EQUITY ANALYSIS REPORT

FOR THE STATE OF

MADHYA PRADESH
EQUITY ANALYSIS REPORT
FOR THE STATE OF
MADHYA PRADESH

Planning and Policy Support Unit Society

State Planning Commission, Government of Madhya Pradesh

First Floor, C-Wing,VindhyachalBhawan , Bhopal, Madhya Pradesh – 462004 India

0755-2551564(O), Office Fax: 0755-2772074, E-mail: ppsusmp@gmail.com, spb@mp.nic.in
Project Team
Under the Guidance of:
Shri Ramesh Kumar Shrivastava IFS, Nodal Officer, Planning and Policy Support Unit (PPSUS) &
Principal Adviser, MP State Planning Commission.

Prepared by:
Centre for Public Policy Research (CPPR)
SA Road, Elamkulam, Kochi, Kerala 682020
www.cppr.in, cppr@cppr.in

Authors:
Dr. Martin Patrick,Chief Economist, Centre for Public Policy Research (CPPR)
Ms. Deepthi Mary Mathew, Senior Research Associate, Centre for Public Policy Research (CPPR)
Dr. D Dhanuraj, Chairman, Centre for Public Policy Research (CPPR)
Ms. Chithira Rajeevan, Research Assistant, Centre for Public Policy Research (CPPR)
Ms. Lakshmi Ramamurthy, Research Consultant, Centre for Public Policy Research (CPPR)
Dr. Lekshmi Nair, Research Consultant, Centre for Public Policy Research (CPPR)
Supported by:

Mr. Chandy John (Editing)

Mr. Aravind Anand Shankar (Layout & Design)
Mr. Daniel Robinson (Graphics)

Project facilitation:
Dr. YogeshMahor, Participatory Planning Expert and Dy. Team Leader, Planning and Policy
Support Unit (PPSUS), MP State Planning Commission.
Shri Sujan Sarkar, PME Officer, UNICEF Bhopal,MP
Shri SP Batra, Specialist Statistics, PPSUS,MPSPC
Smt Swati Parihar, PPSUS, MPSPC
Shri Alok Asthana, Research Associate, PPSUS,MPSPC

Sponsored By:
UNICEF, Bhopal

Disclaimer:
The statements in this publication are the views of the author(s) and do not necessarily reflect the
policies or the views of UNICEF.
Foreword

Early investment in the lives of deprived population will lead to a reduction in inequality in
both the short and long run. Inequality is not inevitable and henceforth, the prevailing scenario
of gross inequality needs a change, which is clearly defined in the 2030 Agenda for Sustainable
Development, here is a need to change the dominant development paradigm and progressively
move towards a sustainable, inclusive and long-term economic, social and environmental approach
centred around concerns for human rights and social equity.

The result of multiple inequities and deprivations since early years, it lasts not only throughout the
life cycle of the present generation and replicates continuously.

This report stated that in lack of equity in access to and enjoyment of the rights to human development are not isolated
facts. Both the inequality and inequity in social services are linked to wider economic, social, cultural or environmental
contexts that impede access and enjoyment of the rights to the most deprived or vulnerable population, especially the
tribal population in our State.

Thus, this report also identifies an urgent need for reliable data, solid evidence and validated knowledge based to
improve planning and decision-making processes in social development. This will also allow planners to design and
implement widespread, inclusive and sustainable policies to address situations of deprivation, vulnerability and risks
mainly affecting the poorest population in Madhya Pradesh.
I would like to place on record the efforts of Planning and Policy Support Unit of State Planning Commission, to leverage
the support of UNICEF and Centre for Public Policy and Research (CPPR), Kerala.

I hope that the publication of this report will help the MP State Planning Commission and the departments to achieve
clearly about the subject dimensions and higher-level results we want to achieve; to develop and act on strategies to
achieve those results; to use systematically lessons drawn from studies to make decisions; and, ultimately, to improve
the contribution to the advancement of human development in the state.

Aniruddhe Mukerjee
Principal Secretary, Planning Economics and Statistics, Govt. of MP

ii
Preface
Recent decades have seen rising inequality and inequities, which in turn are partly responsible
for the increasing disparity in wealth distribution in the globe thus conversely undermining
efforts geared towards the attainment of Sustainable Development Goals (SDGs). While the rise
in inequality may be driven largely by worldwide competing processes such as globalization,
competition and competitiveness of various economies, others are caused by the impact of
climate change and man-made factors and policies. Rising inequity is a problem that can and
should be tackled by all stakeholders and therefore, more assertively be placed on the agenda
for sustainable development 2030 with tagline of “No one should be left behind, and no
human right ignored”.

Globally, UNICEF is mandated by the United Nations General Assembly to advocate for the protection of rights of children
to help meet their basic needs and to expand their opportunities to reach their full potential. As such, UNICEF and other
development partners are providing technical assistance in priority setting of national development agenda and in sync
with Madhya Pradesh State Vision/SDG 2030. Remarkably, the equity analysis report based on the secondary sources
would provide viable-framework for strategic planning and priority setting in addressing critical deprivations impacting
women and children as well as will inform child-centric budgeting to ensure inclusive social development with child
lenses.

This equity analysis report reflects that though great efforts were made to improve the lives of children in the State
of Madhya Pradesh, the disadvantaged children continue to lack access to basic services due to geographic, social,
economic and political constraints. This report highlights challenging issues of the various sectors such as health, nutrition,
education, water, sanitation and hygiene and protection which are closely interconnected and have impact on the overall
development of children and women in the State.

District-wise analysis revealed that districts with higher rates of urbanization, such as Bhopal, Indore, Gwalior, etc. have
performed better in the realization of both health and education outcomes. Moreover, increased levels of urbanization
in certain districts have led to an increase in the per capita income as well. In addition, it has also underlined a uniquely
differentiated relationship between literacy rates and nutritional levels as it was found that prevalence of anemia in
women was more influenced by male literacy than female literacy. In such male dominated societies, it is thus crucial
that maternal and child health interventions along with strategies for nutritional improvements, be tailored to both sexes
to maximize benefits and help reduce under-nutrition.

The report also has revealed that due to the existence of separate entities like education and tribal development boards
to oversee school management which largely have created administrative and managerial challenges in the education
sector, and as such, inevitably require vertical integration and synchronization of the entities to enhance improved
productivity, seamless functioning and better education outcomes. Moreover the involvement of local self-governance
in the delivery of key services like water and sanitation and provision of oversight functions with active participation
of local communities is crucial for sustainability of the projects. Uniquely, the report underlined that the use of latest
technology in the generation of required data for real time analysis is critical for ensuring effective monitoring and
improved accountability.

Overall, the equity analysis report has highlighted key issues, and gaps impacting children and women across the
State within the framework of vertical and horizontal equity, which would enable the planners and decision-makers in
the Government to rethink and synchronize their existing programmes and schemes to enhance better inclusivity and
reduced exclusion of the most deprived women and children in order to achieve inclusive social-economic development
in accordance with the underlying principles of SDGs/Vision 2030 of Madhya Pradesh State.

Michael Steven Juma

Chief, UNICEF Madhya Pradesh iv
Acknowledgements
I would like to thank all the individuals for their cooperation and support in completing the report.
It is to be emphasised that the report is the result of persistent and concerted efforts of many
individuals.

I am grateful to the members of the Planning and Policy Support Unit (PPSU), State Planning
Commissionfor their support throughout the study. The authors would like specifically thank Mr
Ramesh Srivastava and Dr Rajendra Mishra for their coordination and support in completing the
report. I would also like to thank Dr. Yogesh Mahor, Mr. S.P.Bhatra, and Ms. Swati Parihar and Mr. Alok Asthana for providing
us with data and critical comments at various stages of developing the report.

We would like to extend our gratitude to the officials of UNICEF Bhopal- Mr. Sujan Sarkar, Mr. JitendraPandit and
Mr. B Azhaganathan for their valuable suggestions in developing the report.

I am thankful to the officials of Rajya Siksha Kendra, Directorate of Public Instruction, Women and Child Development,
Integrated Child Development Services (ICDS), Public Health and Family Welfare, Public Health Engineering, National
Health Mission Tribal Welfare, and Social Justices for providing us with data and valuable insights. I am also thankful to the
officials of the above departments for their active participation in Focus Group Discussions.

At the organisation, I would like to thank all the members of CPPR for their support in successfully completing the report.

Dr. D Dhanuraj
Chairman, Centre for Public Policy Research

vi
Contents
Chapter 1 Introduction 1
Chapter 2 Demographics 7
Chapter 3 Health and Nutrition 15
Chapter 4 Education 31
Chapter 5 Water, Sanitation and Hygiene 43
Chapter 6 Social and Child Protection 51
Chapter 7 Connectedness 57
Readiness for Equitable Social Development
Chapter 8 Analysis: Intra state Issues 61
Chapter 9 Key recommendations 79
Chapter 10 Conclusion 87
References 90
Abbreviations 93

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List of Tables
Table 1:1 Madhya Pradesh Development Indicators 4
Table 2:1 Per cent of Urban Population in EAG states 8
Table 2:2 Per cent of ST population and Sex Ratio 10
Table 3:1 Health and Nutrition Indicators 27
Table 3:2 Output Indicators 27
Table 3:3 Manpower in Health Institutions 29
Table 4:1 Education Indicators - Across Social Groups 39
Table 5:1 Target for 2017 45
Table 5:2 Target for 2022 45
Table 5:3 Districts with Fluoride Contamination 46
Table 6:1 Proportion of Population living below poverty line by Social Groups 52
Table 6:2 Disabled Population- Social Groups 52
Table 6:3 Participation of Women in Government Services 53
Table 6:4 Basic Police Data 56
Table 7:1 Profile of Roads in Madhya Pradesh 58
Table 8:1 Districts Identified with Crucial Health Problems 61
Districts where Grading of General Literacy and Adult Literacy
Table 8:2 vary 63
Table 8:3 Districts Identified with Crucial Educational Problems 64
Table 8:4 Districts Identified with Crucial Nutrition related Problems 66
Table 8:5 Districts Identified with Crucial WASH related Problems 69
Table 8:6 Districts Identified with Crucial Social Protection Problems 71
Table 8:7 Districts Identified with Crucial Problems relating to SC & ST 73
Districts Identified with Crucial Problems relating to Women &
Table 8:8 Children 75
Table 9:1 Categories of Districts and Strategy to be adopted 84

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List of Figures
Figure 1:1 GSDP and NSDP growth rate 3
Figure 1:2 Sector wise shares in GSDP (per cent) 3
Figure 1:3 Health Index 4
Total Population (in thousands) and Decadal Growth Rate in
Figure 2:1 7
Population (in per cent)
Figure 2:2 Urban Population vs Slum Population 8
Figure 2:3 Density of Population (per sq km) 9
Figure 2:4 Age Pyramid - 2011 9
Figure 2:5 Age Pyramid (2026) 9
Figure 2:6 Workforce Participation Rate 9
Figure 2:7 Sex Ratio 10
Figure 2:8 Sex Ratio among STs 10
Figure 2:9 Sex Ratio vs Workforce Participation Rate (females) 11
Figure 2:10 Variation in Child Sex Ratio (0-6 years) from 2001 to 2011 11
Figure 2:11 CBR and CDR among EAG states 12
Figure 2:12 CBR, CDR vs Per Capita Income 12
Figure 3:1 Health links to GDP 15
Figure 3:2 Maternal and Child Health Targets 16
Figure 3:3 Maternal and Child Health Indicators 16
Figure 3:4 Per Capita Income and Total Fertility Rate 17
Figure 3:5 Female Literacy and Total Fertility Rate 18
Figure 3:6 Family Planning and Total Fertility Rate 18
Figure 3:7 Infant Mortality Rate 19
Figure 3:8 IMR - Males vs Females 19
Figure 3:9 IMR- Rural vs Urban 19
Figure 3:10 Institutional Delivery and Neonatal Mortality 20
Figure 3:11 Sanitation Levels and Neonatal Mortality 20
Figure 3:12 Full Antenatal Care and Neonatal Mortality 21
Figure 3:13 Women’s Education and Neonatal Mortality 21
Figure 3:14 Sanitation Levels and Under-5 Mortality 22

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Figure 3:15 Immunisation and Under-5 Mortality 22
Figure 3:16 Home Deliveries and Maternal Mortality 23
Figure 3:17 Institutional Deliveries and Maternal Mortality 24
Figure 3:18 Antenatal Care and Maternal Mortality 24
Figure 3:19 Postnatal Care and MMR 24
Figure 3:20 Prevalence of Anaemia in Women and Wasting in Children 25
Figure 3:21 Prevalence of Anaemia in Women and Children 25
Figure 3:22 Male Literacy and Anaemia in Women 26
Figure 3:23 Stunting Rate and Iron Folic Consumption 26
Figure 3:24 Women’s Education and Stunting in Children 27
Figure 3:25 Sub-Centres (Actual vs Required) 28
Figure 3:26 Primary Health Centre (Actual vs Required) 29
Figure 3:27 Community Health Centres (Actual vs Required) 29
Figure 4:1 Targets for Education 32
Figure 4:2 Education Indicators 32
Figure 4:3 Literacy Rate (per cent) 33
Figure 4:4 Literacy Rate: Rural - Urban 33
Figure 4:5 Sex ratio and Literacy Gap 34
Figure 4:6 Adult Literacy Rate (per cent) 34
Figure 4:7 Adult Literacy and Per Capita Income 34
Figure 4:8 Gross Enrolment Ratio 35
Figure 4:9 GER and Per Capita income 35
Figure 4:10 Women’s Education and GER 35
Figure 4:11 GER and Type of School 36
Figure 4:12 GER and Households with Improved Sanitation 36
Figure 4:13 ST Teachers and ST Enrolment 36
Figure 4:14 Retention rate and Type of School 37
Figure 4:15 Retention Rates and Anaemia in Children 37
Figure 4:16 Adult Literacy and Dropout Rates 38
Figure 4:17 Per Capita Income and Dropout Rates 38
Figure 4:18 Stunting Rate and Dropout Rate 38

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Figure 4:19 ST Girls Enrolment and Number of Teachers 39
Figure 4:20 Infrastructure and Enrolment 39
Figure 4:21 Pupil-Teacher Ratio 40
Figure 4:22 Student-Classroom Ratio 40
Figure 4:23 Learning Outcomes and Private School Enrolment 41
Diarrhoea and access to improved sanitation facilities and drinking
Figure 5:1 44
water source
Figure 5:2 Rural Households with Piped Water Supply connection (2016-17) 45
Figure 5:3 Per cent of habitations- Partially Covered 46
Figure 5:4 Sub- Centre Infrastructure 47
Figure 5:5 Share of Anganwadis with Access to Drinking Water 47
Figure 5:6 Share of Schools with Access to Drinking Water 47
Percentage of households in the districts of MP having individual
Figure 5:7 48
latrines (2011)
Figure 5:8 Per cent of schools with Girls Toilet 48
Figure 6:1 Per cent of population below poverty line 52
Figure 6:2 Share of Main and Marginal Workers (Female) 53
Figure 6:3 Children under-5 years whose birth were registered (per cent) 54
Figure 6:4 Incidence of Child Marriage (in per cent) 54
Figure 6:5 Per cent of child workers in total main and marginal workers 55
Figure 6:6 Crime against children (2015-16) 55
Figure 7:1 Urban Households with Internet Connection 58
Figure 7:2 Urban Households with Mobile Phones 59
Figure 7:3 Rural Households with mobile phones 59
Figure 7:4 Banking Penetration 60
Figure 8:1 Women Empowerment Index Scores 2015-16 75

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List of Maps
Map 8:1 Classification of Districts on the basis of Health Index 63
Map 8:2 Classification of Districts on the basis of Education Index 65
Map 8:3 Classification of Districts on the basis of Nutrition Index 68
Map 8:4 Classification of districts on the basis of WASH Index 70
Map 8:5 Classification of Districts with Social Protection Index 72
Map 8:6 Classification of Districts based on Adult Literacy Status (Female) 76
Map 8:7 Classification of Districts based on Adult Literacy Status (Male) 77
Map 8:8 Classification of Districts with composite index 77

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 Chapter 1

Introduction

Equity means individuals should have equal pregnancy, obesity, violence, addiction and
opportunities to pursue a life of their choosing and imprisonment, and the consequences are felt
be spared from extreme deprivation in outcomes by all members of society, not just poor people
(World Development Report, 2006). Equity is thus (Wilkinson and Pickett, 2009). The need to focus
the absence of avoidable or remediable differences on equity therefore goes far beyond economic
among groups of people, whether those groups are benefits.
defined socially, economically, demographically or
geographically (WHO). Greater equity is imperative 1.1 Achieving equity- From MDG to
for poverty reduction: through potential beneficial SDG
effects on aggregate long-run development and
The Millennium Development Goals (MDGs) were
through greater opportunities for poorer groups
a manifestation of the Millennium Declaration
within any society.
(2000), an international pledge to create a more
When one part of society is excluded from the tolerant, peaceful and equitable world. A central
development process, it will lead to widening aspect of MDG was equity, justifiable allocation
disparities with its impact felt across society. and division of resources. The goals intended to
Excluding parts of society from reaping the fruits look at development beyond the conventional
of development undermines the nation’s continuous economic factors and incorporated indicators of
efforts across the social, economic and political health, education, gender equity and environment.
spectrum. The inequities, prevalent in society, thus Although significant achievements have been made
undercut its economic growth as well as its poverty on many of the MDG targets worldwide, progress
reducing potential. has been uneven across regions and countries,
leaving significant gaps (MDG Report, 2015).
Inequity, also leads to poor health and education
outcomes. There exists a positive relationship The lessons from the MDGs were subsequently used
between economic inequity and poor health. to forge a new path to a more sustainable future.
Economic inequity leads to shorter, unhealthier The Sustainable Development Goals (SDGs) were
and unhappier lives, and to higher rates of teenage born in 2012 at the United Nations Conference

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

SDG Goals

1. End poverty in all its forms everywhere

2. End hunger, achieve food security and improved nutrition, and promote sustainable
agriculture
3. Ensure healthy lives and promote well-being for all at all ages
4. Ensure inclusive and equitable quality education and promote life-long learning
opportunities for all
5. Achieve gender equality and empower all women and girls
6. Ensure availability and sustainable management of water and sanitation for all
7. Ensure access to affordable, reliable, sustainable and modern energy for all
8. Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all
9. Build resilient infrastructure, promote inclusive and sustainable industrialization and
foster innovation
10. Reduce inequality within and among countries
11. Make cities and human settlements inclusive, safe, resilient and sustainable
12. Ensure sustainable consumption and production patterns
13. Take urgent action to combat climate change and its impacts
14. Conserve and sustainably use the oceans, seas and marine resources for sustainable
development
15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably
manage forests, combat desertification, halt and reverse land degradation and halt
biodiversity loss
16. Promote peaceful and inclusive societies for sustainable development, provide
access to justice for all and build effective, accountable and inclusive institutions at
all levels
17. Strengthen the means of implementation and revitalize the global partnership for
sustainable development

on Sustainable Development, Rio de Janeiro. The The new agenda under SDG goes far beyond
monitoring framework and indicators for the SDGs the MDGs in encompassing issues related not
are developed based on the successes and failures only to economic, social and cultural rights but
of its predecessor – the MDGs. It offers a universal, also civil rights, political rights and the right to
holistic framework for development through three development. Hence, it effectively mirrors the
main dimensions - economic development, social human rights framework. It is grounded in the
inclusion and environmental sustainability. The Universal Declaration of Human Rights and other
SDGs “seek to realise the human rights of all and international instruments such as the Declaration
to achieve gender equality and the empowerment on the Right to Development. It intends to realize
of all women and girls.” Towards this end, a set a world free of poverty, hunger and disease, and
of 17 Sustainable Development Goals and 169 a world of universal respect for human rights
accompanying targets with 234 indicators were and human dignity, of justice and equality. SDGs
proposed. address availability, accessibility, affordability

