Child Survival in India: A Serious Issue

The level of child undernutrition remains unacceptable throughout the world, with 90 per cent of the developing world’s chronically undernourished (stunted) children living in Asia and Africa. Detrimental and often undetected until severe, undernutrition undermines the survival, growth and development of children and women, and diminishes the strength and capacity of nations. With persistently high levels of undernutrition in the developing world, vital opportunities to save millions of lives are being lost, and many more millions of children are not growing and developing to their full potential. Nutrition is a core pillar of human development and concrete, large-scale programming not only can reduce the burden of undernutrition and deprivation in countries but also can advance the progress of nations.

Fast Facts: In India 20 per cent of children under five years of age suffer from wasting due to acute undernutrition. More than one third of the world’s children who are wasted live in India. Forty three per cent of Indian children under five years are underweight and 48 per cent (i.e. 61 million children) are stunted due to chronic undernutrition, India accounts for more than 3 out of every 10 stunted children in the world. Undernutrition is substantially higher in rural than in urban areas. Short birth intervals are associated with higher levels of undernutrition. The per centage of children who are severely underweight is almost five times higher among children whose mothers have no education than among children whose mothers have 12 or more years of schooling. Undernutrition is more common for children of mothers who are undernourished themselves (i.e. body mass index below 18.5) than for children whose mothers are not undernourished. Children from scheduled tribes have the poorest nutritional status on almost every measure and the high prevalence of wasting in this group (28 per cent) is of particular concern. • India has the highest number of low birth weight babies per year at an estimated 7.4 million. • Only 25 per cent of newborns were put to the breast within one hour of birth. • Less than half of children (46 per cent) under six months of age are exclusively breastfed. • Only 20 per cent children age 6-23 months are fed appropriately according to all three recommended practices for infant and young child feeding. • 70 per cent children age 6- 59 months are anaemic. Children of mothers who are severely anaemic are seven times as likely to be severely anaemic as children of mothers who are not anaemic. • Only half (51 per cent) of households use adequately iodized salt. • Only one third (33 per cent) Indian children receive any service from an anganwadi centre; less than 25per cent receive supplementary foods through ICDS; and only 18 per cent have their weights measured in an AWC.
Source: UNICEF 

Maternal Health in India: UNICEF

India continues to contribute about a quarter of all global maternal deaths. WHO defines maternal mortality as the death of a woman during pregnancy or in the first 42 days after the birth of the child due to causes directly or indirectly linked with pregnancy. 
Fast Facts
Globally, every year over 500,000 women die of pregnancy related causes and 99 percent of these occur in developing countries.
• The Maternal Mortality Ratio (MMR) in India is 254 per 100,000 live births according to Sample Registration System (SRS) Report for 2004-2006.  This is a decline from the earlier ratio of 301 during 2001-2003.

• In the region, the MMR in China stands at 45, Sri Lanka at 58, Bangladesh at 570, Nepal at 830 and Pakistan at 320 in 2006.

• Wide disparities exist across states in India. The MMR ranges from 95 in Kerala to 480 in Assam.

• MMR has a direct impact on infant mortality Babies whose mothers die during the first 6 weeks of their lives are far more likely to die in the first two years of life than babies whose mothers survive.

• Only 47 per cent of women likely in India have an institutional delivery and 53 percent had their births assisted by a skilled birth attendant. As many as 49 percent of pregnant women still do not have three antenatal visits during pregnancy. Only 46.6 percent of mothers receive iron and folic acid for at least 100 days during pregnancy.
Key Issues
• About half of the total maternal deaths occur because of hemorrhage and sepsis. A large number of deaths are preventable through safe deliveries and adequate maternal care.
• More than half of all married women are anaemic and one-third of them are malnourished

Neonatal Health In India : UNICEF

Introduction
Child mortality is a sensitive indicator of a country’s development.  In India, the Infant Mortality Rate (IMR) (under one year) has shown a modest decline in recent years.

The average decline of IMR per year between the years 2004 to 2008 has been about 1 per cent per year.

In 2008, the IMR was 53/1,000 live births. Eight states contribute to 75 per cent of infant mortality: Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Andhra Pradesh, Orissa, Gujarat and Assam. 

At the current rate of decline, India will miss the XI plan goal of reduction in IMR and the Millennium Development Goal-4 on child survival.
About 70 per cent of the childhood under-five is caused by perinatal conditions (33.1 per cent), respiratory infections (22 per cent) and diarrhea (13.8 per cent). Malnutrition is an underlying cause responsible for about one third of all deaths in childhood.
Fast Facts
• Averting neonatal deaths is pivotal to reducing child mortality. The Newborn period is the period starting from birth and continues throughout 28 days of life.

• Neonatal mortality rate (mortality in the newborn period) stands at 35/1000 lives births, and contributes to 65 per cent of all deaths in the first year of life.

• Between 2004-2008, neonatal mortality has moved from 37/1000 live births to 35/1000 only.

• 56 per cent of all newborn deaths occur in five states: UP, Rajasthan, Orissa, MP and Andhra Pradesh.

• Three major causes contribute to about 60 per cent of all deaths in the newborn period: pre-maturity and low birth weight, birth asphyxia and infections.

Key Issues
• Most of the causes of deaths in the newborn period can be prevented or managed by households, communities and health facilities. But they often are unable to provide the required care.

• Inappropriate practices such as delayed initiation of breastfeeding, delayed clothing and early bathing, not seeking care when newborns are sick and applying harmful material on cord-stump increase the risk of newborn deaths.

• Health facilities are often ill equipped to provide essential newborn care to all newborn and special newborn care to sick newborns.

Indian Health Facts: Report by UNICEF

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Approximately 2 million under-5 children die in India every year (UNICEF state of the World s Children Report, 2007). This is about one-fourth of the global burden of infant and child deaths. Adding to this gloomy statistic is the status of maternal mortality in India. Over 70,000 women die in India every year due to pregnancy related issues. This too accounts for almost one-fourth of the world s maternal deaths. India has among the poorest maternal mortality indicators in the world, and child survival has not improved as it should have. Better early care and immunization, along with tackling diarrhoea and pneumonia among children ensure improvements in child survival, and also contributes to reducing the family size and population stabilization in India India faces the enormous challenge in achieving the Millenium Development Goals by reducing infant mortality from 53 per 1000 live births to less than 30 and maternal mortality from 254 per 100,000 live births to less than 100 by 2015. On the face of it, this challenge seems almost unsurpassable in the given timeframe. With just five years to the 2015 deadline for achieving the MDGs the country as a whole will not be on track for a majority of the targets related to poverty, hunger, health, gender equality and environmental sustainability unless concerted national efforts are made by government and all sections of civil-society working in tandem.