Niti Aayog’s Healthy States Progressive India report ranks states on the quality and access to healthcare and offers invaluable insights into how states have prioritised services on 23 key indicators of health outcomes, governance and information, and key inputs and processes.

For example, states such as Odisha, Madhya Pradesh and Assam with traditionally poor newborn and child death indictors have shown significant improvements, while others like Uttarakhand have shown consistent decline across more than one indicator.

Here’s how India’s larger stares have performed on five key women and child health indictors since 2015-16, which is the base year in the report.

Newborn deaths

At least two in three infant deaths occur in the first four weeks of birth, which makes neonatal mortality rate (NMR, or deaths in the first 28 days of birth/1,000 live births) a key indicator of the quality and access to maternal and child health services in a region. There are massive disparities within states, with Kerala’s NMR of six being less than a fifth of Odisha and Madhya Pradesh’s NMR of 32, which is the highest in India.

Both Odisha and Madhya Pradesh, however, had shown significant reductions since 2015-16, with NMR falling from 35 to 32 in Odisha, and from 34 to 32 in Madhya Pradesh since the base year.

Kerala and TN have reached the sustainable development goal (SDG) goal of 12 or less neonatal deaths by 2030, with Maharashtra (13) and Punjab (13) within touching distance. NMR declined in all states except Uttarakhand, where it went up by 2 percentile points, from 28 to 30.

Child deaths

Apart from child health, under-five mortality rate (U5MR) is a critical indicator of the state’s socioeconomic milieu and services, including the mother’s education, nutritional status of women and children, immunisation and health services, water and sanitation, among others. India’s U5MR is a high 39 (deaths per 1,000 live births) compared to countries in the same socioeconomic group, but it has declined or remained steady in all states, except for Uttarakhand, where it went up from 38 to 41, and in and Chhattisgarh, where it rose from 48 to 49 deaths.

U5MR was the highest in Madhya Pradesh (62) and the lowest in Kerala (11). While Kerala, Tamil Nadu (19), Maharashtra (21) and Punjab (24) have achieved the SDG U5MR goal of 25, the two states with the highest U5MR in 2016, Assam and Madhya Pradesh, reported declines by 10 and 7 points respectively against the national average of four points.

Low birth weight

Underweight babies with low birth weight (LBW) of 2.5 kg or less are at higher risk of malnutrition, infections, stunting and impaired cognitive development in early life and are at an added risk of chronic diseases in adult life. Children in Jammu & Kashmir are born the healthiest, with only 5.5% of newborns having LBW, while close to one in five children in Odisha (18.2%) have LBW. Other poor performing states include Nagaland (4.1%) and Goa (15.6%).

Rajasthan and Haryana have shown the largest improvement with a 40% decline in LBW babies since 2015-16, mainly because of interventions such as early registration of pregnancies, early detection and management of high risk pregnancies, and regular monitoring of Health Management Information System, among others.

Sex ratio at birth

Chhattisgarh and Kerala are the only two states in India where the sex ratio at birth (SRB), or the number of born for every 1,000 boys, is more than 950 girls for every 1,000 boys, which shows the use of gender-based sex-selective abortions to have sons is still widely prevalent across other states. Chhattisgarh has the highest SRB at 963, while Haryana has the lowest (832).

What’s more worrying is that between 2013-15 and 2014-16, the SRB has declined in Kerala, Odisha, West Bengal, Karnataka, Himachal Pradesh, Andhra Pradesh, Bihar, Telangana, Assam, Maharashtra, Rajasthan and Gujarat.

Full immunisation

Kerala, Jharkhand, Jammu and Kashmir, Andhra Pradesh and Manipur have 100% immunisation coverage, which means all the children received the BCG vaccine against tuberculosis, three doses of DPT vaccine against diphtheria, pertussis (whooping cough), and tetanus, three doses of oral polio vaccine, and the measles vaccine. Another 10 states and union territories have full immunisation levels of 90% or more.

Other high achievers are Himachal Pradesh, Odisha, Meghalaya, Andaman and Nicobar Islands, Lakshadweep and Daman and Diu, which have had 15-percentage point or more decline in the number of fully-immunized children. The underachieving states of Odisha, Nagaland, and Daman and Diu have immunisation coverage less than 60%, but have started immunisation drives to vaccinate missing children against life-threatening diseases.