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

and quality of education, health, water and other GSDP of the state increased from 3.9 per cent in
services related to those rights. 2014-15 to 10.6 per cent in 2016-17 at `59,052.
Figure 1:1 GSDP and NSDP growth rate
1.2 Madhya Pradesh- Moving from MDG
to SDG
The world’s most populous countries China and India
have played a central role in the global reduction
of poverty (MDG Report, 2015). Although, India has
made significant strides in achieving MDG targets,
widespread deprivation and inequity still remain.
As per India’s MDG framework, over 40 per cent of
the targets were achieved while the remaining was
Source: Department of Economics and Statistics,
either ‘in progress’ or ‘nearly achieved’. Various Madhya Pradesh
reports reiterate the achievements in poverty The main contributor to the state’s economy is
eradication and access to primary education while the primary sector- largely agriculture, fishing
stating the difficulties in meeting the targets of and forestry. Agriculture and allied activities play
maternal and child mortality, sanitation and also an important role in the state’s economy with a
reducing the proportion of underweight children. steady rise in its sectoral share while there has
been a decline in the shares of industrial and
Madhya Pradesh is one among the Indian states that
service sectors.
has been performing below the national average in
terms of achieving MDG goals. Madhya Pradesh was Figure 1:2 Sector wise shares in GSDP (per
cent)
one among the states with the highest poverty head
count ratio and poverty gap ratio, compared to the
MDG targets in 2015. There exists visible inequity
in terms of different social indicators among the
women and children in Madhya Pradesh. High levels
of women mortality are seen in terms of key women
related survival indicators in Madhya Pradesh.
Gender inequity is also a major area of concern
in the state that denies women their rights and
freedom to choose and avail the required services Source: Department of Economics and Statistics,
Madhya Pradesh
in the state.
The growth in agriculture sector increased from
1.3 State of the Economy 3.7 per cent in 2014-15 to 20.4 per cent in 2016-
17. The state registered double digit growth rate
The Gross State Domestic Product (GSDP) of Madhya
in agriculture when the national average was 4.9
Pradesh in 2016-17 is US $ 99.4 billion, which has
per cent.
increased significantly at a growth rate of 15.21 per
cent from 2011-12 .The Net State Domestic Product 1.4 State of Development
(NSDP) increased significantly at a growth rate of
15.16 per cent between 2011-12 and 2016-17 to US Though Madhya Pradesh has registered a
$ 88.77 billion. In 2016-17, the state registered a remarkable performance by achieving higher GSDP
double digit GSDP growth rate of 14 per cent against growth rate, its achievement in terms of human
the national average of 7.1 per cent. Per capita development indicators is among the lowest in
India.
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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Table 1:1 Madhya Pradesh Development Indicators

Indicators MP All India

Literacy Rate (in per cent) (Census 2011) 70.60 74.00

Male Literacy Rate (in per cent) (Census 2011) 80.53 82.14

Female Literacy Rate (in per cent) (Census 2011) 60.02 65.46

Youth Literacy Rate (in per cent) (Census 2011) 83.71 86.14

Infant Mortality Rate (NFHS-4) 51.00 41.00

Maternal Mortality Rate in 2011-13 (SRS Bulletin) 221.00 167.00

Prevalence of Underweight Children under five years of age (in

42.80 35.70
per cent) (NFHS-4)
Poverty Head Count Ratio,2009-10 (in per cent) (Planning
36.70 29.80
Commission)

Source: Census, 2011; NFHS-4; SRS Bulletin

Madhya Pradesh has shown an improving trend Madhya Pradesh is classified as one of the ‘Aspirant’
in its health indicators, but it is still one of the states forming the lowest one-third of the list. In
lowest performing states in the country. The Infant terms of incremental performance, the state was
Mortality Rate (IMR) of the state has been declining found to be one of the least improved with a single
since 2006 but it is still one of the highest in India point increase, and maintaining its rank at 17.
(Government of India, 2015). As per the latest
National Family Health Survey Data (NFHS-4, 2015- Figure 1:3 Health Index
16) the IMR in the state is 51 per 1000 live births,
showing improvement from the previous NFHS-3 (70
per 1000 births) in 2005-06. The survey also shows
a higher rate of infant mortality and under-five
mortality in rural areas when compared with urban
areas. The share of underweight children below
three years is found to be highest (57.9 per cent) in
Madhya Pradesh among the Indian states (NFHS-4).
In an attempt to bring out transformational change
in the health outcomes across states, NITI Aayog
has developed a Health Index to measure states’
performances and track incremental changes.
The index comprises health outcomes like MMR,
U5MR, TFR, institutional deliveries, immunization
coverage etc., governance and information aspects
such as data integrity and key inputs or processes Source: Healthy States, Progressive India-2018
including proportion of functional PHCs and vacant
healthcare provider positions.

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

In education, the state’s performance is below with equity lenses and to ensure sustainable
the national average in terms of the outcome development.
indicators. The adult literacy rate (15 years and
above) as per the Census 2011 is 64 per cent while 1.5 Framework of the Study
the national adult literacy rate is 69 per cent. There Equity has been recognized globally as an important
is a high disparity between the literacy levels of contributing factor to development and has been
men and women in the state clearly evident from the focus of programming by many development
the difference of 20 points. Mothers’ education agencies. Equity is taken as a starting point
level is known to improve child nutrition, reduce for arguments for the intrinsic value of greater
chances of both maternal and child deaths, and equality (Melamed and Samman, 2013). In the 2010
hasten demographic transition to lower birth rates Human Development Report of Equality, United
(UNESCO Girls’ Education Fact Sheet, 2013). Nations Development Program (UNDP) repeated
The state has made significant progress in providing the definition of human development, signaling
access to drinking water and sanitation facilities to the importance accorded to equity (UNDP, 2010).
the households, but it still lags behind other states Defining and measuring ‘equity’ is a difficult task
in the country. Based on a survey conducted by and hence an attempt has been made to develop a
the National Sample Survey Office in 2016, open framework for understanding equity as it exists in
defecation is among the highest in Madhya Pradesh, MP across districts.
higher than the national average in both urban and In the first phase, the study analyses the status
rural areas (Government of India, 2016). This trend quo of health, education, nutrition, and water,
is evident even among the richer households in the sanitation and hygiene (WASH) sectors in Madhya
state (World Bank, 2016). Pradesh. Secondly, district wise analysis is carried
For the achievement of SDG there is a need to focus out to understand the various factors influencing
on critical sectors such as education, health, water, the outcome indicators. Thirdly, an index for each
sanitation and nutrition. These sectors are key sector for all the districts has been developed to
areas prioritised by the government along with UN identify the strategies to be implemented across
agencies. They are known to have multiplier effects the districts. A composite index has been developed
and could jump start SDG target attainments. to understand the position of the districts in terms
With this background, the present report addresses of attainment of SDGs.
the following objectives:
The policies along with central/ state schemes
• To analyze the trends and patterns in the health, focussing on sectors such as education, health,
education, nutrition, and water and sanitation nutrition, WASH and tribal development will be
development outcome indicators across districts reviewed. Attention will be given to understand
and social groups. the impact of existing policies/schemes and
• To determine the social, political and institutional to determine the gaps in the existing system.
factors that hamper the realization of children’s Recommendations will be provided to confirm that
and women’s rights. the strategies and policies will be able to address
those bottlenecks.
• To identify the challenging factors that constrain
the implementation of pro equity policies in the 1.6 Data Sources
state.
The study is largely based on secondary data.
• To strengthen the knowledge base of the state Through focus group discussion some relevant
for designing differential policies and programs information has been collected to fill the gap

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

and to substantiate the findings. Various census chapter, the district wise development in the state
reports, various NSSO Rounds, CSO data, Planning in terms of health and nutrition are discussed. The
Commission (MP) District Information for Education fourth chapter makes a district wise analysis of the
(DISE), National Family Health Survey (NFHS), education sector. In the fifth chapter, analysis will
District Level Household and Facility Survey (DLHS) focus on WASH.
of Ministry of Health and Family Welfare, Annual
The sixth chapter discusses the situation of Social
Health Survey, City Development Plans (CDPs), City
and Child Protection in the state. In the seventh
Sanitation Plans (CSPs) etc. are the main sources of
chapter, the status of infrastructure development
secondary data.
is discussed. The seventh chapter also discusses
the readiness for SDG attainments with the focus
1.7 Structure of the Report
on intra state issues. Recommendation on various
The report is organized as follows. After discussing issues relating to Health, Education, WASH and
the relevance and scope of the study in the nutrition are discussed in the eighth chapter. The
first chapter, the second chapter discusses the ninth chapter summarises and concludes the study.
demographic profile of the state. In the third

6
 Chapter 2

Demographics

“Our demographic dividend is our strength. The youth have what it takes to engage with latest
technology” – Narendra Modi, Prime Minister of India

Demographic characteristics provide an overview The population growth rate in the state is more than
of population size, its growth rate and composition, the national average. During 2001-2011, the state
territorial distribution, birth and death rates, registered a growth rate of 20.3 per cent against
expectancy of life etc. Madhya Pradesh, called the the national growth rate of 17.7 per cent. But the
‘heart of India’ covers 9.4 per cent of the total land decadal growth rate has declined from 27.24 per
area of the country, and comprises 6 per cent of the cent during 1981-91 to 20.3 per cent during 2001-
total population of India. As per Census 2011, the 11. Thus from 1981-91 onwards a declining trend
total population of Madhya Pradesh is 72,626,809 of is visible in the decadal growth rate of population.
which male and female constitute 51.8 per cent and
48.2 per cent respectively.
Figure 2:1 Total Population (in thousands) and Decadal Growth Rate in Population (in per cent)

Source: Handbook of Statistics on Indian States, RBI

7
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

2.1 Rural-Urban Divide As per census 2011, 28 per cent of the urban
population in the state lives in slum areas.
Rural population has a share of 72.37 per cent It was reported that in the states of Andhra
whereas the urban population accounts for 27.63 Pradesh, Chhatisgarh, Madhya Pradesh, Orissa
per cent. At the all India level, the number stands at and West Bengal more than 1 in 5 urban
68.9 per cent and 31.1 per cent respectively. During households lives in a slum.In 2001, there were
2001-2011, the state registered urban population 339 statutory towns in Madhya Pradesh with
growth rate of 25.06 per cent. During the same 142 slum reported towns in 2001. As per census
period, rural population registered a decadal growth 2011, number of statutory towns in the state
rate of 18.42 per cent. Among the Empowered has increased to 364 with 303 slum reported
Action Group (EAG) states, Madhya Pradesh holds towns. Indore (Municipal Corporation) registers
the second position next to Uttar Pradesh (30.23 the highest slum population at 590,257. But
per cent) in terms of share of urban population to when it comes to the share of slum population
the total population. The eight socioeconomically to the total urban population, Jabalpur has
backward states of Bihar, Chhattisgarh, Jharkhand, the highest share at 35 per cent. Bhopal holds
Madhya Pradesh, Orissa, Rajasthan, Uttaranchal the second position with a share of 25 per cent
and Uttar Pradesh are referred to as the EAG states. followed by Gwalior, Indore and Ujjain (Figure
2:2).
Table 2:1 Per cent of Urban Population in EAG
states Figure 2:2 Urban Population vs Slum Population
Per cent of urban
States
population
Bihar 11.30

Chhattisgarh 23.24

Jharkhand 24.05

Madhya Pradesh 27.63

Orissa 16.69

Rajasthan 24.87 Source: Census, 2011

Uttarakhand 22.27 2.2 Density of Population

Uttar Pradesh 30.23 The density of population in Madhya Pradesh has
Source: Handbook of Statistics on Indian States, RBI increased from 156 per sq km in 1991 to 236 per
sq km in 2011. Among the districts, density of
Increasing rate of urbanisation has also led to a
population is found to be higher in the urbanised
corresponding increase in the slum population.
districts of the state. Density of population is
highest in Bhopal with 855 per sq km and Indore is
Bhopal, Indore, Gwalior, Jabalpur and Ujjain
second with 841 per sq km. Over the past decade a
account for around 39 per cent of the total
urban population in the state. Rewa, Dhar rapid increase in the density of population has been
and Satna have the highest share of rural witnessed in the urban districts of Bhopal, Indore,
population. The three districts account Jabalpur and Gwalior. The increasing density of
for around 10 per cent of the total rural population in the above districts can be attributed
population in the state. to increasing migration to urban districts.

8
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 2:3 Density of Population (per sq km) 58.56 per cent in 2011 in the state.

Next to the share of working age group comes the

share of the young population in both 2001 and
2011. The share of young population in the state is
greater than the national average in both periods.
The old age group represents only a small share
of the population while it has increased slightly in
2011 compared to 2001.
Source: Census, 2011
Population growth and the associated labour
2.3 Demographic Dividend - Driver for force is considered to be a major potential for
Economic Growth the country’s economic growth. By 2025, India
is poised to become one of the most populous
The age composition of the population in Madhya
nations with a population of 1.4 billion. Around 64
Pradesh is given in the figure below. It shows that
per cent of India’s population is expected to be in
majority of the population belongs to the working
the age group of 15-59 years by 2026- this could be
population group 15 to 59 years, in both 2001 and
of great consequence for the economic growth of
2011. The share of the working age group (labor
the country. Around 60 per cent of the population
force) increased from 54.11 per cent in 2001 to

Figure 2:4 Age Pyramid - 2011 Figure 2:5 Age Pyramid (2026)

Source: Census 2011 Source: UNFPA, 2016

Figure 2:6 Workforce Participation Rate (in per cent)

Rural Urban

Source: Census 2011

9
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

increase in India would come from Madhya Pradesh, Figure 2:8 Sex Ratio among STs
Bihar, Uttar Pradesh and Rajasthan. As per Census
2011, median age of Madhya Pradesh stands at
23, whereas the median age of India is at 24. The
young median age suggests a positive impact on the
economic growth of the state.

The workforce participation rate for rural areas

is higher in Madhya Pradesh both for males and
females than the national average (Figure 2:6).
But in urban areas, workforce participation rate in
the state is less than the national average. By 2026,
working age group (20-64) is going to have a share of
58 per cent to the total population in the state. The
Source: Census, 2011
state will be able to reap its demographic dividend
only if it can generate skilful working population with a high proportion of rural population register
and step up its workforce participation rate. higher sex ratio than their urban counterparts.
Madhya Pradesh is also the state with the highest
2.4 Sex Ratio share of tribal population, accounting for 14.7 per
cent of the total ST population in the country. It
Madhya Pradesh has a low sex ratio of 931 compared
to the national average of 940. The sex ratio of the Table 2:2 Per cent of ST population and
state has improved from 919 in 2001 to 936 in 2011. Sex Ratio
The state also follows the national trend with sex Districts Per cent of Sex Ratio
ST population
ratio in urban areas lower than the rural areas. The
Alirajpur 89.00 1011
low sex ratio in urban areas could be attributed to
Jhabua 87.00 990
the increasing migration of men than women to the
Barwani 69.40 982
urban areas.
Dindori 64.70 1002
Figure 2:7 Sex Ratio Mandla 57.90 1008
Dhar 55.90 964
Anuppur 47.90 976
Umaria 46.60 950
Shahdol 44.70 974
Betul 42.30 971
Khargone 39.00 965
(West Nimar)
Seoni 37.70 982
Chhindwara 36.80 964
Khandwa 35.00 943
(East Nimar)
Singrauli 32.60 920
Burhanpur 30.40 951
Source: Census, 2011
Ratlam 28.20 971
The districts registering high sex ratio in the states
Harda 28.00 933
are Balaghat (1021), Alirajpur (1011), Mandla (1008),
Sidhi 27.80 957
Dindori (1002). It should be noted that districts
Source: Census, 2011

10
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

is interesting to note, apart from Balaghat, all the participation rate among females. Districts with
three districts registering sex ratio above 1000 are sex ratio above 1000 register higher work force
tribal districts. Similarly districts with more than participation rate for females: Balaghat (47),
25 per cent of tribal population register sex ratio Alirajpur (48.6), Mandla (49) and Dindori (52.9).
greater than the state average (except Singrauli).
When the child sex ratio is taken into account, it
There exists a positive correlation (0.83) between can be seen that it declined from 932 in 2001 to
sex ratio and workforce participation rate among 918 in 2011 (Figure 2:10). It should be noted that
females (Figure 2:9). Districts registering high the decline in child sex ratio is more prominent
female workforce participation rate also register in rural areas than in urban areas. The decline in
high sex ratio. Bhind registers the lowest sex ratio in child sex ratio is also more prominent among the
the state at 837 and it also has the lowest workforce STs compared to the overall decline in child sex
participation rate (female) of 8.4 per cent. Similarly ratio in the state (Figure 2:10).
the worst performing districts such as Morena (16.8),
The districts registering highest decline in child
Gwalior (14.5), Datia (26) register low workforce
Figure 2:9 Sex Ratio vs Workforce Participation Rate, females (in per cent) *

Source: Census, 2011

Figure 2:10 Variation in Child Sex Ratio (0-6 years) from 2001 to 2011

Madhya Pradesh STs in Madhya Pradesh

Source: Census, 2011

* 50 districts represented in the graph

11
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

sex ratio are Rewa, Sidhi, Sheopur, Singrauli and average, registering the third highest birth rate in
Annupur. All the above districts have a high share the country. CBR in rural areas is higher than in
of rural population. The declining child sex ratio urban areas with the state registering CBR of 26.7
reveals the preference for a male child over female. and 19.8 respectively.

2.5 Crude Birth Rate (CBR) and Crude Crude death rate, which is the average annual
Death Rate (CDR) number of deaths during a year per 1,000 persons
in the population at midyear, measures the risk of
Crude birth rate is the average annual number of mortality in a population. The crude death rate
live births during a year per 1,000 persons in the declined from 12.6 in 1990 to 7.1 in 2016 in Madhya
population at midyear. Crude birth rate in the state Pradesh. Though there has been a significant
of Madhya Pradesh has fallen from 37.1 in 1990 to decline in crude death rate in the state, its CDR
25.1 in 2016. Despite this, the crude birth rate in is higher than the national average. Like CBR, CDR
the state is consistently higher than the national is higher in rural MP than in urban MP at 18.2 and
Figure 2:11 CBR and CDR ( in per cent )among 13.7 respectively.
EAG states
An inter-district analysis shows that districts with
high per capita income perform well in terms of
CBR and CDR. There exists a negative correlation
between CBR, CDR and per capita income (Figure
2:12). Districts such as Bhopal, Indore and Gwalior
with the highest per capita income register low
birth rate and death rate. A similar inverse relation
can be seen in districts with low per capita income
registering high birth rate and death rate.

2.6 Life Expectancy

Life expectancy at birth, which is the number of
Source: Annual Health Survey, 2012-13 years, a person would be expected to live, reflects

Figure 2:12 CBR, CDR vs Per Capita Income*

Source: Annual Health Survey, 2012-13

* 45 districts represented in the graph

12
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

a population’s overall mortality and thus the quantity has initiated schemes like ‘MP Skill and Quality
of life, across all age groups. Life expectancy in the Improvement Programme’ for skill development
state of Madhya Pradesh has increased from 55.4 that would add to the employment generation in
years to 64.8 years in the period 1993-97 to 2011- the state. The scheme aims to have at least one
115. Yet the state has the lowest life expectancy Skill Development Centre (SDC) in all the 313 blocks
in the country with the national average being 68.3 of the state. Madhya Pradesh should develop into
years. Life expectancy at birth of women has a globally competitive destination by opening up
increased compared to that of men in the state. But its economy. This will enable the state to attract
it still remains the lowest when compared with the more investors and create more opportunities. The
other Indian states. state should create a conducive environment to
attract investment- the encouragement of English
2.7 Summing Up education is an important step. More linkages to
The state will be able to reap its demographic the market will lead to more access, which in turn
dividend only by enabling the youth to acquire skills can have a positive impact across sectors.
required in the job market. The state government

13
 Chapter 3

Health and Nutrition

“Better health is central to human happiness and well-being. It also makes an important contribution to economic
progress, as healthy populations live longer, are more productive, and save more.”- World Health Organisation

“Nutrition is both a maker and a marker of development. Improved nutrition is the platform for progress in health,
education, employment, empowerment of women and the reduction of poverty and inequality, and can lay the
foundation for peaceful, secure and stable societies” - Ban Ki-Moon, 8th Secretary General of UN

Health and nutrition exert great influence on each malnutrition to Indian GDP is estimated to be 4 per
other. Poor health can lead to poor nutrition, and cent1.
vice-versa, which in turn reduces GDP per capita by
On both the health and nutrition front, Madhya
reducing labour productivity and the relative size
Pradesh is among the lowest performers in the
of labour force. According to World Bank estimates
country. As per the Health Composite Index (2018),
India loses 6 per cent annually due to premature
Madhya Pradesh was one of the worst performing
deaths and preventable diseases. The cost of

Figure 3:1 Health links to GDP

Assocham and EY.2017. Bridging the Gap: Tapping the Agriculture Potential for Optimum Nutrition
1

15
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

states with a composite score of 40.09, compared Goals).

to 76.55 for Kerala (best performer). Though the
The MP Planning Commission sets targets to be
state was able to register a meagre improvement in
achieved across various sectors including health
the score, she was not able to improve her ranking,
and nutrition. These targets cover indicators of
maintaining the position at 17. In Madhya Pradesh, 17
both maternal and child health.
districts have been identified as high priority districts2
The latest maternal and child health indicators
by Ministry of Health and Family Welfare.
Figure 3:2 Maternal and Child Health
High Priority Districts -Raisen, Tikamgarh, Targets
Sidhi, Singrauli, Sagar, Damoh, Satna, Dindori, • Reduce Maternal Mortality Ratio to 125 per
Shahdol, Anuppur, Umaria, Chhatarpur, Panna, 100,000 live births
Barwani, Mandla, Jhabua and Alirajpur • Reduce Infant Mortality Rate to 35 per 1,000
live births
India has the largest share of undernourished children • Reduce Total Fertility Rate to 2.1
• Reduce malnourishment to 20 per cent and
(around 50 per cent) in the world3. Within the
anaemia to 25 per cent
country, Madhya Pradesh, Uttar Pradesh and Bihar
Source: MP XII Five Year Plan (2012-2017)
account for the highest share of undernourished
children. The Poshan Abhiyan Mission was started show an improvement in the performance of
in 2017-18 to reduce stunting, wasting, low birth indicators such as infant mortality and maternal
weight and anaemia in the country. It has identified mortality, as per SRS Bulletin and NFHS 2015-16.
37 districts in Madhya Pradesh to be included in 3.2 Indicators for Health Monitoring
the mission. All the high priority districts are also Figure 3:3 Maternal and Child Health
included in the Poshan Abhiyan districts. Indicators
3.1 Health and Nutrition: Attaining • Infant Mortality Rate 51
SDGs • Maternal Mortality Ratio 221
• Under 5 mortality Rate 65
Though health had a prominent stake in the
• Total Fertility Rate 2.8
millennium development goals (MDGs), it was • Children under 5 years who are stunted 42
restricted to child and maternal mortality and per cent
communicable diseases. However, the discourse • Children under 5 years who are wasted 25.8
shifted to ensuring good health and wellbeing per cent
with emphasis on social determinants of health. • Children under 5 years who are underweight
42.8 per cent
The third goal, ensuring health and wellbeing,
• Women who are anaemic 52.5 per cent
encompasses the following nine targets that need
Source: SRS Bulletin, NFHS, 2015-16
to be achieved by 2030 (Sustainable Development

