Thiruvananthapuram, May 15: The infant mortality rate among Kerala's tribal population may not be comparable to Somalia's but a Unicef-assisted study has found it to be six times higher than the state's average across communities.
Prime Minister Narendra Modi had on May 9 told an election rally in the state that on the question of "child death ratio among the Scheduled Tribes, the situation in Kerala is more dangerous than Somalia".
World Bank data show that the infant mortality rate (number of infants per 1,000 live births who die before one year) in Somalia was 85 in 2015, behind fellow African countries such as Angola (96), Central African Republic (92) and Sierra Leone (87).
India's figure was 38 - worse, according to World Health Organisation data, than the global average of 32 and nearly four times Europe's average of 10.
The Unicef-assisted study, which covered four panchayats in Kerala's Wayanad district in 2012-13, found an infant mortality rate of 41.47 among the forest-dwelling tribal community.
The comptroller and auditor general (CAG) of India, which cited the study in a 2014 report, added perspective by stating that the overall infant mortality rate in the state was 7 at the time.
"A survey covering the children in the age group of zero to 72 months in four grama panchayaths (Poothady, Moopainadu, Noolpuzha and Thirunelli) was conducted (2012-13) by district administration (under Unicef assistance)," the report said.
"Data collected and analysed by survey on 1,855 births in four selected grama panchayaths revealed that the infant mortality rate was as high as 41.47 among tribal population."
In 2013, according to figures available at data.worldbank.org, the infant mortality rate in India was 41, so the finding of the Wayanad survey was just about par. In Somalia, the figure was 90, more than twice that suffered by the Kerala tribal communities surveyed.
The CAG report, tabled in the Kerala Assembly on June 10, 2014, said that while the average infant mortality rate in the state had dropped from 12 in 2008 to 7 in 2013, Wayanad's had risen from 7.73 to 9.67 --- and its tribal populations' from 28.97 in 2008-09 to 41.47.
V. Jithesh, district reproductive and child health officer, had conducted the study for Unicef. He told The Telegraph he recalled that the infant mortality rate among tribal communities in Wayanad was roughly four times the district average.
Jithesh attributed this to anaemia - a consequence largely of poverty and malnutrition - saying that about 80 to 90 per cent of the tribal population was anaemic and 20 to 25 per cent of births underweight.
State Congress spokesperson Pandalam Sudhakaran declined comment, saying he had not studied the subject. BJP spokesperson J.R. Padmakumar said the survey's findings bore out what Modi had said about the condition of the state's tribal communities.
Congress chief minister Oommen Chandy had been quick to interpret Modi as saying "Kerala is like Somalia" and write a protest letter to the Prime Minister.
In an election season where the BJP has emerged a force, Modi's comment was seen as an insult to Malayalis, with Congress and Left supporters taking to the social media to lampoon him with the hashtag "#PoMoneModi" (go away, son Modi).
BJP national president Amit Shah defended Modi here on Friday, arguing: "The issue is the death of children due to starvation, not who said what."
He demanded that Chandy apologise for the death of a tribal woman's newborn twins in Wayanad that day. One of the babies had died in the womb and the other on delivery.
Union tribal affairs minister Jual Oram visited the Kozhikode hospital where the woman is being treated and was quoted as saying the doctors had linked the deaths to malnutrition.
He announced that the Centre would send a team to study the problems of Kerala's tribal communities.
The CAG report also pointed to inadequacies in the district's health infrastructure, saying just 5 of its 35 government hospitals and public health centres offered delivery services.
It said that this fell short of the Indian Public Health Standards, which require delivery services at all public health centres.
Last September, a 27-year-old tribal woman lost her triplets after the Mananthavady district hospital in Wayanad, lacking neonatal care facilities, referred her to the Kozhikode Medical College Hospital, it said.
The CAG noted that "most of the cases of maternal deaths (in Wayanad) were of those who belonged to the tribal population. During 2008-09 to 2012-13, there were 51 deaths, out of which 32 were tribal women in the age group 19-35."