INDIA’S PROBLEM OF CHILD MORTALITY
CONTEXT :
- Recently two global reports were released on child mortality and on stillbirths.
- The report on child mortality — ‘Levels and Trends in Child Mortality’, by the United Nations Inter- agency Group for Child Mortality Estimation (UNIGME).
CHILD MORTALITY :
- Child mortality is the mortality of children under the age of five.
- Under-five mortality rate refers to the probability of dying between birth and exactly five years of age expressed per 1,000 live births.
- It encompasses neonatal mortality and infant mortality (the probability of death in the first year of life).
REPORT HIGHLIGHTS :
- According to ‘Levels and Trends in Child Mortality’ report estimates that globally five million children died before their fifth birthday (under -five mortality) in 2021.
- Over half of these occurred among children aged 1 59 months, while the remainder occurred in just the first month of life (neonatal deaths).
- India’s share in these child mortalities was estimated at 7,09,366 under -five deaths. Out of which 5,86,787 infant deaths (death before first birthday) and 4,41,801 were neonatal deaths.
SAMPLE REGISTRATION SYSTEM :
- According to Sample Registration System (SRS) released in September 2022, it showed wide inter – State variations in child mortality in India.
- For every 1,000 live births, the infant mortality rate in Madhya Pradesh was six fold of the rate in Kerala.
- The children in rural parts in any age subgroup have much higher mortality rates than their urban counterpart.
Infant Mortality Rate :
- Infant Mortality Rate has registered a two-point decline to 28 per one thousand live births in 2020 from 30 per one thousand live births in 2019.
Under five Mortality Rate :
- Under five Mortality Rate for the country has also shown a significant decline of three points from 32 in 2020 to 35 per one thousand live births in 2019.
The neonatal Mortality Rate :
- The neonatal Mortality Rate has also declined by two points from 22 in 2019 to 20 per one thousand live births in 2020.
CHALLENGES IN INDIA’S CASE OF CHILD MORTALITY :
PRETERM BIRTHS :
- The first challenge is of children being ‘born too early’ (preterm births), which means they are born alive before 37 weeks of pregnancy are completed.
- This is a challenge because these ‘preterm babies’ are two to four times at higher risk of death after birth in comparison to those born after 37 weeks of gestation.
PROBLEM OF STILLBIRTHS :
- A baby who dies any time after 22 weeks of pregnancy, but before or during the birth, is classified as a stillborn.
- In 2021, the absolute estimated number of stillbirths in India was 2,86,482.
- Half the stillbirths happen before delivery due to antepartum causes and the remaining during delivery (intrapartum).
POOR ACCESS TO HEALTH SERVICES :
- According to UNICEF, 2.9 million children in India under one year of age had not been vaccinated with the first dose.
EARLY MARRIAGES OF GIRLS :
- As teenage pregnancies resulting in low birth weight of the newborns and thus more prone to mortality.
SOLUTIONS :
For reducing both stillbirths and preterm births, the focus must be on:
- Increasing access to family planning services
- Improving antepartum services such as health and nutrition,
- Including the intake of iron folic acid by pregnant mothers
- Providing counselling on the importance of a healthy diet, Optimal nutrition
- Identification and management of risk factors.
- A majority of these births can be prevented by scaling up known and proven interventions and improving the quality of health services.
- Measures should be taken to ensure early registration of pregnancies, and for early detection of high risk cases, improving institutional deliveries, providing skill development training to health staff.
- Reduce future neurological complications for preterm babies by ensuring the Kangaroo mother care and early initiation of exclusive breastfeeding, among others.
- Government should commit to invest minimum of 2.5% of the GDP on health.
- Strengthening and appropriate funding of primary health care centres.
- Timely and granular data on stillbirths should be available from the block, district and State levels.
GOVERNMENT INITIATIVES :
Kangaroo Mother Care (KMC) :
- Care have been found to be very effective for stable newborns in providing adequate thermal care, reducing nosocomial infections, improving exclusive breastfeeding and weight gain, besides fostering greater maternal and family involvement in care.
Poshan Abhiyan :
- It is intended to reduce stunting in identified districts of the country with the highest malnutrition burden by improving utilization of key Anganwadi Services and improving the quality of Anganwadi services delivery.
India Newborn Action Plan (INAP) was launched in 2014 to make concerted efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate”, by 2030.
Nutrition Rehabilitation Centres :
These are the centres in which children with severe acute malnutrition are admitted.
WAY FORWARD :
- According to Delhi based not-for-profit, “The Foundation for People Centric Health Systems” reported the need for multi- stakeholder collaboration and flagged the need for better data.
- The maternal and perinatal deaths surveillance guidelines need to be effectively implemented and the International Classification of Diseases definition for perinatal mortality must be adopted. The use of this classification will help standardise the causes of stillbirth reporting.
Syllabus : MAINS, GS 1 SOCIETAL ISSUES, GS 3 HEALTH