SDG Targets - Health and Nutrition

• Reduce Global Maternal Mortality to less than 70 per 100,000 live births
• Reduce Neonatal Mortality to at least 12 per 1,000 live births and under five mortality to 25 per 1,000
live births
• Reduce stunting in children under-5 by 40 per cent
• Reduce anaemia in women of reproductive age by 50 per cent
• Reduce prevalence of low-birthweight babies by 30 per cent
• Increase the rate of exclusive breastfeeding, up to first 6 months, to at least 50 per cent
• Reduce and maintain childhood wasting to less than 5 per cent

2
Bottom 25per cent districts within a State taken according to ranking based on Composite Index) plus LWE or Tribal districts fall-
ing in bottom 50per cent
3
Assocham and EY.2017. Bridging the Gap: Tapping the Agriculture Potential for Optimum Nutrition

16
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Input Indicators Output Indicators Outcome Indicators

• Number of PHCs/ SHCs • Antenatal Care • Total Fertility Rate

• Number of beds in • Births attended by Skilled • Maternal Mortality Rate
District Hospitals Personnel • Neonatal Mortality Rate
• Number of Health • Institutional Deliveries • Under-5 Mortality Rate
Personnel • Immunisation Coverage • Stunting
• Number of ASHA workers • Family Planning • Wasting
• Number of Anaganwadi • Breastfeeding • Low Birth-Weight
Centres • Access to supplements • Anaemia

3.3.1 Total Fertility Rate

The health status of a society is often monitored
The average number of children a woman would
through a set of performance indicators viz.
have by the end of her childbearing years if she
mortality rates, disease burden. However, only bore children at the current age-specific fertility
tracking the performance of these outcome rates.
indicators is not sufficient as it does not clarify the
Total Fertility Rate (TFR) in Madhya Pradesh has
factors that affected the performance.
shown a declining trend from 3.1 (2005-06) to 2.3
This analysis examines the health status of Madhya (2015-16). The NFHS-4 Report also found one of the
Pradesh through three main indicator categories - greatest differentials in TFR exists in the case of
input, output and outcome. The outcome indicators schooling; women with no schooling would have
are the conventional performance indicators used 1.3 children more than women with 12+ years of
while discussing health and nutrition. Improvements schooling.
in outcome indicators are dependent on the better
The subsequent analysis intends to look into the
performance of the output indicators, which are in
external factors that have significant implications
turn impacted by the robustness of input indicators.
for the fertility rates.

3.3 Outcome Indicators There exists a strong negative relationship (-0.638)

Figure 3:4 Per Capita Income and Total Fertility Rate*

Source: AHS, 2012-13

* 45 districts represented in the graph

17
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

between per capita income and fertility rates at the the targets to be achieved. The targets for total
district level (Figure 3:4). Districts with highest per fertility rates were set by the XII Five Year Plan
capita income were found to have lower levels of and only two districts - Bhopal and Gwalior - were
fertility rates. The districts registering highest per at that level.
capita income in the state had already achieved the
The results of NFHS 4 with that of its previous
TFR target.
edition revealed that the share of married women
The analysis of district level data on female aged 15-49, using some method of family planning
literacy and total fertility rate revealed a negative fell from 56 per cent (2005-06) to 51 per cent
correlation (-0.403). Districts like Bhopal, Indore, (2015-16). However, data analysis also revealed
Jabalpur and Gwalior with a higher share of literate a weak negative relationship (-0.121) between
women had the lowest level of TFR; while higher family planning services and total fertility rates
fertility rates were found in districts such as Jhabua, at the district level (Figure 3:6). The correlations
Barwani and Panna (Figure 3:5). show stronger influence of other factors such as
per capita income and female literacy, rather than
As per the SDG agenda, universal access to sexual
family planning services.
and reproductive healthcare services is one of
3.3.2 Infant Mortality Rate

Figure 3:5 Female Literacy and Total Fertility Rate*

Source: AHS 2012-13

Figure 3:6 Family Planning and Total Fertility Rate*

Source: AHS, 2012-13

* 45 districts represented in the graph

18
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

mortality and under -5 mortality.

IMR refers to the number of child deaths below 1
In Madhya Pradesh, following the national trend,
year of age per 1000 live births
IMR in rural areas is much higher than in urban
areas. In the districts of Shahdol, Neemuch and
Child mortality indicators are an important measure
Mandsaur, the rural IMR is more than double that
of an economy’s socioeconomic development
of urban.
and quality of life. These broadly include infant

Figure 3:7 Infant Mortality Rate

Source: AHS 2012-13

Figure 3:8 IMR - Males vs Females

Source: AHS 2012-13

Figure 3:9 IMR- Rural vs Urban

Source: AHS 2012-13

(Districts where IMR data of rural-urban separately are only included)

19
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

IMR has two main components- neonatal and post- between neonatal mortality and institutional
natal mortality rate. The neonatal mortality rate of deliveries in the districts (Figure 3:10). Districts
the state is at 34 per 1000 live births, whereas the with high rates of institutional deliveries were
post-natal mortality rate of the state stands at 16 found to have the lowest neonatal mortality rates.
per 1000 live births. In India, 68 per cent of infant
deaths occur during the neonatal period. Madhya A research study conducted in tribal
Pradesh registers one of the highest neonatal
districts of Alirajpur, Barwani and Khandwa
mortality rates in the country. It is thus important to
found out that 53.4 per cent deliveries were
understand the factors influencing neonatal deaths
done in hospitals and rest at home. But only
in the state.
21.9 per cent home deliveries were done
In Madhya Pradesh, there has been significant by trained people. Moreover, the delivery
improvement in institutional deliveries. Institutional
practices were not safe as only 59.8 per cent
deliveries have increased from 26.2 per cent in
of them used new blades to cut placenta.
2005-06 to 80.8 per cent in 2015-16. The graph
(Rajesh Mishra, 2017)
above establishes a negative relationship (-0.484)

Figure 3:10 Institutional Delivery and Neonatal Mortality Rate

Source: AHS 2012-13

Figure 3:11 Sanitation Levels and Neonatal Mortality Rate

Source: AHS, 2012-13; NFHS, 2015-16

20
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 3:12 Full Antenatal Care and Neonatal Mortality Rate

Source: AHS, 2012-13; NFHS, 2015-16

Figure 3:13 Women’s Education and Neonatal Mortality Rate

Source: AHS, 2012-13; NFHS, 2015-16

Districts with a larger share of households with Mothers who received full antenatal care (ANC)4
improved sanitation were also found to have lower have increased from 4.7 per cent in 2005-06 to
rates of neonatal mortality, indicating a strong 11.4 per cent in 2015-16. A negative correlation
negative correlation (-0.600). Districts such as Panna, (-0.453) was observed such that in districts where
Satna, Damoh etc. with low improved sanitation full ANC coverage was less, neonatal mortality
coverage had the highest neonatal mortalities, rates were higher than the state average (Figure
well above the state average (Figure 3:11). 3:12).

Janani Suraksha Yojana (JSY) was launched in April, 2005 with the aim of reducing IMR and MMR
by promoting institutional deliveries among the poor population, through provision of referral,
transport, and escort services. JSY provides cash assistance with delivery and post-delivery care for
women. As per the national guidelines, all the pregnant women delivering in government institution
or accredited private institutions are eligible for getting JSY benefits of Rs 1,400 in rural areas
and Rs 1,000 in urban areas. JSY was able to make significant progress in increasing institutional
deliveries in the state. But JSY beneficiaries in the state had to travel, on average, 10.4 km to
reach the ultimate place of delivery. Women spent approximately one hour and eight minutes to
arrange transport and reach the ultimate place of delivery, and another 31 minutes on average
after reaching the institution on registration and administrative process and as waiting time until
someone attended them (CORT, 2007).

4
Full antenatal care is at least four antenatal visits, at least one tetanus toxoid (TT) injection and iron folic acid tablets or syruptaken for 100 or more days

21
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Literature suggests that there exists a negative of child deaths also include preventable measures
relationship (-0.348) between mother’s level of such as infection control measures, vaccinations
education and child mortality rates (Figure 3:13). and access to safe water and sanitation. Under-5
An analysis of the education level of women and the mortality rate in Madhya Pradesh has declined
respective neonatal mortality rates at the district from 93 in 2005-06 to 65 in 2015-16 (NFHS-4).
level shows a negative relationship between the Though there is considerable improvement in the
two. At the state level, the share of women with reduction of under-5 mortality rate, it still remains
more than 10 years of schooling is only 23.2 per one of the highest in the country.
cent (2015-16), although it has increased from 14
The following section discusses the important
per cent in 2005-06.
factors that influence U-5 mortality rate in the
3.3.3 Under-5 mortality rate state.

District wise comparison of under-5 mortality

Under-5 mortality rate is an important indicator
and sanitation levels show an evident negative
of the development of a society since the first
relationship (-0.643). Districts such as Sidhi,
five years of life is considered one of the most
Panna and Satna which struggle with low levels of
vulnerable periods. The causes and determinants
sanitation facilities are also crippled by high rates

Figure 3:14 Sanitation Levels and Under-5 Mortality Rate

Source: AHS, 2012-13; NFHS, 2015-16

Figure 3:15 Immunisation and Under-5 Mortality Rate

Source: AHS, 2012-13

22
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Total Fertility Rates and Under - 5 Mortality

Outcome indicators exert a strong influence on each other. Thus, targeted interventions and
strategies towards one would have a spillover effect and create overall positive impacts.

For instance, data shows a strong positive correlation (0.705) between the total fertility rates and
under-5 mortality at the district level. The causality could be explained from both sides. Higher
fertility rates leads to larger family sizes which in many cases would lead to resource scarcities. This
would have a detrimental impact on the health of women and children in particular. Alternatively,
high levels of under-5 mortality could lead to increasing fertility rates as people tend to have more
children than they need; evidenced in Pakistan, Nepal and Bangladesh (UN Economic and Social
Commission for Asia and the Pacific, 1985).

of under-5 mortality. On the other hand, districts (SRS 2016-17) as against the national MMR of
with high share of households having access to 178 in 2016. Over the years Madhya Pradesh was
improved sanitation register low U-5 mortality rate able to reduce its MMR, but it still remains more
(Figure 3:14). than triple the SDG target. According to UNFPA,
important factors influencing maternal deaths
Immunisation coverage is an important aspect
are antenatal care, skilled birth attendance,
determining U-5 mortality rate (-0.596).
emergency obstetric care and postnatal care with
Immunisation coverage (children aged 12-23 months
follow up of health workers.
fully immunised) in the state has increased from
40.3 per cent in 2005-06 to 53.6 per cent in 2015- Analysis shows that maternal mortality rates
16. Immunisation coverage is lowest in the districts have a positive correlation (0.591) with deliveries
of Jhabua, Tikamgarh, Mandla, Umaria and Panna conducted at home and a negative correlation
(Figure 3:15). The low level of immunisation is with the share of home deliveries attended by
also reflected in the U-5 mortality rate in the above health professionals (-0.468) (AHS 2012-13).
districts being higher than the state average (AHS, The districts with low share of deliveries at
2012-13). home are coupled with high percentage of these
deliveries being attended by health personnel-
3.3.4 Maternal Mortality Rate
Indore, Shajapur and Ratlam had lower maternal
Maternal Mortality Ratio in Madhya Pradesh is 221 mortality. Conversely districts with low levels of

Figure 3:16 Home Deliveries and MMR

Source: AHS, 2012-13

23
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 3:17 Institutional Deliveries and MMR

Source: AHS, 2012-13

Figure 3:18 Antenatal Care and MMR

Source: AHS, 2012-13; NFHS, 2015-16

skilled health personnel during birth had the highest from the data. Districts with low share of women
share of maternal mortality rate. receiving full ANC - Sidhi Panna, Tikamgarh, Sagar,
Dindori, Umaria and Shahdol - were found to have
A strong negative correlation (-0.594) exists between
the highest maternal mortality (Figure 3:18).
institutional delivery and maternal mortality ratio
(Figure 3:17). Districts such as Dindori and Shahdol In Madhya Pradesh the share of mothers receiving
with low rates of institutional births were found to postnatal care (PNC) from health personnel
have the highest maternal mortality. increased from 24.9 per cent (2005-06) to 55 per
cent (2015-16) (NFHS). The district wise analysis
Antenatal Care is a critical element of maternal
shows a negative correlation (-0.464) between
health. A negative relationship (-0.317) is evident

Figure 3:19 Postnatal Care and MMR

Source: AHS, 2012-13

24
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

postnatal care visits and maternal mortality. Districts (2005-06) to 25.8 per cent (2015-16) respectively.
struggling with high MMR have a low percentage of The prevailing high levels of stunting and wasting
women receiving PNC within two days of delivery found in the state have serious consequences
viz. Damoh, Sagar, Dindori etc (Figure 3:19). for the health, learning outcomes and overall
development of the child.
3.3.5 Anaemia, Stunting and Wasting
The district-level analysis exhibits a positive
The state has one of the highest levels of correlation (0.449) between the prevalence of
malnutrition in the country. Even more worrisome anaemia among women and wasting in children
is the prevalence of anaemia, especially among (below 5 years). Districts such as Rewa and Sagar
pregnant women and young children. enjoy lower levels of both anaemia in women and
wasting in children (Figure 3:20).
Although the share of women and children affected
by anaemia has declined, 69 per cent of children (6 The analysis revealed a positive correlation
- 59 months) are still afflicted. The share of women between prevalence of anaemia among children
affected is also a staggering 52.5 per cent, with a and women (0.445). Those districts with a high
higher prevalence for pregnant women (NFHS 2015- prevalence for anaemia among women (Barwani,
16). Burhanpur and Sheopur) were found to have a high
prevalence among children as well (Figure 3:21).
Stunting and wasting among children is also a serious
Conversely, in districts such as Rewa, Ashok Nagar
concern although it has decreased from 50 per cent
and Jabalpur, lower levels of anaemia were found
(2005-06) to 42 per cent (2015-16) and 35 per cent
for both children and women.

Figure 3:20 Prevalence of Anaemia in Women and Wasting in Children

Source: NFHS, 2015-16

Figure 3:21 Prevalence of Anaemia in Women and Children

Source: NFHS, 2015-16

25
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 3:22 Male Literacy and Anaemia in Women

Source: NFHS, 2015-16

An analysis of the literacy rates of both men and ICDS Program is an important program to ensure
women, at the district level, with the prevalence nutrition to a large section of the marginalized
of anaemia in women revealed a stronger negative population. The program addresses malnutrition
correlation with male literacy (-0.461) than female among small children, lactating mothers and
literacy (-0.235). This indicates that maternal and pregnant women. ICDS is being implemented
child health interventions and awareness strategies through 453 projects (278 rural, 73 urban and
must not be only targeted towards women but must 102 tribal projects) in all 313 development
also be tailored for both sexes to achieve maximum blocks of Madhya Pradesh to reduce maternal
benefits. In districts like Alirajpur, Barwani and mortality rate, infant mortality rate and
Burhanpur, with the lowest male literacy rates, the malnutrition among children and women.
prevalence of anaemia among women was found to A total of 80,160 Anganwadi centers and 12,070
be high, above 65 per cent. In districts like Bhopal, sub-anganwadi centers are sanctioned in 453
Sagar and Indore with higher male literacy, anaemia child development projects. Through these
among women was lower than 47 per cent. centers, about 97.68 lakh beneficiaries have
been provided with ICDS.

Figure 3:23 Stunting Rate and Iron Folic Consumption

Source: NFHS, 2015-16

26
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 3:24 Women’s Education and Stunting in Children

Source: NFHS, 2015-16

Stunting in children under-5 years was found to have Jabalpur and Betul (Figure 3:24).
a negative correlation (-0.301) with the percentage
of mothers who consumed iron folic acid (Figure 3.4 Health and Nutrition Indicators-
3:23). Districts with the lowest share of mothers Across Social Groups
having taken iron folic acid (Tikamgarh, Alirajpur
The outcome/output indicators across the social
and Sidhi) showed high prevalence of stunting as
groups will help to identify the most deprived
well.
group in the state. From the table given below,
Prevalence of stunting in children under-5 and the it is evident that the situation of the SC and ST
level of women’s education at the district level population is a major cause of concern. Among the
shows a negative correlation (-0.336). Districts with social groups, highest fertility and child mortality
relatively higher rates of women with more than rates are registered by the ST community. These
10 years of education were found to have lower indicators are further assessed in terms of the
than state average prevalence of stunting - Indore, output indicators.
Table 3:1 Health and Nutrition Indicators
Total Neonatal Postnatal U-5 Weight
Height Anaemia
Fertility Mortality Mortality IMR Mortality for
for Age (Women)
Rate Rate Rate Rate Height
SC 2.44 39.60 14.70 54.30 69.60 47.60 25.50 51.70
ST 2.73 43.10 15.80 58.90 78.50 48.20 30.20 64.00
OBC 2.24 37.00 14.60 51.70 62.60 39.70 24.90 49.90
Others 1.92 23.07 10.80 34.60 42.80 31.60 21.50 47.40
Source: NFHS-4

Table 3:2 Output Indicators

Per cent women
Per cent of Children Utilisation of Utilisation of
receiving ANC
women with receiving ICDS services ICDS services
from a skilled
PNC check up basic vaccines (Mother) (Children)
provider
SC 69.9 60.0 51.6 74.2 64.9
ST 54.5 50.6 41.0 71.7 67.1
OBC 72.7 63.1 59.3 73.4 63.3
Others 78.6 66.5 58.8 58.0 56.3
Source: NFHS-4

27
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

of Health and Family Welfare, 2012).

3.5 Health Infrastructure
Primary Health Centre’s (PHC) jurisdiction is
From the above analysis, it is clear that the state in accordance with Alma Ata declaration i.e.
requires a strong health infrastructure to address provision of medical care, maternal-child health
both health and nutritional issues. In the urbanised including family planning, safe water supply and
districts, the private sector plays an important role basic sanitation, prevention and control of locally
in providing the necessary healthcare facilities. In endemic diseases, collection and reporting of
other districts and in the rural areas, the public vital statistics, education about health, referral
health sector still plays a dominant role. Each public services, training of health guides, health workers,
health facility is established according to certain local dais and health assistants and basic laboratory
population norms set by Ministry of Health and workers (Fiyas.BI, 2012).
Family Welfare, Government of India. SCs and PHCs have an important role in ensuring
child and maternal health. In Madhya Pradesh,
Sub Centre (SC): 1 per 5,000 population in general
areas and 1 per 3,000 in difficult/tribal and hilly there are 9192 Sub Centres (SC), 1171 Primary
areas Health Centres (PHC). From the graphs given
Primary Health Centre (PHC): 1 per 30,000 below it can be inferred that there exists a wide
population in general areas and 1 per 20,000 in gap between the required and actual number of
difficult/tribal and hilly areas PHC and SC in all the districts. It is interesting to
Community Health Centre (CHC): 1 per 120,000 note that the gap (both SC and PHC) is highest in
population in general areas and 1 per 80,000 in urbanised districts such as Jabalpur, Indore and
difficult/tribal and hilly areas
Bhopal. But the above districts perform well in
terms of registering lowest IMR, U-5 mortality rate
The jurisdiction of Sub Centres is maternal and
and MMR. This highlights the important role played
child health which includes antenatal, intranatal
by private clinics and hospitals in the urbanised
and postnatal care, child health, family planning
districts. But the existing gap is a serious concern in
and contraception, counselling and referral for
tribal districts as well as in districts such as Panna,
safe abortion, adolescent health care, assistance
Sidhi (tribal district), Satna, Damoh and Shivpuri
to school health services, control of locally
which register the worst child and maternal
endemic disease, disease surveillance, water
mortality indicators.
quality monitoring, promotion of sanitation which
encompasses proper garbage disposal and use of In addition to PHC and SC, Madhya Pradesh has 334
toilets and community needs assessment (Ministry Community Health Centres (CHC), 66 sub divisional

Figure 3:25 Sub-Centres (Actual vs Required)

Source: RHS, 2015

28
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 3:26 Primary Health Centre (Actual vs Required)

Source: RHS, 2015

Figure 3:27 Community Health Centres (Actual vs Required)

Source: Rural Health Statistics, 2015

hospitals and 51 district hospitals. There also exists Though the state has adequate number of ANMs
a significant gap between the actual and required and ASHA workers as pointed out in a Focus Group
number of CHCs across the districts. Inadequacy Discussion (FGD), there exists a dearth in the
of health infrastructure in health institutions is a available number of doctors/specialist. The below
major problem hampering the efficient delivery of table highlights the inadequacy of manpower in
health services in Madhya Pradesh. PHC and SC across the state:

Table 3:3 Manpower in Health Institutions

Required In Position

Health Worker (Female)/ANM at SC 9192 11057

Health Worker (Female)/ANM at SC and PHC 10363 12412

Health Worker (Male) at SC 9192 4295

Surgeons at CHC 334 51

Obstetricians and gynaecologist at CHC 334 55

Physicians at CHC 334 72

Paediatricians at CHC 334 85

Nursing Staff at PHC 3509 3629

Source: RHS, 2015

29
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

CHC as referral units have an important role to play 3.6 Summing Up

in ensuring child and maternal health. But in districts
such as Sheopur, Datai, Tikamgarh, Panna, Damoh, From the analysis, it is clear that outcome indicators
Satna, Umaria, Shahdo, Sidhi, Mandsaur, Ujjain, are greatly influenced by factors such as per capita
Shajapur, Barwani, Rajgarh, Harda, Narsimhapur, income, literacy rate etc. Better results in these
Dindori, Mandal and Seoni, there is complete factors can positively influence the health outcome
absence of obstetricians and gynaecologists at CHC indicators. Inadequate supply of doctors, lack of
(DLHS, 2012-13). quality infrastructure and improper functioning of
the health units are the major issues plaguing the
With a population of 7.33 crore, the state has
health sector in the state. Immediate steps need to
only five government medical colleges with 620
be taken to address these issues. Accredited Social
MBBS and 311 PG seats5. This clearly shows that
Health Activist (ASHAs) and Auxiliary Nurse Midwife
the education sector is insufficient to provide the
(ANMs) had a positive impact on various output/
required doctors and specialists, making it difficult
outcome indicators and it’s time to introduce new
for the state to achieve the WHO norm of 1 doctor
initiatives involving ASHA workers and ANMs.
per 1000 population.

