JOIN USIf people are asked about what can be the biggest cause of distress, then the death of a child is likely to be cited as the cause of most acute distress. Despite this, somehow, improvement of child survival has not received the priority it deserves in India compared to several other countries, even those like Vietnam which faced more difficult conditions.
Infant mortality rate (IMR) in India remains unacceptably high at 48 (per 1,000 live births). Other countries which started with similar or worse disadvantages or suffered more obstacles have been able to bring down IMR much more substantially. Cuba has an admirable IMR of 5, while China's IMR is 16 and that of Vietnam is 19. India’s IMR is higher than not just Sri Lanka (14) but also Bangladesh (38) and Bhutan (44). (Comparative data from Human Development Report 2013) Similarly, the under-5 mortality rate of India remains shockingly high at 63 per 1,000 live births, compared to 6 for Cuba, 18 for China, 17 for Sri Lanka, 23 for Vietnam, 48 for Bangladesh and 56 for Bhutan. In the case of both IMR and under-5 mortality, India’s rates are much above the world average.
For age-groups above 5 years, disaggragated age data is difficult to get. However various scattered sources suggest that going by the official definition of children, there are about 1.5 million to 2 million child deaths in India in a year. If we look at achievements in comparable conditions in some neighbouring countries or even Kerala state within India (with an admirable IMR of 13) then it should be possible to save the lives of over a million children per year — if a well planned child-survival campaign is taken up with the close involvement of people.
High maternal mortality
While planning such a campaign, it will be most appropriate to link it with the closely related issue of reducing maternal mortality. Here too the condition in India is pathetic at present. Maternal mortality (deaths per 10,000 live births) has remained very high in India at 200, compared to 35 for Sri Lanka, 37 for China, 59 for Vietnam and 180 for Bhutan.
Sex-ratio of children in the 0-6 age group has steadily worsened during the last 3 decades, from 966 (girls per 1000 boys) in 914 in 2011. This could have been caused due to increasing female foeticide/infanticide and/or discrimination against the girl child in health and nutrition.
Perhaps the most important factor in improving child survival rates is to improve the nutrition of children, as well as pregnant and lactating women. According to National Family Health Survey-III (2005-06), almost half of all the under-5 deaths were closely associated with poor nutritional status.
The percentage of under weight children (moderate and severe) under age 5 is much higher in India compared to most neighbouring countries. This percentage at 42 is much higher than in the case of China (4), Bhutan (13) and Pakistan (31). It is also marginally higher than Nepal (39) and Bangladesh (41). What is most shocking is that this percentage of under weight children in India is substantially higher than the average for all countries classified as 'Least developed countries (27). (HDR-2013)
It is true that some of these data have been disputed recently, but other experts with a much closer grasp of grassroots reality here emphasised that very high levels of undernutrition and malnutrition among children are confirmed by several reliable sources. Therefore efforts to improve child nutrition should get the highest priority.
Janani Suraksha Yojna (JSY) is the most important effort of the government at present for reducing infant and maternal mortality and for ensuring safe child deliveries. While JSY has succeeded in improving the percentage of institutional child deliveries in rural primary health centres and community heath centres these have not been adequately equipped to handle the increasing work. As a result mothers do not get all facilities of safe delivery and frequently have to return home too early due to difficult conditions in the government health centre, leading to later-day complications. Overall improvement of health services, health budgets and poverty alleviation have to provide conducive conditions for the reduction of child and maternal mortality. There should be wide consensus cutting across the political divide to accord high priority to the programme at all levels and implement it with the enthusiastic and informed participation of people.