rearing practices that are projected as natural deaths due to pneumonia.

The healthcare staff say there are also cases of choking of infants who only feed on breastmilk, most of which could be suspected as infanticide. “Bad child-rearing practices, which mean not bringing up a child properly is one of the common reasons for infant deaths. Some people give unnecessary oil baths, keeping the child near the fire. 

Other environmental factors too contribute to pneumonia deaths,” says paediatrician Dr Mohan Kumar of the Institute of Child Health, Egmore.

“There used to be cases earlier when newborn girls are done away with by giving medicines or poison. Now, they are trying herbs, head bath and oil bath to initiate illnesses such as pneumonia to make it appear a natural death. 

We recently had an incident of a father discarding a healthy child. Such incidents continue, but are projected as natural deaths,” says Dr A R Santhi, secretary, Doctors’ Association for Social Equality.

States, including Madhya Pradesh, Chhattisgarh, Rajasthan, Gujarat and Himachal Pradesh, have included pneumococcal vaccines in the immunisation schedule. Senior officials of the Health Department say that a Statewide pneumonia control programme is being planned and the government is planning to start vaccines for pneumococcal diseases in 2022.

It was in 1992 that the government launched the cradle baby scheme in Salem to encourage parents to leave their girl child in the cradles at government hospitals instead of killing them. However, over the years, the scheme has become unpopular. Till 2019, more than 5,200 infants were saved from being abandoned, of which more than 4,000 were girls.

However, the number seems to be dipping every year with only about 100 infants being dropped in the cribs at the government hospitals, whereas the number used to be more than 150 children five years ago. Though it can be seen as a good sign of reduced gender discrimination, experts also view it as an indicator of an increase in foeticide and infanticide cases.

The senior officials of the Social Welfare department say the scheme is not so effective now, as many centres remain non-functional while others receive just 2-3 newborns every year. However, Health department officials say the gap in girl-boy deaths has come down. “The gender factor has reduced to a large extent. The number of girl child deaths is reducing over the years. 

Though the cases of infanticide are there, the Health Department is taking several initiatives to prevent it,” says Public Health Director Dr K Kolandaisamy.