5
Madhya Pradesh Public Health Workforce.National Health System Resource Centre. http://nhsrcindia.org/sites/default/files/Madhya%20
Pradesh%20Public%20Health%20Workforce%20Report.

30
 Chapter 4

Education
“Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for life-time”
– Laozi, Ancient Chinese Philosopher

Education is a critical link in any socio-economic of individuals to achieve their educational potential
development framework. Literacy and educational irrespective of personal and social circumstances.
attainments play a significant role in both individual Inclusion is ensuring basic minimum standard of
development and overall societal welfare. Over and learning outcomes for all.
above the improvements in productivity and long
term earning capacity of the individuals, there are The Annual Status of Education Report (ASER),
indirect benefits that accrue to the community and released by Pratham Education Foundation, sheds
economy as a whole. light on the dismal state of education in Madhya
Pradesh, specifically its learning outcomes.
World-over education is considered a basic human Some of the key findings from the survey (2016)
right that is pivotal to the economic development conducted across the 51 districts of the state are:
of the State. It is well established that investing in ● Madhya Pradesh is the state with the
education leads to better pay-offs in the future, in highest proportion of out-of-girls6
terms of higher wages. However, in an increasingly aged 11-14 years (8.5 per cent), after Uttar
knowledge based global economy the skills of the Pradesh (9.9 per cent) and Rajasthan (9.7 per
workforce are critical in ensuring each country cent).
a place in the global pecking order. An inclusive ● Reading outcomes (proportion of students in
education system is the only gateway for countries to a particular class capable of reading. Class
capitalise on the opportunities of global trade. This II text) are significantly higher for private
requires an ecosystem unfettered by institutional schools than government schools.
failure, poor governance and infrastructural
o In 2016, the proportion of Class V
inadequacies. Expanding educational opportunities
students who can read Class II text
also requires focused attention on quality and
was much higher in private schools
equity.
(63.3 per cent) than government
(31.3 per cent).
Equity in education primarily focuses on two aspects-
fairness and inclusion. Fairness refers to the ability ● Arithmetic outcomes in schools (government
6
Percentage of children not enrolled in school

31
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

and private) have significantly fallen from while addressing relevant barriers such as gender
2010 to 2016. inequalities, strong socio-cultural norms and low
o The proportion of students in Class levels of economic development. The following
VIII who can do division dramatically targets encompass some of the main aspects that
declined from 80.1 per cent to 33.4 form the crux of the fourth goal.
per cent.
In the XII Five Year Plan, the MP Planning Commission
● Arithmetic outcomes are better for private
identified areas requiring focussed attention based
schools when compared with government
on the previous years’ performance. These include
schools.
universal enrolment, gender gap in education and
o In 2016, the proportion of Class VIII
retention in schools.
who could do division was considerably
higher in private schools (51.5 per Figure 4:1 Targets for Education
cent) than government schools (29.2
• Achieve 100 per cent literacy
per cent).
• Reduce gender gap in literacy to almost zero
● Proportion of children enrolled in private • Ensure Universal Enrolment
schools has been steadily increasing from • No Out of School Children in age group 6-14
12.15 per cent (2006) to 25.90 per cent (2016). years
● Proportion of girls enrolled in government • Reduce Dropout Rate to less than 5 per cent
schools is higher than boys’ enrolment, except by 2016-17
in the age group of 15 - 16 years. • Eliminate gender disparity in elementary
● Proportion of boys enrolled in private schools education
are higher than girls’ enrolment across all age Source: MP XII Five Year Plan (2012-17)
brackets (7 - 16 years).
The DISE reports show the status of education in
4.1 Attaining SDGs in Education the state through indicators such as enrolment
The Sustainable Development Goals place great rates, dropout rates and overall literacy levels.
emphasis on inclusive and equitable quality
Figure: 4:2 Education Indicators
education. The targets set cover a host of areas
• Overall literacy 70.6 per cent
including better literacy levels, higher completion
o Female 60 per cent
rates, addressing barriers to access of these services
o Male 80.5 per cent
and so on. India has performed well in universalising
• Enrolment Ratio (Primary)
primary education along with improving enrolment
o Gross 94.47 per cent (GER)
and completion rates for girls. However, there
o Net 79.83 per cent (NER)
still exists a need for ensuring equal access to
• Ratio of Girls’ to Boys’ Enrolment - 0.90
opportunities and maintaining quality of education,
Source: DISE, 2015 - 16

SDG Targets - Education

• Girls and Boys complete free, equitable and quality primary and secondary education
• All have access to quality early childhood development, care and pre-primary education
• Eliminate gender disparities and ensure equal access to all levels of education
• Substantially increase supply of qualified teachers
• Substantially increase the number of youths and adults with relevant skills for employment and
entrepreneurship

32
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

4.2 Indicators for Monitoring Education There simultaneously exist districts with more
than 80 per cent literacy (Indore, Bhopal and
4.2.1 Literacy Rate Jabalpur) and those with less than 50 per cent
literacy (Barwani, Jhabua, and Alirajpur). Sheopur
The literacy rate for the state of Madhya Pradesh
and Dhar join this group when less than 60 per cent
has witnessed an increase of total literacy from
literacy is considered.
63.7 per cent (2001 Census) to 69.3 per cent (2011
Census). There is also improvement in literacy rate It is evident from the figure that the urban areas
in all districts in 2011 as compared to 2001 census. have higher literacy rates when compared with
The highest literacy rate was reported in Jabalpur rural Madhya Pradesh (Figure 4:4). The greatest
with 81.1 per cent, followed by Indore (80.9 per rural-urban divide was found in districts such as
cent) Bhopal (80.4 per cent), Gwalior (76.7 per Alirajpur, Jhabua and Barwani. The average rural-
cent), and Sagar (76.5 per cent) and the lowest was urban literacy differential index analysed in the
in Bharwani with 49.1 per cent followed by Sheopur state was 0.27 point (Jhariya and Jain, 2014).
(57.4 per cent), and Dhar (59 per cent). Only ten This is highest in Alirajpur (1.28) district followed
districts in the state have a literacy rate above the by Jhabua (1.00) Barwani (0.67) and Dhar (0.42)
national average of 74 per cent in 2011. district.

Figure 4:3 Literacy Rate (per cent)

Source: Census 2011

Figure 4:4 Literacy Rate: Rural - Urban

Source: Census 2011

33
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:5 Sex ratio and Literacy Gap

Source: Census 2011

The analysis found that the districts with the from 26.3 per cent in Alirajpur to 78.6 per cent in
lowest sex ratios (Bhind, Morena, Datia etc.) had a Jabalpur. While the range of general literacy is 32
greater literacy gap than those with high sex ratios per cent, the range of adult literacy in the state
(Balaghat, Alirajpur, Seoni, Barwani etc.). is 52.3 per cent. Considering this wide range it is
very clear that the inequity is very high in respect
4.2.2 Adult Literacy Rate
of adult literacy across districts.
Adult Literacy Rate is the share of literates in the
age group of 15 and above A strong positive relationship is clearly evident
between adult literacy and per capita income
Adult literacy data show that all-district average (0.612). As adult literacy levels decreased across
is 61.7 per cent. There are 22 districts with adult districts, the per capita income levels also declined
literacy above state average, whereas 28 districts (Figure 4:7).
come under below state average. But it varies

Figure 4:6 Adult Literacy Rate (per cent)

Source: Calculated from Census 2011

Figure 4:7 Adult Literacy and Per Capita Income

Source: Census 2011; Data.gov

34
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:8 Gross Enrolment Ratio

Source: DISE, 2015-16

4.2.3 Enrolment education by 2020. Still, the state has an average

of 41.9 per cent schools with enrolment less than
Gross Enrolment Ratio (GER) is the total enrolment
or equal to 50 student (DISE ,2015-16).
in Grades I-V as a share of population aged 6 - 11
The district level analysis found a positive
Madhya Pradesh has adopted the Rashtriya
correlation between the GER with the per capita
Madhyamik Shiksha Abhiyan (RMSA) targets for
income levels (0.506). Districts such as Mandla
secondary education, which is to achieve a Gross
and Rewa with lower levels of per capita income
Enrolment Ratio (GER) of 75 per cent by 2012, 100
were also found to have lower GER (Figure 4:9).
per cent by 2017 and universalization of secondary

Figure 4:9 GER and Per Capita income

Source: DISE, 2015-16, data.gov.in

Figure 4:10 Women’s Education and GER

Source: DISE, 2015-16, data.gov.in

35
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:11 GER and Type of School

Source: DISE 2015-16

The districts with low rates of female literacy and The district level data shows a positive correlation
low share of women with more than 10 years of between households having access to improved
schooling were found to have strong correlations sanitation facilities and the enrolment levels
with enrolment rates at the district level (0.279 and (0.317). The access to sanitation was found to
0.424 respectively) (Figure 4:10). have a direct impact on the health and nutritional
level of children (Figure 4:12).
The district wise analysis of single teacher schools
and enrolment rates show a negative correlation The study also revealed a high positive correlation
(-0.349). Although not a strong correlation, it is between enrolment levels for ST students and the
evident that districts with fewer single teacher share of ST teachers (-0.935). Districts with a higher
schools were found to have the highest enrolment share of ST teachers- Alirajpur, Anuppur, Jhabua
rates - Indore, Bhopal and Gwalior (Figure 4:11). etc. were found to have higher ST enrolments
(Figure 4:13).
Figure 4:12 GER and Households with Improved Sanitation

Source: DISE 2015-16

Figure 4:13 ST Teachers and ST Enrolment

Source: DISE 2015-16

36
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:14 Retention rate and Type of School

Source: DISE 2015-16

Figure 4:15 Retention Rate and Anaemia in Children

Source: DISE 2015-16 and NFHS-4

4.2.4 Retention Rate

District wise analysis shows a negative correlation
(Enrolment in Grade V in year ‘t’ - Repeaters in
(-0.370) between retention rates and prevalence
Grade V in year ‘t’) / (Enrolment in Grade I in t-4
year) * 100 of anaemia in children. Retention rates are lower
in districts with a higher share of children who are
Retention Rate was found to have a weak negative
anaemic - Barwani, Jhabua, Dhar, Gwalior and
relationship with type of school - single classroom
Shajapur (Figure 4:15).
schools and single teacher schools. Districts with a
high percentage of single teacher schools such as 4.2.5 Dropout Rate
Alirajpur, Jhabua and Morena had lower retention
Number of students dropping out from a particular
rates. The same correlation was found for districts grade in a particular year as a share of total
with larger shares of single classroom schools - Dhar, students in that grade in the same year.
Ashoknagar, Barwni and Alirajpur (Figure 4:14).

37
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:16 Adult Literacy Rate and Dropout Rate

Source: DISE 2015-16

The district wise analysis of adult literacy (15+)and The analysis also revealed a negative relationship
dropout rates shed light on the significant negative between dropout rates and the per capita income
correlation between the two (-0.557). Districts at the district level (-0.223). From the figure it
with lower levels of adult literacy such as Jhabua, is evident that the districts with lower per capita
Barwani, Sheopur and Guna struggled with the income levels also have higher dropout rates
highest dropout rates in the state (Figure 4:16). (Figure 4:17).

Figure 4:17 Per Capita Income and Dropout Rates

Source: DISE 2015-16

Figure 4:18 Stunting Rate and Dropout Rate

Source: DISE 2015-16 and NFHS-4

38
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:19 ST Girls Enrolment and Number of Teachers

Source: DISE 2015-16

There exists a positive correlation between stunting help identify the most marginalised communities
prevalence in children under-5 and dropout rates at in the society.
the district level (0.500). The study revealed that
in the districts with lower prevalence of stunting, Table 4:1 Education Indicators - Across Social
Groups
the dropout rates were much lower- Balaghat,
Literacy Enrolment Girls’
Chhindwara, Mandsaur etc (Figure 4:18).
Rate Rate Enrolment
78.7 per 16.9 per 47.3 per
The district level analysis of ST enrolment (girls) SC
cent cent cent
shows significantly strong relations with number
59.2 per 25.2 per 47.5 per
of ST teachers (0.889) and number of female ST ST
cent cent cent
teachers in particular (0.929). Districts with high 42.6 per 47.3 per
OBC -
enrolment levels of ST girls - Alirajpur, Barwani, Dhar, cent cent
Jhabua, etc. were found to have higher proportion 5.5 per 48.1 per
Other -
of ST teachers as well as female ST teachers (Figure cent cent
Source: Census 2011; DISE 2015-16
4:19).

4.4 Infrastructure and Enrolment

4.3 Education Indicators - Across Social
Groups Infrastructure plays an important role in influencing
enrolment. Drinking water, computer, mid-day
The education indicators across social groups will
Figure 4:20 Infrastructure and Enrolment

Source: DISE 2015-16

39
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

meal and girls’ toilet are key drivers of school in primary schools to total classrooms in primary
enrolment; playground, electricity and other such schools
facilities have the least influence. The correlation
and various infrastructure aspects are given below. As per the Right to Education Act 2009, the required
pupil-teacher ratio (PTR) is 1:30; one teacher for 30
The diagram implies that schools having facilities students. The percentage of schools maintaining a
like toilets, drinking water, electricity, mid-day PTR of greater than 30 is 21.52 per cent (2015-16)
meals, playground and all weather roads motivate at the state level, decreasing from 26.9 per cent in
students to enrol. However, there exist significant 2014-15. The regulation also prescribes a student
inter-district disparities for the same. For instance - classroom ratio of 1 classroom per 30 students.
the proportion of schools having access to electricity The share of schools having a greater ratio also
has a range of 57.11 per cent, with Alirajpur being fell from 19.6 per cent (2014-15) to 15.73 per cent
the lowest at 8.51 per cent and Bhopal with 65.62 (2015-16).
per cent schools electrified.
Districts such as Jhabua, Singrauli, Chhatarpur,
Alirajpur, Umaria, Burhanpur and Tikamgarh had
4.5 Pupil - Teacher Ratio and Student- the highest share of schools with a pupil-teacher
Classroom Ratio ratio greater than 30.

Pupil-Teacher Ratio is the ratio of total enrolment With respect to schools with a student-classroom
in primary schools to total teachers in primary ratio of more than 1:30, the districts with the
schools highest proportion are Tikamgarh, Burhanpur,
Student - Class Ratio is the ratio of total enrolment Jhabua, Ashoknagar, Indore and Katni.

Figure 4:21 Pupil-Teacher Ratio

Source: DISE 2015-16

Figure 4:22 Student-Classroom Ratio

Source: DISE 2015-16

40
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 4:23 Learning Outcomes and Private School Enrolment

Source: ASER 2016

4.6 Learning Outcomes and Private 4.7 Summing up

School Enrolment
It is clear that education is a critical sector with
The district level analysis shows a significant a large direct and indirect impact on the lives of
positive correlation between learning outcomes people. The study revealed a host of factors that
and enrolment in private schools. Specifically, the have strong or weak influences on the educational
analysis revealed that there exists a positive relation indicators of the state. For instance, a strong
between the share of students of class III - V who correlation was found between the adult literacy
can read a class I text (0.595), share of students of rates and per capita income at the district level.
class VI-VIII who can read a class II text (0.585) and A similar relationship was found for the latter with
the percentage of children (aged 6-14) enrolled in district level enrolment rates. Over and above
private school (Figure 4:23). the relations discussed, the study also shed light
on the infrastructural deficiencies prevailing in
The district level analysis shows a significant the state. The lack of basic infrastructure such
positive correlation between learning outcomes as school boundary wall, supply of water and
and enrolment in private schools. Specifically, the electricity, sanitation facilities and so on have a
analysis revealed that there exists a positive relation high correlation with enrolment. Furthermore,
between the share of students of class III - V who the study discussed the learning outcomes in the
can read a class I text (0.595), share of students of state with respect to both private and government
class VI-VIII who can read a class II text (0.585) and schools. It was found that the learning outcomes in
the percentage of children (aged 6-14) enrolled in both reading and arithmetic were better in private
private school. There also exist high levels of inter- schools, explaining the increase in private school
district disparities with the range for both learning enrolment rates in the state. However, it was
outcomes being 29.2 per cent and 41 per cent also revealed that a higher proportion of boys are
respectively. enrolled in private schools when compared with
girls.

