United Nations crc/C/ind/3-4

Table 6.1
Plan outlay on disability-related programmes and number of beneficiaries

Year	Plan outlay (Rs in millions)	No. of beneficiaries (in millions)
2002-03	2,295	0.454
2003-04	2,195	0.443
2004-05	2,255	0.453
2005-06	2,506	0.500
2006-07	2,430	0.438
2007-08	2,210	0.450

Source: India: Third and Fourth Combined Periodic Report on the CRC draft, Inputs of Ministry of Social Justice and Empowerment, September 2009, Annexure 1.

34. 
    A study conducted by the World Bank in rural Uttar Pradesh and Tamil Nadu in 2005 revealed that the overall awareness about the PWD Act, 1995, in these States was very low, specifically among households with PWDs compared to others. These findings were supported by evidence from other States, such as Orissa, indicating low awareness about the PWD Act, 1995, entitlements among a range of civil society and public sector actors. The findings point not only to a general need for raising awareness about the rights of PWDs, but also specifically the need for enhanced and focused information outreach to the core target group of PWDs.
    

6B.7 Capacity Building

35. 
    National Institute of Public Cooperation and Child Development (NIPCCD) undertakes training programmes for persons engaged/working in the area of disability, both at the headquarters as well as its regional centres. The broad contents of the programme include prevalence, causes and implications of the various types of disabilities in children; prevention of childhood disabilities; rehabilitation of CWDs; and community-based approaches for prevention, early detection and management of disabilities.¹
    
36. 
    The Rehabilitation Council of India, established as a statutory body, regulates the training policies, programmes and standardisation of training courses for professionals dealing with PWDs. The Council is running 57 long-term/short-term courses, to update the knowledge of professionals and personnel in the area of disabilities.²
    
37. 
    The Composite Regional Centres functioning in six States facilitate capacity building at the central, State and District levels and below, to establish, strengthen and upgrade rehabilitation services to reach the un-reached disabled population. The District Disability Rehabilitation Centres provide supportive and complementary services to promote education, vocational training and employment for PWDs by providing orientation training to teachers, community and families; and providing training to PWDs for early motivation and early stimulation for education, vocational training and employment.³
    
38. 
    The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999, provides for training of school teachers to handle the special needs of students with disabilities in inclusive classrooms through the State Nodal Agency Centres. Special training is also provided to teachers with focus on early intervention and autism.⁴
    

6B.8 Challenges

39. 
    The Government has strengthened its commitment towards PWDs, as is evident from the ratification of UNCRPD in 2007, adoption of National Policy for PWDs in 2006 and focus on inclusion in the 11th Plan. The shift from welfare-based approach till the Ninth Plan to the rights-based approach since then, and review of the PWD Act, 1995, to make it more effective, are indicative of Government’s continued commitment.
    
40. 
    Following are the challenges related to CWDs:
    

• 
  To harmonise definitions of disability used in collection of data, and to include all types of disabilities, leading to better data.
  
• 
  Effective coordination in planning and implementing programmes among Ministries to comprehensively address the needs of CWDs.
  
• 
  Limited access to education, health and nutrition services for CWDs.
  
• 
  Improving an understanding of skills of service providers, including teachers, on the needs of CWDs.
  
• 
  Generating and increasing awareness about the provisions of the PWD Act, 1995, especially among the target group.
  
• 
  To tackle instances of discrimination faced by CWDs in access to education, health, etc.
  
• 
  To improve resource allocations for CWDs.
  

6C. Health and Health Services
Article 24

6C.1 Health Status and Trends

41. 
    This section provides the status and trends about nine indicators of child health, that is infant and neonatal mortality, maternal mortality, under-nutrition, childhood diseases, communicable diseases, vector-borne diseases, water-borne diseases, Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) and new emerging diseases.
    

6C.1.1 Infant and Neonatal Mortality

42. 
    (See Section 6A for details.)
    

6C.1.2 Maternal Mortality

43. 
    The goal of the NRHM is to reduce the MMR to 100/100,000 by 2012. In 2001-03, the MMR in India was 301 per 100,000 live births, representing a decline of 24% from 1997-98, when it was recorded as 407.⁵ The SRS for 2004-06 shows that the MMR has declined further to 254.⁶ Nearly two-thirds of the maternal deaths in the country are reported from Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh and Uttarakhand.
    
44. 
    In India, more than one-third of women in the 15-49 age group have Body Mass Index (BMI) less than 18.5 kg/m2 and 55.3% have anaemia. Efforts are being made to increase attention to maternal nutrition, as a woman’s nutritional status has important implications for her health, as well as the health of her children. A woman with poor nutritional status, as indicated by a low BMI, short stature, anaemia or other micronutrient deficiencies, has a greater risk of obstructed labour, having a baby with a low birth weight, having adverse pregnancy outcomes, producing lower-quality breast milk, death due to postpartum haemorrhage, and illness for herself and her baby.
    
45. 
    The lacunae in maternal health include varying availability and understanding of technical guidelines, resulting in differences in implementation. The training of Auxiliary Nurse Midwives (ANMs) needs greater attention at the State level. The pace of comprehensive emergency obstetric and neonatal care training requires acceleration. Safe medical termination of pregnancy (MTP) needs greater attention in most States. Further, the data on anaemia in women underscore the need for improvement in the nutritional status of women both before and during pregnancy. Also, there are constraints in public facilities for meeting an increased demand for institutional deliveries, often leading to sub-standard quality of institutional deliveries and lack of full complement of inputs in the First Referral Units (FRUs).⁷
    

6C.1.3 Under-Nutrition

46. 
    Under-nutrition continues to affect a large number of children in the country. Almost half of children under five years of age (48%) are stunted and 43% are underweight. The proportion severely undernourished children is 24% according to height-for-age (stunting) and 16% according to weight-for-age (wasting).
    
47. 
    The proportion of stunted or underweight children increases rapidly with the child’s age through age 20-23 months. Under-nutrition decreases thereafter for stunting and levels off for underweight. For both of these measures, under-nutrition peaks at the age of 20 months. Wasting generally decreases throughout the age range. Even during the first six months of life, when most babies are breastfed, 20-30% of children are under-nourished, according to the three nutritional indices. It is notable that at the age of 18-23 months, when many children are being weaned from breast milk, 30% of children are severely stunted and one-fifth are severely underweight.⁸
    
48. 
    A comparison of nutritional status of children under three years of age for NFHS-2 and NFHS-3⁹ is given in Figure 6.3. The improvement in height-for-age, combined with a somewhat slower improvement in weight-for-age, actually produced an increase in wasting and severe wasting over time.¹⁰