41
 Chapter 5

Water, Sanitation and Hyggiene

“ We shall not defeat any of the infectious diseases that plague the developing world until we have also won the
battle for safe drinking water, sanitation and basic health care”- Kofi Anan, 7th Secretary General, UN

Water and Sanitation are the crucial components in

Sustainable Development Goal 6
determining the overall health and development
6.1 By 2030, achieve universal and equitable
of a society. Across the globe, 840,000 people access to safe and affordable drinking water
die each year because they do not have clean for all
reliable drinking water, while 2.5 billion people 6.2 By 2030, achieve access to adequate and
lack access to improved sanitation. Nearly equitable sanitation and hygiene for all, and
80 per cent of illness in developing countries end open defecation, paying special attention
can be attributed to the lack of clean water to the needs of women and girls and those in
and sanitation. The economic and educational vulnerable situations
costs associated with poor sanitation and In India, 89.9 per cent households have access to
water facilities are disproportionately borne improved drinking water source, whereas 48.4
by women and children. At least 20 per cent of per cent of households have access to improved
girls drop out of school due to lack of access sanitation facility. India still faces the issue of
to safe sanitation facilities. This contributes to ensuring safe drinking water with more than 1
the increased occurrence of early marriages and lakh people dying annually due to water borne
teen child bearing. diseases. As per estimates, US $ 106.7 billion has
been wiped off from India’s GDP (5.2per centof
MDG has made a significant landmark in reducing
GDP) in 2015, due to poor access to sanitation
child and maternal death, but millions across the
facilities.
globe are still dying of preventable diseases. Hand
washing, water quality, sanitation and hygiene are
5.1 Access to drinking water and
core interventions for maternal and child health,
ensuring a healthy and productive society. Against
sanitation
this background, SDG has given greater emphasis Diarrhoea among children is taken as the proxy
to WASH as each SDG can be achieved at a greater indicator to measure the impact of inadequate
pace by the inclusion of WASH practices. access to clean drinking water and improved

43
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 5:1 Diarrhoea and access to improved sanitation facilities and drinking water source

Source: NFHS-4

sanitation. In India, Bihar, Orissa and Madhya In Balaghat the share of households with improved
Pradesh are the worst performing states registering drinking water source and improved sanitation
high prevalence of diarrhoea at 10.4, 9.8 and 9.5 per facilities are below the state average and the
cent respectively. During 2012-17, Madhya Pradesh prevalence of diarrhoea in the district was found to
accounted for 7.2 per cent of the total diarrheal be on the lower end (5.6 per cent) when compared
deaths in the country. with the state average (9.5 per cent). This could
be attributable to the high literacy levels found in
In Madhya Pradesh, 84.7 per cent households have
the district, especially among women.
access to improved drinking water sources and
33.7 per cent households have access to improved Along with accessibility of drinking water, source
sanitation. A district wise analysis shows that and quality of drinking water is an important
there exists a relation between the prevalence of determining factor. Although more than 80 per
diarrhoea and access to improved drinking water cent households in Madhya Pradesh have access
source and improved sanitation. For instance, to improved drinking water sources, these also
Umaria district which has the highest prevalence include public taps, tube wells or boreholes, as per
of diarrhoea also accounts for the lowest per cent the NFHS definition. Department of Drinking Water
of households with improved drinking water source and Sanitation, Government of India, came up with
and improved sanitation facility. a strategic plan to ensure that 90 per cent of rural
households are provided with piped water supply
Contrary to the existing literature, there exists
by 2022. The plan has put a target of providing
a positive correlation between households with
piped water supply to at least 55 per cent rural
improved drinking water source & sanitation facility
households by 2017. The targets for 2017 were
and prevalence of diarrhoea in some districts.
incorporated in the 12th Five Year Plan. In Madhya
For instance, Raisen has high levels of access to
Pradesh, Public Health Engineering Department
improved sanitation facilities and drinking water
is responsible for implementing drinking water
source, but the district also registers the highest
schemes as per the norms of NRDWP.
prevalence of diarrhoea among children, next to
Umaria. In 2016-17, against the target of 35 per cent, only

44
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Table 5:1 Targets for 2017 Table 5:2 Targets for 2022
• Ensure piped water supply to • Ensure piped water supply to
o at least 55 per cent of rural households o at least 90 per cent of rural households
o at least 35 per cent of rural households o at least 80 per cent of rural households
through a household connection through a household connection
• Ensure that • Ensure that
o less than 20 per cent use public taps o less than 10 per cent use public taps
o less than 45 per cent use hand pumps o less than 10 percent use hand pumps
or other safe and adequate private or other safe and adequate private
water source water source
• Ensure that all rural households, schools and • Ensure that all rural households, schools and
anganwadis have access to and use adequate anganwadis have access to and use adequate
quantity of safe drinking water quantity of safe drinking water
• Provide enabling support and environment • Provide enabling support and environment
for Panchyat Raj Institutions and local for Panchyat Raj Institutions and local
communities to manage at least 60 per cent communities to manage at least 60 per cent
rural drinking water sources rural drinking water sources
Source: MP Strategic Plan 2011- 2022

Figure 5:2 Rural Households with Piped Water Supply connection, 2016-17 (in per cent)

Source: Ministry of Drinking Water and Sanitation, NRDWP

7.16 per cent of the rural households in Madhya 15 lpd is required per person for meeting basic
Pradesh were provide with piped water supply (PWS) needs. In India, NRDWP has fixed 55 litres per
with household connections. Among the districts, capita per day (lpcd) as the minimum supply that
only Burhanpur (31.6 per cent) is close to achieving has to be provided to a habitation for meeting the
the target of 35 per cent (Figure 5:2). Satna, Rewa, basic minimum needs. Habitations where water
Singrouli and Morena have less than one per cent system provides at least 55 lpcd or more to the
households having household connections with PWS. entire population are considered ‘fully covered’,
whereas if water supply systems provide less than
5.2 Demand and Supply of Drinking 55 lpcd to the population it is considered to be
Water ‘partially covered’. With drinking water being a
state subject, states can fix the amount of water
As per WHO estimates, 7.5 litres per day (lpd) to that needs to be provided.

45
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Rural persons in the state will have access to From the graph below, it can be inferred there
70 lpcd within their household premises or at exist a demand-supply gap in terms of access to
a horizontal distance of 100 meters or vertical drinking water (Figure 5:3). In Narsimhapur,
Singrauli, Rewa and Shahdol less than 10 per
distance of not more than 10 meters from their
cent of habitations are considered to be partially
household without barriers of social or financial
covered.
discrimination. (12th FYP, Madhya Pradesh)

Figure 5:3 Per cent of habitations- Partially Covered

Source: Ministry of Drinking Water and Sanitation, NRDWP

5.3 Quality of Water Table 5:2 Districts with Fluoride Contamination

Districts with Fluoride Contamination
The quality of water from these sources is an
• Agar • Dhar • Ratlam
important aspect that has significant health
• Malwa • Dindori • Sagar
implications. As per the Madhya Pradesh Ground
• Alirajpur • Jabalpur • Sehore
Water Year Book (2015-16), the districts showing
• Anuppur • Jhabua • Seoni
fluoride concentration beyond the permissible
• Balaghat • Khargone • Shajapur
limits are Agar Malwa, Anuppur, Betul, Chhindwara,
• Betul • Mandla • Sheopur
Katni, Mandla, Narsinghpur, Sehore, Seoni, Shahdol,
• Chhatarpur • Neemuch • Shivpuri
Shajapur, Ujjain and Umaria districts. The data
• Chhindwara • Raisen • Ujjain
published by the NRDWP shows 27 districts as having
• Damoh • Rajgarh • Vidisha
fluoride contaminated drinking water sources, with
• Datia
the highest percentage of tested sources found
Source: National Rural Drinking Water Programme
contaminated belonging to Chhindwara district.
table levels. Deeper drilling for hand pumps and
Exposure to fluoride contaminated water is the chief bore wells are also cited as causes. Most of the
contributing factor of fluorosis, a disabling disease above districts rely on hand pumps as the major
caused by accumulation over the bones affecting source of drinking water.
limb movements. Madhya Pradesh has over 4.5 lakh
people affected by fluorosis, registering the highest 5.4 Drinking Water facilities in
reported cases in the country. SC, Anganwadi and Schools
Experts working in this area attribute the fluoride
The strategic plan (2011-2022) had set the target of
contamination to the change in climatic patterns,
providing drinking water access to all Anganwadis
viz. reduced rainfall, and the decrease in water

46
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 5:4 Sub- Centre Infrastructure (in per cent)

Source: DLHS, 2012-13

Figure 5:5 Share of Anganwadis with Access to Drinking Water (in per cent)

Source: DLHS-4
and schools. Improved sanitation and drinking water were found to have a higher share of SHCs with
facilities are a relevant concern as poor sanitation water supply when compared to those with toilets.
and impure drinking water are the leading cause of The greatest gaps can be seen in districts such as
diarrhoea and have an impact on other health and Indore, Ujjain, Jabalpur and Raisen.
nutritional indicators.
From the figure given above it is evident that
The share of Sub Health Centres (SHCs) with access the existing infrastructure has not been able to
to regular water supply was found to have great provide the required facilities for Anganwadis. In
inter-district disparities, ranging between 24 per districts like Balaghat, Mandla and Seoni, barely 50
cent and 92 per cent (Figure 5:4). Interestingly, per cent of the Anganwadis had access to water
most of the districts were found to have SHCs with (Figure 5:5).
toilets but lacking water supply. Only 10 districts
Figure 5:6 Share of Schools with Access to Drinking Water (in per cent)

Source: DISE 2015-16

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

The districts with the least number of schools with across the state for several years. Unfortunately,
drinking water were found to be tribal districts the state’s progress has been slow, and two thirds
and had high prevalence of diarrhoea viz. Dindori, of the households still do not follow safe hygiene
Khandwa, Ratlam etc. Also, the tribal districts with practices.
100 per cent drinking water supply in schools were
According to the 2011 Census data, only 28.8 per
found to have prevalence of diarrhoea lower than
cent of the households in Madhya Pradesh have
state average, except Barwani (Figure 5:6).
toilets. This could be attributed to the nature of
TSC activities which focus on building facilities,
5.5 Sanitation and Hygiene but not on behavioural change that leads to their
effective utilization. This coupled with the shortage
According to the NFHS-3 data (2005-06), 18.7 per of water availability led to the current status of
cent of the households used improved sanitation low level of hygienic sanitation practices. Majority
facility. After 10 years, this has risen to only 33.7 of the households of the state (60 per cent), lack
per cent (NFHS-4, 2015-16) with wide disparity provision of waste water drainage.
between rural (19.4 per cent) and urban areas (66.6
per cent). In 2003, Madhya Pradesh became the first The recent push in the sanitation sector
state in India to have Total Sanitation Campaign spearheaded by Swachh Bharat Mission reported
(TSC) projects approved in every district. As a that Individual Household Latrine (IHHL) coverage
result, TSC activities have been operating at scale in MP reached 86.7 per cent which is more than

Figure 5:7 : Percentage of households in the districts of MP having individual latrines (2011)

Source: Census, 2011

Figure 5:8 Per cent of schools with Girls Toilet

Source: DISE, 2015-16

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

three times the census data. According to Swachh worst performers in this aspect. It was reported
Bharat Mission, the rural coverage of IHHL has that only 28.98 per cent schools in Madhya Pradesh
exceeded 70 per cent in Madhya Pradesh. Since 2nd have hand washing facility.
October 2014, 57.5 per cent increase was reported
in the number of households with toilets. As of April 5.6 Summing up
2018, 14 districts, 9665 Gram Panchayats and over As a part of SDG, the UN advocates supporting
24,000 villages self-declared as ‘Open Defecation and strengthening the participation of local
Free’ (ODF). By 2017-18, 47.1 per cent of the villages communities in improving water and sanitation
in Madhya Pradesh declared as ODF and 27 per cent management. But till now the approach has been
were verified by the state as ODF. Even though in largely top down with central level policies and
10 districts of MP, all the villages have been verified schemes hardly translating to the desired results
as ODF and thus present a progressive picture, in at the grass root level. The current policy of
25 other districts only less than 10 per cent of the rationing and provisioning water has many flaws
villages achieved ODF status. Some villages have including ignoring the issue of overexploitation
declared themselves as ODF, but have not been of ground water and ensuring adequate quantity
verified so. For example, in the district of Raisen, all and quality of water. It also does not account for
the villages self-declared as ODF, but only one-fifth the participation of the community in ensuring
of them have been verified as the same in 2017-18. sustainability of water resources. Moreover, two-
An important aspect with regard to hygiene practices thirds of the households still do not follow safe
is the provisions of toilet and hand washing facilities hygiene practices. Realisation of the sixth goal
at schools. From the graph it can be inferred none of SDG, ‘clean water and sanitation’ will be a
of the districts register 100 per cent in terms of distant dream if this is the tempo of development,
schools having girl’s toilet (Figure 5:8). The tribal especially in the areas of sanitation and IHHL
districts of Singrauli, Barwani and Harda are the coverage.

49
 Chapter 6

Social and Child Protection

“Child labour perpetuates poverty, unemployment, illiteracy, population growth and other social
problems” - Kailash Satyarthi, Nobel Laureate

Social and Child Protection is a crucial policy tool for 6.1 Poverty
supporting equity and social justice. It addresses the
economic and social barriers that prevent access to As per the Tendulkar Methodology, the poverty line
services, focusing on the most vulnerable sectors for Madhya Pradesh was drawn at Rs 771 (monthly
and thus contributing to a fairer distribution of per capita) for rural areas and Rs 897 (monthly
resources and benefits (UNICEF). Investing in social per capita) for urban areas. Based on the poverty
protection and children is important from both line estimation, 31.65 per cent in the state (35.74
human and economic development perspective. percent- rural, 21 per cent- urban) live below
poverty line. District wise poverty estimates show
Social protection was not explicitly mentioned in
that Dindori has the highest per cent of population
the MDG, but it was widely identified with Goal 1
living below poverty line at 80.11 (State Planning
focussing on the ‘Eradication of extreme poverty
Commission, 2011). It should be noted that the
and hunger’. Similarly, social/child protection is
three districts registering the highest poverty rates
identified with the four goals in SDG.
are all tribal districts viz., Umaria, Mandla and

SDG- Focussing Social and Child Protection

Goal 1: End poverty in all its forms everywhere.

Goal 5: Achieve gender equality and empower all women and girls.
Goal 8: Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all.
Goal 16: Promote peaceful and inclusive societies for sustainable development, provide
access to justice for all and build effective, accountable and inclusive institutions at all
levels.

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 6:1 Per cent of population below poverty line

Source: MP State Planning Commission, 2004-05

Dindori. The low health, nutrition and education 6.2 Disability

indicators in these districts, as discussed in the other
As per Census 2011, total disabled population
chapters, can be attributed to the high incidence of
in Madhya Pradesh stands at 15.5 lakh. Madhya
poverty.
Pradesh accounts for 5.8 per cent of the total
Table 6:1 Proportion of Population living below
disabled population in the country. Among the
poverty line by Social Groups
districts, urbanised districts of Indore, Bhopal
Social groups Rural Urban Total and Jabalpur have the highest share of disabled
population. Indore and Bhopal account for around
SC 55.34 32.27 53.17
10 per cent of the total disabled population in the
state.
ST 41.34 33.17 39.48
Table 6:2 Disabled Population- Social Groups
Others 19.63 13.12 23.56
Disabled Population
Social Group
(in lakh)
All 35.74 21.00 31.65
SC 2.92
Source: Madhya Pradesh State MDG Report, 2014-15
Among the social groups, incidence of poverty is ST 2.86
highest among the STs followed by SC community.
All 15.50
The high incidence of poverty among ST community
has a negative impact on their health, nutrition and Source: Census, 2011
educational outcomes.

Government schemes for Disabled

In Government jobs there is 6 per cent reservation in 100 point roster for Class II, Class III and Class IV
category for direct recruitment for persons with disabilities.
The State Government awards scholarship to those handicapped students whose parent’s income is less
than ` 2000/– per month.
Under Disability pension/Social security pension, persons with disabilities above the age of 65 years
get disability pension at ` 150/– per month, destitute children with disabilities at the age of 14 years
or more get social security pension at ` 150/– per month, and children between 6 to 14 years who are
enrolled in schools and whose families live below the poverty line get social security pension at ` 150/–
per month.
Disabled employees get 5per cent of the basic with a minimum of ` 50/– per month and a maximum of
`100/–per month as conveyance allowance for attending office.

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 6:2 Share of Main and Marginal Workers (Female)

Source: Census, 2011

6.3 Women Empowerment Table 6:3 Participation of Women in

Government Services
Eliminating gender discrimination and empowering Categories Total Male Females
women will have a profound and positive impact on
5495 1735
the survival and well-being of children (UNICEF). Category 1 7230
(76.10) (23.9 )
In this section, the situation of women in Madhya
22022 7215
Pradesh is analysed using the following indicators: Category 2 29237
(75.33) (24.67)
• Share of main and marginal workers to the 365817 71790
Category 3 437607
(83.60) (16.40)
total workers (female)
50984 11654
Category 4 62638
The share of main workers and marginal workers (81.40) (18.60)
to the total workers helps to understand the level Regular 354468 92294
446762
Staff (79.35) (20.65)
of employability among females. Main Workers are
Source: Employment Census, 2016
those workers who had worked for the major part
of the reference period i.e. six months or more. • Share of seats held by women in legislative
assembly
Marginal Workers are those workers who had not
worked for the major part of the reference period Of the total 230 seats in the legislative assembly,
i.e. less than six months. females account for only 30 seats marking a share
of 13.04 per cent. The districts with women
In Madhya Pradesh, 55.5 per cent of the total workers
representatives are Gwalior, Shivpuri, Guna,
(females) were categorized as main workers,
Sagar, Tikamgarh, Chhatarpur, Damoh, Panna,
whereas it stood at 81.2 per cent for males. Indore
Satna, Rewa, Singrauli, Shahdol, Umaria, Jabalpur,
registered the highest share and districts such as
Balaghat, Khandwa, Burhanpur, Khargone, Jhabua,
Umaria, Shahdol and Sehore have the lowest share
Dhar, Indore and Ratlam.
of main workers among females (Figure 6:2).

• Participation of women in government 6.4 Child Protection

services

As per the Employment Census there are 983,924 The United Nations Convention on the Rights of the
people working under the state government. Of the Child, through its 45 articles, has created a space
total government employees, females account for a for children to voice and present their opinions in
share of only 18.7 per cent. decisions regarding them, to ensure that they lead
a meaningful childhood and dignified life. The

53
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 6:3 Children under-5 years whose birth were registered (per cent)

Source: NFHS-4
enlisted child rights are centred on three pillars:
protection, participation and provision (The United The “Ladli Laxmi Yojana” was introduced in
Nations Convention on the Rights of the Child, the State in 2007 to improve the health and
2010). educational status of the girls, to prevent female
feticide and to bring about a positive attitude
6.4.1 Birth Registration towards the birth of a girl child. Cash incentives
are given to poor families with a girl child for
Birth registration is an important measure to ensure registration of birth, immunization, enrolment
that the child is under legal jurisprudence which in school and delaying marriage till the age of
safeguards their economic, social, cultural and 18. However, many reports like those by UNFPA
civil rights. Knowing the age of a child is central to (2010) and Asia Centre for Human Rights have
protecting them from child labour, being arrested shown that financial incentive schemes are not
and treated as adults in the justice system, forcible successful in improving sex ratio, especially
conscription in armed forces, child marriage, child sex ratio, in districts with low levels of
trafficking and sexual exploitation (UNICEF). education.

In Madhya Pradesh, birth registration of children 6.4.2 Child Marriage

under-5 years has improved from 81.9 per cent
in 2005-06 to 92.2 per cent in 2015-16. Birth Child marriage is still widespread in India, though
registration is lowest in the districts of Barwani, the incidence of child marriage has declined from
Alirajpur, Jhabua and Vidisha. It should be noted 54 per cent in 1992-93 to 27 per cent in 2016.
that all the above districts are tribal districts States having high incidence of child marriage
(Figure 6:3).
Figure 6:4 Incidence of Child Marriage (in per cent)

Source: NFHS-4

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 6:5 Per cent of child workers in total main and marginal workers

Source: Census, 2011

above the national average are Jharkhand, Uttar Maharashtra and Madhya Pradesh account for
Pradesh, West Bengal, Madhya Pradesh, Andhra nearly 55 per cent of total working children in
Pradesh, Karnataka, Chhattisgarh and Tripura. In India. In Madhya Pradesh there are 0.70 million
Madhya Pradesh, 30 per cent of women age 20-24 child labourers. It can be seen that the tribal
were married before the legal age 18 (NFHS-4). The districts of Alirajpur, Jhabua and Barwani register
incidence of child marriage is highest in the districts the highest share of child workers (Figure 6:5).
of Jhabua, Mandsaur and Tikamgarh. The incidence
Among the social groups, the incidence of child
of child marriage is lowest in Balaghat, the district
workers (taken as percentage of child workers to
registering the highest literacy rate.
the total main and marginal workers) is highest
among STs at 7.26 per cent followed by SCs at 3.43
6.4.3 Child Labour
per cent.
Child labour prevents children from acquiring the
skills and education they need to have opportunities 6.4.4 Crime against Children
of decent work as an adult (ILO). As per Census
Article 19 of Convention on the Rights of the Child
2011, total child population in India in the age
defines violence against children as “all forms
group 5-14 years is 259.6 million. Of these around
of physical or mental violence, injury or abuse,
10.1 million are working either as main workers or
neglect or negligent treatment, maltreatment or
marginal workers. Uttar Pradesh, Bihar, Rajasthan,

Figure 6:6 Crime against children (2015-16)

Source: National Crime Record Bureau

55
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

exploitation, including sexual abuse, while in the children in the state. As per the NCRB, the state
care of parent(s), legal guardian(s) or any other also tops the list in terms of crime against women.
person who has the care of the child. The high rate of crime against women and
Table 6:4 Basic Police Data children exposes the need to look into the police
infrastructure in the state.
Particulars Sanctioned Actual
The table highlights the police infrastructure gap in
Strength of
87,366 76,770 the state and the need to strengthen it to address
Civil Police
Strength of the high rate of crime against women and children
State Armed 28,360 21,696 in the state (Figure 6:4). The state can look into
Police best practices adopted in other states to address
Strength of the issues of crime against women and children.
-- 4352
Women Police For instance, in the early 1990’s, Tamil Nadu
Total State
115,726 98,466 pioneered the concept of All Women Police Station
Police Force
(AWPS). The existence of AWPS would encourage
Population per
678.69 797.66 the reporting of crimes against children and
Policeman
Policemen per women which in turn could reduce the incidence
lakh of popula- 147.34 125.37 of such crimes.
tion
Policemen per
37.54 31.94
6.5 Summing Up
100 sq km
Source: Bureau of Police Research and Development, Equity means equal access to justice. In order
2016 to ensure that there is equal access to justice,
the state should be able to strengthen its
It should be noted that crimes against children is
police infrastructure and judiciary to minimize
reported highest in Indore and lowest in Sheopur
crimes against children and women. Local self-
and Damoh (with 0 cases reported). But it should
governments should be involved in running
be noted that high rates of crime against children
juvenile homes, destitute homes, child
in Indore can be attributed to the high rates of
welfare units and anti-human trafficking units.
reporting in the district, and the low rates of
Ensuring gender equity can have far reaching
reporting in the other districts. The above data may
impact on child protection.
not fully capture the real picture on crime against

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Chapter 7

Connectedness
“The right signal is that technology is going to boost (economic) development of our nation”
- A P J Abdul Kalam, Former President, India

Infrastructure is often described as basic assets and 7.1 Road and Railway Connectivity
objects that, in the aggregate, are deemed essential
Increased rural connectivity via road construction
for the functioning of society and the economy
and development has implications on the choices
(United Nations 2016). The benefits of infrastructure
individuals make regarding their health and
development are not only restricted to economic
macro health indicators. In a study that evaluates
growth and development, but they also build the
the factors affecting obstetric choices, the
social overhead capital of an economy. Investment
most commonly cited reasons for poor access
in infrastructure is a necessary precursor to empower
were mobility issues and lack of knowledge and
people, communities and government to achieve
information (Ensor and Cooper 2004). Having
the SDGs.
access to health centres can also reduce gender
gaps in health outcomes. Increased connectivity, as
Global Infrastructure gap is estimated to amount
measured by road connectivity and electrification,
to US$ 1 to 1.5 trillion annually in developing
countries (High Level Political Forum, 2017). has increased the likelihood of immunization and
availing of prenatal care (Majid 2013).
Infrastructure forms an integral part of all the It is estimated that for every `1 million invested in
Sustainable Development Goals (SDGs), and having rural roads, 163 people were lifted out of poverty
a goal exclusively based on infrastructure and (World Bank 2009).
technology highlights the importance and centrality
of it to underdeveloped, developing and developed Despite being located in the central part of India,
countries. Infrastructure and technological the road connectivity of Madhya Pradesh is poor
developments have an important role to play in in terms of National Highways and other future
achieving the targets of SDGs focussing on poverty, projects undertaken. Based on the statistics
health, education and WASH. of Government of Madhya Pradesh, out of 200
highways in the country, only 18 pass Madhya
Goal 9: Build resilient infrastructure, promote Pradesh. Out of 13,252 km of proposed Golden
inclusive and sustainable industrialization and Quadrilateral, North- South and East-West (E-W)
foster innovation. corridors, only 621 km (4.68 per cent) would pass

57
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Pradhan Mantri Gram Sadak Yojana in its impact assessment recorded that after all-weather roads
were constructed, 83 per cent habitations were connected to the nearest Primary Health Centre (PHC)
and government hospitals and 82 per cent were connected to a private hospital/nursing home (CMI
Social Research Centre,2011). 22 per cent of the habitations recorded an increase in the availability/
visits of government doctors, 17 per cent habitations witnessed an increase in Anganwadi centres and
deliveries at home were reduced from 76 per cent to 57 per cent after the roads were constructed.

through the state. Table 7.1 shows the profile of Bhopal, the other airports are not connected with
roads in the state. the rest of India.

Table 7:1 Profile of Roads in Madhya Pradesh

7.2 Mobile-Internet Penetration
Length of Road Km
The total number of mobile telephone subscribers
National Highways 4709 in India was 102,7166,644 as on February 29, 2016.
Of the total mobile subscribers in India, Madhya
State Highways 10,859 Pradesh had a share of 6.34 per cent at 65,142,091.
Madhya Pradesh witnessed a yearly growth (2016-
Major District Roads 19,574
17) of 9.72 per cent of both wire-line and wireless
telephone subscribers from 67.51 million in 2016
Village Roads 24,209
to 74.08 million in 2017. Of the total 74.08 million
Source: Govt of MP, 2017
subscribers, 33.45 million belonged to rural areas
and 40.63 million to the urban areas.
According to data of Ministry of Railways,
Government of India, the average rail line network Total number of internet subscribers increased
in MP is only 16.07 km when the national average is from 391.50 million in 2016 to 445.96 million in
19.46 km per 1000 sq km in 2016. MP is behind nine 2017, recording a yearly growth rate of 13.91 per
states— Rajasthan, Maharashtra, Gujarat, Bihar, UP, cent. A disparity can be observed between rural
Jharkhand, Punjab, Uttaranchal and West Bengal. and urban subscriber base in Madhya Pradesh.
Regarding air connectivity, the state of Madhya While the former is 6.24 million, the latter is
Pradesh has only five of the 125 major airports in 16.94 million. The internet subscribers per 100
India. Among these five airports, except Indore and population in rural areas is 8.12 whereas it stands

Figure 7:1 Urban Households with Internet Connection

Source: Census, 2011

58
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 7:2 Urban Households with Mobile Phones

Source: Census, 2011

Figure 7:3 Rural Households with mobile phones

Source: Census, 2011

at 57.46 for urban areas. Districts with high ST population have low region
wise connectedness in terms of households with
For a district wise analysis, census data is being used,
internet and mobile phone compared to other
though the present scenario would be different due
districts.
to changes in the market.

Only five districts in urban areas have households 7.3 Banking Penetration
with internet higher than the state average while all
the other 45 districts have households with internet A well-developed financial system is necessary for
below the state average. Figure 7.2 shows that 26 economic development and poverty alleviation
districts in urban areas have households with mobile (Beck, Demirguc-Kunt and Levine 2004 and
phones greater than the state average, whereas 24 Honohan 2004a). Given its social (and economic)
districts in urban areas have less than the state benefits, access to finance can be seen on a similar
average. level as access to basic needs such as safe water,
health services and education (Peachey and Roe,
In rural areas, there are 25 districts with households
2004).
owning mobile phone above the state average and
the rest have households with mobile phones below The following section discusses access to banking
the state average. facilities across the districts. The indicator used to
By comparing region wise connectedness, it can be measure access to finance is the number of bank
seen that there is a negative correlation between branches per 100,000 people. Banking per sq km is
the ST population and region wise connectedness. another indicator that could be used to measure

59
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 7:4 Banking Penetration

Source: Computed from State Level Bankers Committee Report, 2017

banking penetration, but since Madhya Pradesh has employment opportunities. To attract foreign
a large share of forest area it is not included in the investment, infrastructure development including
analysis. road, railway and banking are prerequisites.
Various government initiatives are helping the
From the graph it is evident that banking penetration
state in terms of infrastructural development. For
is highest in the urbanised districts of Bhopal and
instance, BharatNet an initiative of the central
Indore. Sheopur, Morena and Alirajpur register the
government to provide high-speed broadband
lowest banking penetration in the state. Most of
connectivity to all gram panchayats in the country
the tribal districts in the state register low banking
by March 2019, has covered 6355 gram panchayats
penetration in terms of the number of banks per
in Madhya Pradesh in its first phase. Infrastructure
100,000 population. There are 9263 ATMs in Madhya
development not only creates economic benefits
Pradesh marking the ATM penetration in the state at
but has a positive impact on poverty reduction and
12.6 for 100,000 population.
across sectors such as health, education, nutrition
and WASH.
7.4 Summing Up

Infrastructure is critical for economic development.

The state will be able to reap its demographic
dividend only if it is successful in creating ample

60
 Chapter 8

Chapter 1 Readiness for Equitable Social Develop-

ment Analysis: Intra state Issues

Readiness for Equitable Social

Development Analysis: Intra state Issues

Madhya Pradesh has proved to be a laggard among the areas of health, nutrition, education and
the socioeconomically backward states, also sanitation. The main inter-district gaps in
known as the Empowered Action Group States, in equitable social development process as well as in
most indicators of development. In most areas of policy interventions are identified in this chapter.
socioeconomic development, the state displays The study has also developed an index for each
disparities across districts, gender and social groups. sector as well as a composite index to highlight
Though there have been many policy interventions the inequities and inter-district disparities of the
in this regard, the government needs to take a state7.
stronger stance on equitable development for the
sustained economic growth of the state. 8.1 Health: Intra state Issues

One of the objectives behind this study is to The critical problems in the health sector have
understand the extent of equity in realizing a been discussed at various stages of the report. A
better standard of life at the district level in focused district wise summary of the main pain
points are presented in Table 8.1

Table 8:1 Districts Identified with Crucial Health Problems

Districts Indicators

Panna High TFR with 4.1, IMR with 85, NNMR with 61, U-5 MR with 127

Shivpuri High TFR with 4.0, IMR with 69, NNMR with 43

Vidisha High TFR with 3.9, IMR with 65, U-5 MR with 94, NNMR with 48

Barwani High TFR with 3.9, IMR with 66, PNMR with 25, U-5 MR with 89

7
The indices are based on available data and globally used parameters are taken into consideration but customized to the local context. It is thus not
comparable to other global

61
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Chhatarpur High TFR with 3.8, IMR with 63 ,NNMR with 46

High TFR with 3.6, PNMR with 27, IMR with 83, U-5 MR with 121, NNMR
Satna
with 57

Sehore High TFR with 3.5, IMR with 72 , U-5 MR with 84, NNMR with 44

Damoh High TFR with 3.5, IMR with 71, U-5 MR with 106, NNMR with 53

Guna PNMR with 29, IMR with 75, U-5 MR with 93, NNMR with 46

Datia PNMR with 30, IMR with 73, U-5 MR with 94, NNMR with 43

Sheopur PNMR with 29, IMR with 72, U-5 MR with 98, NNMR with 43

Ratlam PNMR with 27, IMR with 65, U-5 MR with 92

Shahdol PNMR with 27, IMR with 71, U-5 MR with 85, NNMR with 44

Jhabua PNMR with 26, IMR with 64, U-5 MR with 86

Chhindwara IMR with 69, NNMR with 45

Raisen IMR with 69, U-5 MR with 88, NNMR with 48

Sagar IMR with 69, U-5 MR with 92, NNMR with 57

Mandla IMR with 68, U-5 MR with 84, NNMR with 51

Sidhi IMR with 67, U-5 MR with 112, NNMR with 46

East Nimar IMR with 67, U-5 MR with 94, NNMR with 43

Rewa IMR with 68, U-5 MR with 100, NNMR with 57

Umaria U-5 MR with 99, NNMR with 43

Source: NFHS-4

It is revealed that 21 districts suffer from low 2012-13, but the data for variables considered in
performance in at least two indicators. Panna the present context pertain to 2015-16.
presents the worst situation as four health indicators
The inequity across districts in health is evident
display adverse conditions.
from the map 8.1 Districts are classified into four
The variables considered are mothers who had full based on the UNDP methodology. Those districts
ANC, institutional births, children aged 12-23 months with a score of less than 0.55 were categorized
fully immunized and mothers who received postnatal as ‘low’ development, between 0.55 and 0.699
care from a medical professional within two days. are considered as ‘medium’ development ,
The justification for selecting these variables is that between 0.700 and 0.799 are ‘high’ development
data relating to the mortality variables pertain to districts and those with 0.8 and above ‘very high’

62
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Map 8:1 Classification of Districts on the basis of Health Index

developed districts. Two districts viz. Jabalpur Table 8:2 Districts where Grading of General
and Indore enjoy ‘very high’ development. Dewas, Literacy and Adult Literacy vary

Bhopal, Shajapur and Raisen follow them in the Category Category

DistrictsUnder General Under Adult
‘high’ development category. While 20 districts Literacy Literacy
exhibit ‘medium’ development, the remaining High Moderate
Chhatarpur
have ‘low’ development in health performance performing performing
indicators. Sidhi, Alirajpur, Singrauli, Barwani and Very high High
Datia
performing performing
Panna constitute the bottom five districts.
High Moderate
Dindori
performing performing
8.2 Education: Intrastate Issues High Moderate
Guna
As mentioned earlier, inter districts issues relating performing performing
to education begins with literacy. The combined Very high High
Harda
performing performing
analysis of general literacy and adult literacy
High Moderate
shows a difference in the performance of the two Panna
performing performing
indicators in 11 districts as shown in table 8.2. Very high High
Raisen
performing performing
Those districts with < 20 per cent of literacy
Very high High
or adult literacy are ‘very low performing’, Satna
performing performing
between 20 and 40 per cent are ‘low
Very high High
performing’, between 40 and 60 per cent are Seoni
performing performing
‘medium performing’, between 60 and 80 per High Moderate
Sidhi
cent are ‘high performing’ and above 80 per performing performing
cent are ‘very high performing districts’. Very high High
Ujjain
performing performing
Source: Computed from Census of India, 2011

63
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

A clear cut strategy has to be devised to increase of inequity should not be confined to literacy.
the adult literacy rate in these 11 districts as well Table 8.3 discusses the critical problem areas in
as formulate interventions for the low performing education pertaining to certain districts.
and very low performing districts. The discussion

Table 8:3 Districts Identified with Crucial Educational Problems

Districts Indicators

Lowest literacy rate (36 per cent) and 26.3 per cent adult literacy rate (the
lowest), lowest GER with 47.73 per cent, lowest NER with 34.02 per cent,
highest dropout rate (20.77 per cent) in classes 1- IV and second lowest
Alirajpur
retention rate with 48.7 per cent, large number of single teacher schools with
739 schools, less than 60 per cent schools to enrolment ratio, women having
10 years of education is the least (9.6 per cent)
Second lowest literacy rate (43.3 per cent) and second lowest adult literacy
Jhabua rate with 33.9 per cent, large number of single teacher schools with 674
schools, low retention rate
< 50 per cent literacy rate and adult literacy rate of 40.6 per cent, large
Barwani number of single teacher schools with 773 schools, Low GER (80 per cent).
Less than 65 per cent schools to enrolment ratio, 61 per cent retention rate
< 60 per cent literacy rate and < 50 per cent adult literacy rate, less number
Sheopur
of schools, poor enrolment
60 per cent literacy rate and adult literacy rate 51.2 per cent, teacher
Singrauli
shortage has been noticed,
51.8 per cent literacy rate, large number of single teacher schools (841), low
Dhar
retention rate

Rajgarh 53.2 per cent adult literacy rate

Shivpuri Adult literacy rate of 54.7 per cent

Shajapur Lowest GER (60 per cent), lowest retention rate in class I-V (46.8 per cent)

Adult literacy rate at 55.4 per cent, High Dropout rate ( 21. 54 per cent) in
Guna
classes VI-VIII

Sidhi Adult literacy rate at 55.8 per cent

58.2 per cent adult literacy rate, teacher shortage has been noticed, Less
Umaria
number of schools, poor enrolment

Tikamgarh Adult literacy rate at 53.4 per cent, teacher shortage has been noticed

Panna 57.1 per cent adult literacy rate

Rewa Largest number of single teacher schools with 1329 schools

Large number of single teacher schools with 757 schools, Only 62 per cent
Mandla
schools to enrolment ratio

Morena Large number of single teacher schools with 646 schools

56.9 per cent adult literacy, Large number of single teacher schools with 586
Khargone
schools

64
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Sagar Large number of single teacher schools with 562 schools

Chhindwara Large number of single teacher schools with 525 schools

Anuppur Less number of schools, poor enrolment of girls

Harda Less number of schools, the lowest enrolment of girls

Neemuch Less number of schools, poor enrolment of girls

Agar malwa Less number of schools, poor enrolment of girls

Datia Less number of schools, poor enrolment of girls

Source: Census 2011, DISE 2015-16

Interventions of different types are required to 2011 is extrapolated for the year 2015-16.
solve the educational problems faced by the above
Map 8.2 shows the classification of districts based on
districts. In order to see the level of inequity that
the education index. Alirajpur was found to be the
exists among the districts in respect to education,
only district with low development in education.
an index is worked out considering all the relevant
Five districts, viz. Jhabua, Barwani, Shajapur, Dhar
variables. However, due to lack of data and
and Khargone, present medium development in
absence of uniformity, there are limitations in
education. In the high development category 33
accommodating all variables.
districts were present and 11 districts exhibit very
In the present context, two variables viz. literacy high development in education. While inequity in
and net enrolment rate at primary level are education exists across the states, the severity of
considered for evaluating the variations in the the same is less when compared with health sector.
performance of districts. Literacy data for the year

Map 8:2 Classification of Districts on the basis of Education Index

65
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

8.3 Nutrition that need immediate attention to realize social

development in an equitable manner. Table 8.4
The variables considered based on the availability
depicts the districts which suffer from variations in
of data expose a number of backward districts
selected nutrition variables.

Table 8:4 Districts Identified with Crucial Nutrition related Problems

Districts Indicators

Children under-5 years who are stunted (height-for-age) 48.6 per cent,
Children under-5 years who are underweight (weight-for-age) 49.6 per cent,
Shivpuri
Mothers who consumed iron folic acid for 100 days or more when they were
pregnant 16.5 per cent
Children under-5 years who are underweight (weight-for-age) 51.2 per cent,
Guna Children under-5 years who are severely wasted (weight-for-height) 12.1
per cent, children age 6-23 months receiving an adequate diet 3 per cent
Children under-5 years who are stunted (height-for-age) 52.0 per cent,
Barwani Children under-5 years who are underweight (weight-for-age) 55 per cent,
children with anaemia 82 per cent
Children under-5 years who are stunted (height-for-age) 50.0 per cent, chil-
dren with anaemia 80.2 per cent. Children under age 6 months exclusively
Burhanpur
breastfed 48.7 per cent, children age 6-23 months receiving an adequate
diet 4 per cent
Children under-5 years who are stunted (height-for-age) 49.7 per cent, chil-
dren age 6-23 months receiving an adequate diet 3.5 per cent, Mothers who
Tikamgarh
consumed iron folic acid for 100 days or more when they were pregnant 14
per cent
Children under age 3 years breastfed within one hour of birth 25.5 per cent,
Children under-5 years who are underweight (weight-for-age) 52.4 per cent,
Children under-5 years who are stunted (height-for-age) 48.6 per cent,
Alirajpur Children under-5 years who are severely wasted (weight-for-height) 11.3
per cent, children age 6-23 months receiving an adequate diet 3.8 per cent,
Mothers who consumed iron folic acid for 100 days or more when they were
pregnant 12.7 per cent
Children under-5 years who are stunted (height-for-age) 48.3 per cent, Chil-
Khargone
dren under age 3 years breastfed within one hour of birth 17.8 per cent,
Children under-5 years who are stunted (height-for-age) 48.1 per cent,
Children under-5 years who are underweight (weight-for-age) 49.6 per cent,
Shajahpur
Children under age 3 years breastfed within one hour of birth 22.7 per cent,
children age 6-23 months receiving an adequate diet 0.8 per cent
Children under-5 years who are stunted (height-for-age) 48.9 per cent,
children age 6-23 months receiving an adequate diet 3.9 per cent, Mothers
Datia
who consumed iron folic acid for 100 days or more when they were pregnant
16.3 per cent
Children under-5 years who are stunted (height-for-age) 52.1 per cent,
Sheopur Children under-5 years who are underweight (weight-for-age) 55 per cent,
children age 6-23 months receiving an adequate diet 1.1 per cent

66
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Children under age 3 years breastfed within one hour of birth 36.5 per cent,
Hoshangabad Children under age 6 months exclusively breastfed 36.5 per cent, children
age 6-23 months receiving an adequate diet 1.6 per cent
Children under-5 years who are underweight (weight-for-age) 52.2 per cent,
Children under-5 years who are stunted (height-for-age) 47.7 per cent,
Children under-5 years who are severely wasted (weight-for-height) 12.5
Morena
per cent, Children under age 3 years breastfed within one hour of birth 36.6
per cent, Children under age 6 months exclusively breastfed 36.6 per cent,
children aged 6-23 months receiving an adequate diet 4 per ent
Children under-5 years who are underweight (weight-for-age) 49.8 per cent,
Children under-5 years who are severely wasted (weight-for-height) 12.6
Bhind per cent, Children under age 3 years breastfed within one hour of birth 33.3
per cent, Children under age 6 months exclusively breastfed 33.3 per cent,
children aged 6-23 months receiving an adequate diet 2.8 per cent
Children under age 6 months exclusively breastfed 30.2 per cent, children
Ashok Nagar age 6-23 months receiving an adequate diet 1.8 per cent, Children under-5
years who are stunted (height-for-age) 42.5 per cent
Children under age 3 years breastfed within one hour of birth 32 per cent,
Panna Mothers who consumed iron folic acid for 100 days or more when they were
pregnant 16 per cent

Dindori Children under age 6 months exclusively breastfed 35.5 per cent

Children under age 6 months exclusively breastfed 36.6 per cent, Mothers
Umaria who consumed iron folic acid for 100 days or more when they were pregnant
16.4 per cent
Children under-5 years who are underweight (weight-for-age) 48.5 per cent,
Children under age 3 years breastfed within one hour of birth 26.4 per cent,
Gwalior
Children under age 6 months exclusively breastfed 26.4 per cent, children
aged 6-23 months receiving an adequate diet 2.1 per cent
Children under-5 years who are stunted (height-for-age) 48.7 per cent,
Sidhi Mothers who consumed iron folic acid for 100 days or more when they were
pregnant 10.2 per cent
Children under-5 years who are underweight (weight-for-age) 49.8 per cent,
Mandla Children under-5 years who are severely wasted (weight-for-height) 11 per
cent, children age 6-23 months receiving an adequate diet 3.2 per cent
Children under age 3 years breastfed within one hour of birth 30.3 per cent,
Harda
children aged 6-23 months receiving an adequate diet 2.3 per cent
Children under age 3 years breastfed within one hour of birth 20.9 per cent
Dhar ,Mothers who consumed iron folic acid for 100 days or more when they were
pregnant 14.1 per cent
Mothers who consumed iron folic acid for 100 days or more when they were
Vidisha
pregnant 15.2 per cent
Source: AHS 2012-13, NFHS-4

67
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

The study identified 23 districts having serious height).

problems related to nutrition. Interventions are
The index sheds light on the inequity across
needed not only for so-called backward districts in
districts. No district falls under ‘very high’
MP, with a dominant SC and ST population, but also
development indicating the need for strong
in urban centred districts. The analysis reveals that
interventionist strategies for promoting
Gwalior, an urbanised district also faces nutritional
development in the nutrition sector. There is
challenges.
only one district viz. Narsinghpur which performs
The variables selected for the index are mothers
with ‘high’ development in respect of nutrition.
who consumed iron folic acid for 100 days or more
Eleven districts including Jabalpur, Balagat and
when they are pregnant, children under age 3 years
Chhindwara, come under the medium category
breastfed within one hour of birth, children under-5
and most of the other districts present ‘low’
years who are stunted (height-for-age), and children
development in the case of nutrition.
under-5 years who are severely wasted (weight-for-

Map 8:3 Classification of Districts on the basis of Nutrition Index

68
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

8.4 WASH
MP government gives thrust on drinking water sanitation. Still many districts suffer from problems
problems in rural areas along with promoting related to drinking water, sanitation and hygiene.

Table 8:5 Districts Identified with Crucial WASH related Problems

Districts Indicators

Improved drinking water source 56.3 per cent, improved sanitation facility 15.8 per cent,
Singrouli
IHHL 11.3 per cent, Households using clean fuel for cooking 17.4 per cent
Improved drinking water source 62.9 per cent, improved sanitation facility 15.1 per
Mandla
cent, IHHL 13.3 per cent, Households using clean fuel for cooking 14.7 per cent
Improved drinking water source 65.8 per cent, improved sanitation facility 19 per cent,
Rajgarh
IHHL 15.9 per cent
Improved drinking water source 66.6 per cent, improved sanitation facility 16.9 per cent,
Shahdol
IHHL 17.5 per cent, Households using clean fuel for cooking 13.5 per cent
Improved drinking water source 65.6 per cent, improved sanitation facility 22.2 per
Shivpuri
cent, IHHL 14.6 per cent
Improved drinking water source 68.6 per cent, improved sanitation facility 18.6, IHHL
Umaria
13.7 per cent, Households using clean fuel for cooking 12.5 per cent

Anuppur Improved drinking water source 69.3 per cent, improved sanitation facility 22.2 per cent

Improved drinking water source 71.3 per cent, improved sanitation facility 6.9 per cent,
Dindori
IHHL 5.7 per cent, Households using clean fuel for cooking 4 per cent
Improved drinking water source 70.3 per cent, improved sanitation facility 10 per cent,
Sidhi
IHHL 7.5 per cent, Households using clean fuel for cooking 6.9 per cent
Improved sanitation facility 14.5 per cent, Improved drinking water source 72.7 per cent,
Chatarpur
IHHL 15.3 per cent, Households using clean fuel for cooking 13.5 per cent
Improved sanitation facility 22.2 per cent, Improved drinking water source 78.3 per cent,
Damoh
IHHL 14.4 per cent, Households using clean fuel for cooking 13.3 per cent
Improved sanitation facility 19.8 per cent, Improved drinking water source 78.1 per cent,
Panna
IHHL 10.2 per cent, Households using clean fuel for cooking 11.3 per cent
Improved sanitation facility 15.4 per cent, Improved drinking water source 93 per cent,
Sheoupur
IHHL 12.9 per cent, Households using clean fuel for cooking 13.8 per cent
Improved sanitation facility 13.9 per cent, Improved drinking water source 74 per cent,
Tikamgarh
IHHL 10.2 per cent, Households using clean fuel for cooking 14.6 per cent
Lowest improved sanitation facility 17.6per cent, using clean fuel for cooking 11.7per
Alirajpur
cent Improved drinking water source 89.1per cent, IHHL 10.5 per cent
Second lowest improved sanitation facility 13 per cent, using clean fuel for cooking 9.1
Jabaua
per cent
Source: NFHS-4

69
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Map 8:4 Classification of districts on the basis of WASH Index

Water and sanitation problems are every crucial for to have ‘medium’ development, the rest (22
16 districts based on the variables considered8 . The districts) were of ‘low’ development stature. The
WASH index is worked out based on two variables disparity observed in other sectors is reiterated
- percentage of household with improved drinking more aggressively in this sector.
water source and improved sanitation facility.
Considering the importance of access to drinking 8.5 Social Protection
water, two-third weightage is assigned to it and Social protection is evaluated based on parameters
one-third weightage to sanitation. such as poverty, percentage of marginal workers to
Indore is the only district that falls under ‘very total workers, and women (age 15-19 years) who
high’ development in WASH, followed by Bhopal, were already mothers or pregnant at the time of
Gwalior, Jabalpur, Ujjain, Dewas and Harda with the survey. Table 7.6 shows the districts with critical
‘high’ development. While 21 districts were found problems of social protection and reinforces the
wide disparities prevalent across the state.

8
Improved drinking water, improved sanitation facility, individual households with latrines (IHHL) and households having clean cooking fuel

70
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Table 8:6 Districts Identified with Crucial Social Protection Problems

Districts Indicators

80.11 per cent of population below poverty line, Women age 15-19 years who were
Dindori
already mothers or pregnant at the time of the survey with 10.3 per cent
75.54 per cent of population below poverty line, per cent of marginal workers to
Mandla
total workers -41.9

Umaria 74.49 per cent of population below poverty line

Raisen 61.62 per cent of population below poverty line

61.54 per cent of population below poverty line , per cent of marginal workers to
Seoni
total workers 41.9
61.02 per cent of population below poverty line, Women age 15-19 years who were
Sagar
already mothers or pregnant at the time of the survey with 11.1 per cent

Chhatarpur 60.6 per cent of population below poverty line

Damoh 59.16 per cent of population below poverty line

55.9 per cent of population below poverty line ,Women age 15-19 years who were
Jhabua
already mothers or pregnant at the time of the survey with 24 .4 per cent
49.64 per cent of population below poverty line, Women age 15-19 years who were
Tikangarh
already mothers or pregnant at the time of the survey with 17.1 per cent
Women age 15-19 years who were already mothers or pregnant at the time of the
Barwani
survey with 14.8 per cent
Women age 15-19 years who were already mothers or pregnant at the time of the
Alirajpur
survey with 13.5 per cent
women marrying before age of 18 years is the highest, Women age 15-19 years who
Narashinhapur
were already mothers or pregnant at the time of the survey with 12.5 per cent
Women age 15-19 years who were already mothers or pregnant at the time of the
Singrouli
survey with 11.7 per cent
54.85 per cent of population below poverty line, per cent of marginal workers to
Sidhi
total workers 40.3
52.26 per cent of population below poverty line, per cent of marginal workers to
Katni
total workers 41.9
32.29 per cent of population below poverty line. Women age 15-19 years who were
Shajahpur
already mothers or pregnant at the time of the survey with 10.2 per cent
48.46 per cent of population below poverty line , per cent of marginal workers to
Shahdol
total workers 51.2
50.1 per cent of population below poverty line, per cent of marginal workers to total
Balaghat
workers 40.6
41.95 per cent of population below poverty line, per cent of marginal workers to
Rewa
total workers 36.5

71
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

47.35 per cent of Population below poverty line, per cent of marginal workers to
Sehore
total workers 36.5
48.72 per cent of population below poverty line , per cent of marginal workers to
Panna
total workers -36
Source: NFHS -4, State Planning Commission, MP 2004-05

Social protection is largely examined with a poverty remains unexplored. Owing to the inadequacy of
lens. The poverty index worked out shows wide 9
available data, the study is compelled to drop
spread disparities across districts. Neemuch has poverty (pertains to the year 2004-05), work
the highest poverty index with 92.74 (2004-05) participation rate and percentage of marginal
indicating lowest burden of poverty, followed by workers (year 2011) in the calculation of social
Indore, Rajgarh and Mandsaur. The lowest was protection index. Households with any member
reported in Dindori with 19.89, implying greatest covered by a health scheme or health insurance,
poverty burden followed by Mandla, Umaria and women (age 20-24 years) married before the age
Raisen. of 18 years and women (age 15-19 years) who
were already mothers or pregnant at the time of
As the current data regarding poverty intensity at
the survey are the variables considered for index
district level is not available, the present situation
calculation.

Map 8:5 Classification of Districts with Social Protection Index

9
Poverty index= (Actual value- 100)/(0-100) * 100

72
 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Balagat, Bhopal and Jabalpur are the only districts 8.6 SC and ST
that enjoy very high levels of social protection.
Among the social groups the most deprived classes
Jhabua, Tikamgarh, Barwani and Alirajpur are
are Scheduled tribe and scheduled caste. The
ranked at the bottom. The classification of districts
various problems faced across districts are given
reveals that most (33) have ‘low’ levels of social
in table 8.7
protection.

Table 8:7 Districts Identified with Crucial Problems relating to SC & ST

Districts Indicators

The highest ST population with 88.98 per cent, Literacy rate among ST is 32.4 per
Alirajpur
cent, Literacy rate among SC is 35.6 per cent,
ST population with 87 per cent, , Literacy rate among ST is 37.2 per cent low child
Jhabua
sex ratio of 879 among SC
ST population with 69.43 per cent, Literacy rate among ST is 39.3 per cent,
Barwani
Literacy rate among SC is 53.7 per cent

Dindori ST population with 64.7 per cent, Low child sex ratio of 979 among ST

Mandla ST population with 57.88 per cent

ST population with 55.94 per cent, Literacy rate among ST is 46.3 per cent Low sex
Dhar
ratio of 990 among ST

Anuppur ST population with 47.85 per cent, Literacy rate among ST is 59.3 per cent

ST population with 46.64 per cent, Literacy rate among ST is 55.1 per cent, lowest
Umaria
WPR of 43.3 per cent among SC
ST population with 44.65 per cent, Literacy rate among ST is 54.9 per cent, lowest
Shahdol
WPR of 46.4 per cent among SC
ST population with 42.34 per cent, Literacy rate among ST is 52.8 per cent, lowest
Betul
WPR of 45.9 per cent among SC
Highest percentage (26.37 per cent) of SC population, Literacy rate among SC is 63
Ujjain
per cent, Low sex ratio of 955 among ST
SC population with 25.46 per cent, low sex ratio of 869 among SC , low child sex
Datia ratio of 868 among SC, lowest WPR of 42.3 per cent among SC, Low sex ratio of 914
among ST, Low child sex ratio of 912 among ST, Low WPR of 42 per cent among ST
SC population with 25.02 per cent, low sex ratio of 897 among SC, low child sex
ratio of 883 among SC, Literacy rate among SC is 59.5 per cent, lowest WPR of 45.1
Tikamgarh
per cent among SC, Low sex ratio of 943 among ST, Low sex ratio of 907 among ST,
Low WPR of 47.7per cent among ST

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

SC population with 23.40 per cent, low sex ratio of 934 among SC, low child sex
Shajapur ratio of 915 among SC, Literacy rate among SC is 61.5 per cent, Low sex ratio of 949
among ST, Low sex ratio of 930 among ST
SC population with 23 per cent, low sex ratio of 883 among SC, low child sex ratio
Chatarpur of 909 among SC, Literacy rate among SC is 56.3 per cent, lowest WPR of 43 per
cent among SC, Low sex ratio of 933 among ST, Low WPR of 45.2per cent among ST
SC population with 22.1 per cent, lowest sex ratio of 835 among SC, lowest ST
Bhind enrolment, low child sex ratio of 874 among SC, lowest WPR of 31.1 per cent among
SC, Lowest sex ratio among ST with 867, Lowest WPR of 32.1 per cent among ST
SC population with 21.44 per cent, low sex ratio of 844, lowest child sex ratio of
844 among SC, Literacy rate among SC is 66.8 per cent, lowest WPR of 34.7 per
Morena
cent among SC, Low sex ratio of 903 among ST, Low child sex ratio of 900 among ST,
Low WPR of 36.7 per cent among ST
SC population with 21.09 per cent, low sex ratio of 884, Low sex ratio of 934 among
Sagar
ST, Low child sex ratio of 943 among ST
SC population with 20.8 per cent, lowest sex ratio of 906 among SC, Literacy rate
Ashoknagar among SC is 61.1 per cent, lowest WPR of 38.7 per cent among SC, Low sex ratio of
934 among ST, Low WPR of 42.9 per cent among ST
SC population with 20.69 per cent, lowest sex ratio of 919 among SC, Literacy rate
Sehore. among SC is 65.8 per cent, Low sex ratio of 956 among ST, Low WPR of 47 per cent
among ST
Low WPR of 34.6 per cent among SC, Literacy rate among ST is 49.6 per cent, Low
Gwalior sex ratio of 913 among ST, Lowest child sex ratio of 886 among ST, Low WPR of 42.7
per cent among ST
Lowest WPR of 39.8 per cent among SC, Low sex ratio of 953 among ST, Low sex
Hoshangabad
ratio of 936 among ST, Low WPR of 45.1per cent among ST
Source: Census 2011, DISE 2015-16

Many urbanised districts like Gwalior suffer from Bihar. The state has an overall score of 0.23 and is
low sex ratio, low literacy rate among SC & ST. This ranked 3rd (2015-16). This highlights the dire state
requires focused strategies for the advancement of of women in the state despite many significant
the deprived communities in these districts as well government interventions for their welfare.
as an overall strategy for the development of SC &
The low ranking in women empowerment is
ST groups in the state.
further substantiated by the problems women
face in various districts of the state. The identified
8.7 Women and Children
districts along with the crucial problems are shown
The women empowerment index shows Madhya in table 8.8.
Pradesh as the poorest performing state after

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Figure 8:1 Women Empowerment Index Scores 2015-16

Source: Constructed by Hindustan Times based on NFHS data

Table 8:8 Districts Identified with Crucial Problems relating to Women & Children*

Districts Indicators

Bhind Sex ratio of 837,8.4 per cent FWPR among women– the lowest in the state

Morena Sex ratio of 840, 16.8 per cent FWPR among women

Datia Sex ratio of 873, 26 per cent FWPR among women

Sex ratio of 883, 41.1per cent, Children age 12-23 months fully immunized (BCG,
Chhatarpur
measles, and 3 doses each of polio and DPT

Sagar Sex ratio of 893, 28.9 per cent FWPR among women

Sex ratio of 896, 21.6 per cent FWPR among women, 45.7per cent Children age 12-23
Vidisha
months fully immunized (BCG, measles, and 3 doses each of polio and DPT

Raisen Sex ratio of 901, 23.4 per cent FWPR among women

Sex ratio of 901, Low literacy rate of 50 per cent among women, 34.4 per cent Children
Tikangarh
age 12-23 months fully immunized (BCG, measles, and 3 doses each of polio and DPT)
Sex ratio of 901, 28.7 per cent FWPR among women, Low literacy rate of 44.2 per cent
Sheopur
among women
Lowest literacy rate of 30.8 per cent among women, 22.6 per cent Children age 12-
Alirajpur 23 months fully immunized (BCG, measles, and 3 doses each of polio and DPT) –the
lowest,
Low literacy rate of 33.3 per cent among women, 25 per cent Children age 12-23
Jhabua
months fully immunized (BCG, measles, and 3 doses each of polio and DPT)
26.6 per cent Children age 12-23 months fully immunized (BCG, measles, and 3 doses
Panna
each of polio and DPT

*
NCRB data is not used as it is based on the number of reporting cases and may not capture the real picture

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Low literacy rate of 42.4 per cent among women, 41.8 per cent Children age 12-23
Barwani
months fully immunized (BCG, measles, and 3 doses each of polio and DPT)
34.4 per cent Children age 12-23 months fully immunized (BCG, measles, and 3 doses
Sidhi
each of polio and DPT
20.8 per cent FWPR among women 37.2 per cent, Children age 12-23 months fully
Ashok Nagar
immunized (BCG, measles, and 3 doses each of polio and DPT)
40.3 per cent Children age 12-23 months fully immunized (BCG, measles, and 3 doses
Shahdol
each of polio and DPT)
Low literacy rate of 48.5 per cent among women ,42.2 per cent Children age 12-23
Singrauli
months fully immunized (BCG, measles, and 3 doses each of polio and DPT)
Lowest literacy rate of 48.9 per cent among women, 42.7 per cent Children age 12-23
Rajgarh
months fully immunized (BCG, measles, and 3 doses each of polio and DPT)

Gwalior Sex ratio of 864, 14.5 per cent FWPR among women- second lowest

Source: Census 2011, DISE 2015-16

Although only 19 districts have been identified above, index is higher for males across the state and is
lack of women empowerment is a problem across half the index value for women in certain districts.
the state irrespective of the level of development Map 8.6 shows the district wise disparity in adult
of the district. The adult literacy disaggregated by literacy levels.
sex, representative of gender parity, shows that the

Map 8:6 Classification of Districts based on Adult Literacy Status (Female)

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

Map 8:7 Classification of Districts based on Adult Literacy Status (Male)

8.8 Composite Index Showing Inequity As expected districts like Jabalpur, Indore, Bhopal,
Balaghat and Gwalior top the index, while Jhabua,
The composite index for the year 2015-16 is
Alirajpur, Barwani, Singruali and Sidhi are in the
evidence of inequity that exists in the state across
bottom levels of development. Figure 7.8 shows
districts. The sub components of the composite
the extent of inequality and the gap to reach the
index are health index, education index, nutrition
index value of 1.
index, WASH index and social protection index.

Map 8:8 Classification of Districts with composite index

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

8.9 Summing Up include interventions to address inequities in urban

districts. Low female workforce participation and
Districts such as Alirajpur, Jhabua and Tikamgarh low sex ratio are some of the crucial problems
suffer from inequity in health, education, nutrition, faced in these districts.
WASH and social protection. The problems of
The problems in crucial districts along with their
backward social groups like SC & ST are also the
intensity are identified and the implementation
highest in these districts coupled with the neglect
of proper strategies in the right dosage is the only
of women and children. It was also observed that
way to rectify this inequity.
intervention strategies have to be developed not
only for so-called backward districts, but must also

78
 Chapter 9

Key Recommendations

Recent decades have seen the rising tides of inequity The increased earnings and disposable income
in society. Tackling this inequity is thus an urgent with the people have a ripple effect across all the
requirement, especially in light of international sectors and lead to overall upliftment. The strong
mandates viz. Sustainable Development Goals. influence of per capita income on most indicators,
at the district level, is evidence of the same.
As previously discussed, the philosophy of equity
broadly encompasses various aspects of personal The policies and strategies intended to uplift the
liberty. Primarily, it refers to the equal access to marginalised communities are mostly proposed
opportunities that people must enjoy irrespective and developed at the state level. However, the
of their cultural and socioeconomic backgrounds. only way to assure maximum efficiency and
Freedom of choice is yet another facet that is effectiveness in achieving their objectives is
critical in maintaining equity. The very existence of through involvement of district and Local Self
inequities can often be traced back to distortions in Governments (LSG). Thus, capacity building of the
the market due to the limited freedom of choice. District Planning Committees (DPCs) along with
These choices are often limited due to governmental LSGs is critical for success.
policies, or lack thereof, creating high entry level
One of the main hurdles in assessment of the
barriers for market players.
ground realities is the acute lack of authentic data.
The equity analysis conducted sheds light on the The storing of reliable data would help in various
heavily interconnected nature of the sectors processes - from early identification of problem
discussed - Health, Nutrition, Education, Water and areas to formulating better strategies to address
Sanitation. The district-wise analysis shows common them. Real time analysis could be undertaken
factors that have strong effects in improving with immediate remedial action. Robust data
outcomes in these areas. It has been revealed that management systems could thus prove useful in
districts with higher rates of urbanisation, such eliminating the information asymmetry in all the
as Bhopal, Indore, Gwalior, etc. have performed critical sectors.
better in both health and education outcomes. The
Madhya Pradesh faces this data challenge
increased levels of urbanisation in certain districts
to a greater extent, both quantitatively and
have led to an increase in the per capita income.

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

qualitatively. The present study could have done A holistic appraisal of the situation in Madhya
more justice if data were available on many aspects Pradesh points to a few main factors that are
at the disaggregated level. This shortcoming holding the state back - infrastructural deficiencies
must be addressed so that future research on and poor governance. There is immense scope
any aspect is smooth and rigorous. It was strongly for implementing evidence based, data driven
recommended in the FGD that a ‘Madhya Pradesh approaches and better outcomes through
Vinjan Preeshalana Kendra’ has to be set up with better supervision, close monitoring and good
the following objectives: management practices. Even after addressing
these concerns, the state needs high levels of
 Prompt collection of relevant monthly data
community participation and a sense of ownership
from all departments.
in the local activities. Local commitment can only
 Develop appropriate software that will enable
be strengthened through community ownership.
various departments and local bodies to report
Significant impact could be made through
data.
community engagement especially for educational
 Provide training to elected members of local
and health outcomes. Schools and other common
bodies at local level as part of capacity building.
open spaces could be converted into ‘Activity
 Train personnel to use the software developed Centres’ as a venue for different types of non-
by Kendra and to compile and report the academic activities. The possibilities for using
relevant data. this open space, with a focus on community
While the world is galloping towards the fourth engagement, are endless - awareness drives,
industrial revolution, the state is still struggling with medical camps, after-school classes in English,
broadband connectivity to households. Leveraging computers, new farming practices and so on. These
the immense potential of information and centres would also be equipped with electronic
communication technology (ICT) would significantly kiosks to access information without restrictions.
improve the performance of the districts. It can be The study also suggests some concrete
used to empower gram panchayats, health centres recommendations to alleviate the inequities.
and even schools for better service delivery. The Focus group discussions, meetings with heads
study highly recommends the use of geographic of important departments and interviews with
information systems (GIS) designed to capture and selected experts helped to arrive at some key
analyse different geographical data. The data so recommendations. It is presented under various
generated could be used to provide valuable real heads as follows:
time insights and help formulate plans of action.
This system could be implemented across all 9.1 Health and Nutrition
sectors, as discussed subsequently. Government
● The study revealed the large infrastructural
of Andhra Pradesh has drafted a new GIS policy
gaps in the existing healthcare system of
in 2016, for the new state formed in June, 2014.
the state. There is an immediate need to
The rationale behind policy is that the state would
improve the condition of local healthcare
require robust information for the effective and
centres and hospitals. It was stated in
efficient implementation of various development
a focus group discussion that most of
programmes. As part of the GIS policy, AP government
the CHCs are not working efficiently and
also plans to launch a GIS portal ‘Swarna Bhoomi’
transport to these centres is in dilapidated
including all the information that could be used by
condition. The CHCs could be provided
various stakeholders.
with ambulatory services to address

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

accessibility concerns. ● The number of medical colleges in the

state is insufficient to produce enough
● It is also recommended that local healthcare
professionals to cater to the medical needs
centres be provided with mobile phones
of such a diverse and vast populace. Efforts
and other communication tools to be better
should be taken to increase the number of
connected and serve the needs of the
MBBS seats. In addition to setting up more
locals. They must however be provided with
Government medical colleges, MP must
sufficient training to effectively use these
encourage private players to establish
tools.
institutions in medical education like other
● Selective primary care is an inadequate states. Giving autonomy and ensuring
response to the rapidly changing quality medical education along with
epidemiology, ageing population and altering reforms of regulatory institutions (like
lifestyle. It requires more investment in MCI) would help to overcome challenges
public health infrastructure. PHCs/SHCs other states have faced. The involvement
must be provided the necessary equipment, of community and non-profit organisations
such as dialysis units, for effective service in the health sector will be helpful in
delivery. attaining better health indicators.

● Accessibility to hospitals, particularly for ● Discussions with experts revealed that

referral cases, is another concern raised the network of ASHA and ANM workers
during the focus group discussion. Standards are sufficiently large. However, the scope
must be set in place for different levels of their work has increased because of
(PHC, SHC, CHC and District) in terms of the introduction of various new schemes.
hospitals. It also requires strengthening of One ANM/ASHA worker often takes care
existing healthcare centres by provisioning of 7 to 8 villages. Due to the expansive
more beds, equipment, staff etc. topography of the state, they experience
difficulties in reaching remote areas. The
● The demand side constraints, with respect
transport systems of the state need to be
to health sector, are well known; however,
built up to facilitate their activities. They
the study revealed that supply side is
could also be provided with convenient
equally dire. As discussed in previous
modes of transport such as bicycles, two-
chapters, there exists a significant shortage
wheelers, etc.
of qualified medical professionals. Staffing
problems further debilitate the already ● In order to address connectivity issues,
strained medical infrastructure in the state. mobile clinics with basic equipment and
Responsible bodies must be cognizant of the drugs, and manned by a skeletal medical
same and recruit adequate staff. staff could be deployed in regular intervals.
This would address the healthcare needs
● The study observed that doctors were
of those living in remote areas.
reluctant to move to rural areas of the state.
The government is responsible for providing ● The study revealed a unique relationship
the necessary infrastructural facilities to between literacy rates and nutritional
support the public healthcare systems, levels. It was found that prevalence of
especially in remote areas. This includes anaemia in women was more influenced
the availability of good quality schools and by male literacy than female literacy. In
addressing safety and security concerns. such male dominated societies it is thus

81
EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

crucial that maternal and child health streamlined from appointments to salary
interventions, along with strategies for disbursement.
nutritional improvements, be tailored to
● Literature suggests that there are strong
both sexes to maximise benefits
linkages between pre-school education
● Madhya Pradesh is a state with low insurance and life outcomes. Discussions with the
penetration. Only 17.7 per cent households relevant stakeholders revealed that
have any member covered by a health there is sufficient unused infrastructure
insurance scheme. Access to insurance (classrooms) which can be utilised to
must be provided through publicly funded provide pre-school education to the
and privately administered health insurance children.
schemes.
● The work hours can be fixed to local
standards to reduce absenteeism. Flexible
9.2 Education
school timings could be implemented based
● Bottom-up and top-down participatory and on local demands and circumstances.
community management interventions,
● It is evident from our study that
which operate through decentralisation
infrastructure facilities like access
reforms, knowledge diffusion, and increased
to water and electricity, segregated
community participation in the management
toilets and boundary walls strongly
of education systems is required.
influence enrolment rates. It is critical
● The existence of separate entities that management/government take
(Education and Tribal Development Board) cognizance of these requirements in the
to oversee school management creates schools with the objective of increased
administrative and qualitative challenges enrolment and retention of students.
in the education sector. This was observed
● The state has managed to achieve positive
in the analysis as well as the focus group
results in ensuring greater enrolment
discussions (FGDs). The two boards must
(primary); however, the poor quality of
be vertically integrated to enhance their
education provided to the students is a
productivity and functioning.
serious concern. The downward trend
● Integration of the various departments that in the learning outcomes (ASER 2016)
run schools is also essential for creating highlights the need for better teaching
common cadres for government teachers standards. There is a need for more
and rectifying the existing anomalies. investment in teachers’ training as well as
● It was also observed that the teachers R&D for content generation, teaching aides
were involved in management of all and other relevant tools and materials.
activities in the school, over and above ● Another concern raised during discussion
classroom activities. The management/ with experts was the lack of teachers in rural
government should provide supporting staff areas. Due to the remote nature of these
to take responsibility for the non-teaching areas, inadequate infrastructural facilities
activities. and general lack of support systems,
● FGDs also pointed out problems in the teachers are reluctant to stay there. The
teacher’s recruitment process. The study study recommends strengthening the
recommends that the entire process be infrastructural capabilities of the rural

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

schools so as to retain teachers in these vouchers are a system by which government

remote areas. schools could be held accountable and
more responsive to the needs of students
● The income generation capacity is poor
and parents. The study recommends the
due to the inadequately skilled workforce.
use of vouchers on an experimental basis
The scheme that imparts skill formation at
with direct cash transfers to the schools.
school level has to be strengthened with
innovative programmes so that students
9.3 Water and Sanitation
who get such training will be absorbed in
the job market easily. ● The crucial element in improving water
and sanitation conditions in Madhya
● The IT mission needs to be strengthened
Pradesh is empowerment of LSGs and
so as to impart the relevant skill set to the
DPCs. Strengthening and focused capacity
workforce. Further exploration could also
building at this level is critical as it was
be done on the feasibility of smart schools
observed that the role of local bodies
equipped with ICT. It can also be leveraged
is not well recognised. In water and
to provide knowledge sharing platforms
sanitation sectors local bodies can perform
online for both teachers and students with
well. WASH strategies must be formulated
unique multimedia teaching aides.
at the district level based on local
● The study also recommends exploring circumstances and implemented through
options such as mobile libraries to encourage local governments. Their activities could
knowledge sharing and reading habits, include:
especially in inaccessible rural areas. The • Maintenance of traditional drinking
mobile libraries could be modelled to cater water sources and environmental
to diverse age groups and interests - from hygiene
books on modern agriculture techniques to • Preservation of ponds and other
adolescent and children’s books. water tanks
• Maintenance of waterways and
● Geographic information system (GIS) can
canals under the control of Village
be deployed to identify demand-supply
Panchayats
gaps. GIS is a system designed to capture,
• Collection and disposal of solid
store, manipulate, analyse, manage and
waste regulation of liquid waste
present geographical data. The spatial data
disposal,
collected can be utilised to find density of
schools, excess or lack of schools in every ● GIS technology can also be used to collect
locality. Rational decisions can be taken, critical spatial data to formulate plans and
based on real evidence, to merge schools also help in implementation. It can prove
and redeploy excess teachers based on useful in identification of beneficiaries
requirements. rather than using social and geographical
context.
● It is well established that the quality of
education is better at private schools ● Innovative business models have also
than public. The better performance been proposed world-over to address
is attributable to the higher levels of the water crisis. One such model is the
accountability in the former, especially loyalty programmes that can be attached
towards students and parents. School to the individuals’ telecom services. Every

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

individual’s top-up will accumulate loyalty Broad based growth and development should be
points, collected in a common drop fund the first strategy of the state. Increase in the work
that can be used to provide local water participation rate, removal of absolute poverty
and sanitation facilities to the respective and deprivation, gender justice etc. should be
localities. These funds would be owned and the components of broad based growth and
managed by the community thus ensuring development strategy. A multipronged strategy
high levels of ownership covering health, education, nutrition, WASH, and
social protection aspects should be accommodated
9.4 Looking Ahead: Possibilities and to uplift the districts belonging to category one
Strategies i.e. the districts with a high severity of problems.
The theme and sector based strategies should
Having identified the backward districts and
be devised, especially in those districts with
vulnerable categories, it is very clear that Madhya
grave problems in particular sectors (category 2).
Pradesh has to adopt several measures on a war-
Targeted strategies must be used to address the
footing for the realization of SDGs by 2030. At the
poor performance of certain indicators (category
outset it is proposed that measures should be taken
3) - households with any usual member covered by
on the basis of the gravity of the problems faced
a health scheme or health insurance, women age
by the districts. For convenience, the districts are
20-24 years married before 18 years, mothers who
classified into three categories on the basis of the
had full antenatal care etc.
intensity of their problems. Table 9.1 throws light
on this aspect. As discussed earlier, improved technology holds
the key to resolving most of the issues raised.

Table 9:1 Categories of Districts and Strategy to be adopted

District Strategy

• Alirajpur Singrauli Shahdol

• Shajapur Panna Umaria
• Barwani Mandsaur Sidhi Multipronged strategy
• Jhabua Chhatarpur Mandla covering health,
Category 1
• Khargone Rajgarh Tikamgarh education, nutrition, WASH
• Dhar Morena Ratlam and social protection
• Dindori Shivpuri Vidisha
• Burhanpur
• Bhind Anuppur Khandwa
• Satna Ujjain Harda
• Rewa Damoh Sagar
Theme and sector based
Category 2 • Sehore Datia Guna
strategy
• Neemuch Katni Dewas
• Sheopur Ashoknagar

• Jabalpur Gwalior Seoni

• Balaghat Narsimhapur
Category 3 • Indore Chhindwara Indicator based strategy
• Bhopal Betul
• Hoshangabad Raisen

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

How far the state has addressed the nexus between incorporating the role of local bodies. Policy level
technological change and innovation is the real interventions are to be made effective so as to
consideration. The critical role played by local make the local bodies dynamic in their area of
authorities should not be overlooked. Presently, no operation. Decentralized governance should be
effective role is played by local bodies in promoting given prominence for the effective removal of
the development of the region concerned. Regional inequity.
development strategies have to be devised

85
Chapter 10

Conclusion

India is committed to achieve the Sustainable districts are the microcosm of the performance at
Development Goals set by the United Nations the state level. To mention a few, in the education
by 2020. The National Health Policy-2017 was front, there are gains in the secondary schooling
formulated to help realise these goals. MP houses for young, but the achievement among adults is
six per cent of the country’s population. The lower than in other states. While the range of
performance of human development indicators vary general literacy is 32 per cent, the range of adult
across regions, social denominations, time etc. and literacy in the state is 52.3 per cent. Learning
across domains such as education, health, nutrition, outcomes are among the poorest in the country. In
and social protection etc. the health area, IMR is the highest in the country
despite improvement. Malnutrition in the state
Our analysis shows that the people of Madhya
is the highest in the country; open defecation is
Pradesh live in a very unequal environment. Given
higher than most states. The state is still among
the wide range of disparities it is not surprising that
the leading contributors of total maternal and child
inequality is a salient feature of the development
mortality, and morbidity in India. No doubt, various
status of the state. The omission of equity, which
governmental and non-governmental initiatives in
is integral to human development, is a hurdle for
the past decade focusing on improving the health
realizing Sustainable Development Goals.
status have brought in significant improvement in
10.1 Trends and Levels of Inequality the levels of health indices but they have fallen
short of targets as planned. There are significant
The importance accorded to equity in the 2010 Human heterogeneities across the 51 districts in the state
Development Report and the human development of Madhya Pradesh in terms of other development
approach to the post-2015 framework and further indicators too.
SDGs reaffirms the focus on tackling inequality.
In Madhya Pradesh, there exist only regional The picture becomes pathetic when the situation
differences in creating an enabling environment for of tribal and rural population dominated districts
human development as well as gender differences is taken into consideration. They lag significantly
and social group discrimination across districts. The behind in other categories and other districts. The
urban population and those with high per capita

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

income perform much better in terms of education, details present a bleak situation. The Madhya
health, food and nutrition as well as water and Pradesh government has made significant progress
sanitation facilities; still they suffer from some in improving food and nutrition security; stunting
peculiar problems as mentioned earlier. Above all, among children less than 5 years, the percentage of
the achievements of the districts are not uniform underweight children has declined but these cannot
exacerbating the inequity in the state. be considered satisfactory results. To improve child
nutrition in the state, the MP government should
10.2 Evaluation of SDGs and Inequity pay more attention to breastfeeding program and
‘Transforming the World: the 2030 Agenda for antenatal care, both of which are linked to better
Sustainable Development’ aims to realize 17 goals health outcomes for children. Out of 25 districts
with 169 associated targets by 2030. The present where the breastfeeding rates were below MP
report does not consider all the goals stated in state average, 16 districts had a higher proportion
the document; the major goals considered are of severely wasted children below 5 years than
evaluated below in the context of MP, recognizing the state average. Districts like Bhind, Gwalior,
the wide inequity that is substantiated in the Hoshangabad and Morena, where only about a
previous chapters. third of women gave only breast milk to the child
below 6 months of age had the highest proportion
SDG 1: End Poverty in all its forms - Everywhere of children less than five years who were severely
wasted. Further, a positive relationship between
This goal envisages a world free of poverty, hunger, institutional births and child nutrition and health
disease and want where all life can thrive. In Madhya is found. The government must also focus on
Pradesh the population below poverty line has quality care for pregnant women. By improving
reduced significantly from 48.59 per cent in 2004- mothers’ micronutrient intake, MP could improve
05 to 31.98 per cent in 2011-12. The same trend is the mother’s and the child’s health. A realist and
observable both in rural and urban. There is however rigorous approach is needed to realize the SDG
considerable heterogeneity in the level of poverty goal as is evident from the index for nutrition.
among the districts. The range of the distribution
is very high (72.85), which indicates that poverty SDG 3: Ensure Healthy Lives and Promote well-
as an indicator has high variation among districts being for all at all Ages
and we are not closer to the realization of SDG
agenda by 2030. In more than 50 per cent of the Mortality rates are not favourable for many
districts, poverty ranges from 30 to 50 per cent with districts .The infant mortality rate is higher in rural
a great intensity in tribal districts. This suggests that areas than in urban, and child mortality is more
the state’s poverty elevation programs need to be than twice as high in rural areas. Infant, child and
revisited and that the state must also devise more under five mortality rates are also higher for ST, SC
efficient ways of program implementation that suit and OBC than other social groups. Children whose
the tribal districts demographics. mothers belong to these groups also have the lowest
vaccination coverage. One hurdle that needs to be
SDG 2: End hunger, achieve food security and looked into is the population covered by health
improved nutrition and promote sustainable institutions. There exist inter-district disparities in
agriculture the population coverage. The population covered
by SCs range from 10,255 in Rewa district and 8698
This goal was not specifically examined in the report. in Umaria district to just 4136 in Mandla and 4627
The aspect of nutrition was taken care of and its in Dindori districts respectively. The population

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 EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

covered by PHCs range from 95,591 in Bhopal should be on how to remove inequities among
district and 70,814 in Chhatarpur district to just districts and vulnerable categories.
13,538 in Mandla and 16,739 in Vidisha districts
respectively. The population covered by CHCs SDG 5: Achieve Gender Equality and Empower
range from 229,374 in Rewa district and 228,605 in all Women and Girls
Indore district to just 47,924 in Narasimhapur and
91,592 in Guna districts respectively. The schemes Gender development, equity and empowerment
like Pradhanmantri Surakshit Matratva Yojna, Janani present a dissatisfactory picture for almost all
Suraksha Yojna, ASHA and Anganwadi workers could districts. Absolute and relative development has
also not reduce MMR or other mortality rates. to be realized for the attainment of the SDG. The
Considering the present scenario and the tempo problem starts with sex ratio and extends to all
under which the machinery works there is little education and health parameters. Rural and urban
hope for ensuring achievement of the goal by 2030. differences are evident from all types of data with
regard to women.
SDG 4: Ensure inclusive and equitable quality
education and promote lifelong learning
opportunities for all SDG 6: Ensure Availability and Sustainable
Management of Water and Sanitation for all
Two things are pertinent in this SDG: inclusive and
quality education. The need to ensure education The Madhya Pradesh government gives great
with equity and equality is the central theme in the emphasis to water and sanitation concerns.
state. Quality is a distant dream for many districts However, there are significant rural-urban
and vulnerable categories like women, ST and SC. variations in the source of drinking water in the
The gross enrolment among SC and ST shows high state. Though the proportion of rural households
disparities across different districts in the state. depending upon hand pumps/tube wells as the
Despite the significant interventions for improving primary and dominant source of drinking water
learning outcomes in Madhya Pradesh like Pratibha has risen sharply, dependence on the ground water
Vikas Programme, activity based learning approach stock in the state is high. Groundwater status in
etc., it must be noted that the literacy rates are half the districts of the rural parts of the state
among the lowest in the country, and there are have been classified as ‘semi-critical’, ‘critical’
only three districts above 80 per cent in the state. and ‘over-exploited’, as per studies (Das, 2012).
Moreover, there are wide regional variations in The problem is worse in tribal districts. There is
terms of male-female differential in literacy rate as every possibility that open defecation may be
well as wide rural-urban differentials. tackled within a decade but the availability of safe
drinking water and hygiene to all will be a hurdle
It is difficult to state that Madhya Pradesh is moving
for the agencies involved in it. They have to be
in the right direction. Inclusiveness needs to be
promoted with constant efforts for the realization
taken care of in the coming years. A major hurdle is
of this SDG by 2030.
the inadequate infrastructure facilities in the state.
For instance, Ministry of Human Resources and
Development (MHRD) ranked Madhya Pradesh third
among states having the poorest record of electricity
provision in 28 per cent of primary, middle, high
and higher secondary schools (2014-15)10. The focus

Based on the data collected by National University of Educational Planning and Administration
10

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EQUITY ANALYSIS REPORT FOR THE STATE OF MADHYA PRADESH

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Abbreviations

AHS Annual Health Survey NSDP Net State Domestic Product

ANC Ante Natal Care NSSO National Sample Survey

Organisation
ANM Auxiliary Nursing Midwife
OBC Other Backward Class
ASER Annual Status of Education Reports
PCI Per capita Income
ASHA Accredited Social Health Activist
PHC Primary Health Centre
AWC Aganwadi Centres
PNC Post Natal Care
AWPS All Women Police Station
PNMR Post Natal Mortality Rate
BPL Below Poverty Line
PTR Pupil-Teacher Ratio
CBR Crude Birth Rate
PWS Piped Water Supply
CDR Crude Death Rate
RBI Reserve Bank of India
CHC Community Health Centre
RMSA Rashtrya Madhyamik Shiksha
CSO Central Statistical Organisation Abhiyan

DH District Hospitals RTE Right to Education

DISE District Information for Education SC Schedule Caste

DLHS District Level Household and SC Sub-Centre

Facility Survey
SDG Sustainable Development Goals
EAG Empowered Action Group
SRS Sample Registration System
FWPR Female Workforce Participation
Rate SSA Sarva Siksha Abhiyan

GDP Gross Domestic Product ST Schedule Tribe

GER Gross Enrolment Ratio TFR Total Fertility Rate

GSDP Gross State Domestic Product TRAI Telephone Regulatory Authority

of India
ICDS Integrated Child Development
Services TSC Total Sanitation Campaign

IHHL Individual Household Latrines U-5 MR Under-5 Mortality Rate

IMR Infant Mortality Rate UNDP United Nations Development

Programme
JSY Janani Suraksha Yojana
UNESCO United Nations Educational,
MDG Millennium Development Goals Scientific and Cultural
Organisation
MMR Maternal Mortality Ratio
UNFPA United Nations Population Fund
NER Net Enrolment ratio
UNICEF United Nations Children’s Fund
NFHS National Family Health Survey
WASH Water, Sanitation and Hygiene
NNMR Neo-Natal Mortality Rate
WHO World Health Organisation
NRDWP National Rural Drinking Water
Programme WPR Workforce Participation Rate

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MADHYA PRADESH
OCTOBER 2018