CHILD MORTALITY IN INDIA - POLICIES
NEWS: The United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) has recognized India as one of five “exemplar countries” for its efforts in reducing child mortality.
WHAT’S IN THE NEWS?
Findings of the UN IGME Report (United Nations Inter-agency Group for Child Mortality Estimation)
• Global Exemplars:
Countries such as India, Nepal, Senegal, Ghana, and Burundi have been recognized in the report for implementing effective, scalable strategies that significantly reduced preventable child deaths over recent decades.
• Global Child Mortality Trend (2023):
The total number of under-five child deaths globally dropped to 4.8 million, showing sustained progress in global child health.
Additionally, stillbirths declined to 1.9 million, reflecting improvement in prenatal and neonatal care services worldwide.
• India’s Achievement:
Since the year 2000, India has achieved a 70% reduction in under-five mortality and a 61% reduction in neonatal mortality, making it a key contributor to global child survival gains.
Understanding Neonatal Mortality
• Definition:
Neonatal Mortality Rate (NMR) refers to the number of deaths among live-born infants during the first 28 days of life, per 1,000 live births in a given year or period.
• Types of Neonatal Deaths:
1. Early Neonatal Deaths: Occur within the first 7 days of life.
2. Late Neonatal Deaths: Occur from the 8th to the 28th day of life.
• Significance:
NMR is a crucial indicator of maternal and newborn health, as well as the effectiveness of healthcare systems, especially during and immediately after childbirth.
Why India Has Performed Well in Reducing Child Mortality
• 1. Strengthening the Health System:
• Major investments in health infrastructure, including rural health centers and hospitals.
• Recruitment and training of skilled healthcare professionals, such as ASHAs and ANMs.
• Deployment of digital health surveillance and monitoring systems for real-time data collection and response.
• Introduction of Ayushman Bharat, the world’s largest public health insurance program, covering ₹5 lakh (~$5,500) per family annually for secondary and tertiary care.
• 2. Maternal and Child Health Services:
• Free institutional delivery services, including C-sections, are provided under various schemes.
• Essential newborn care such as medications, vaccinations, diagnostics, and neonatal transport are provided free of cost in public healthcare institutions.
• 3. Expanded Immunization Coverage:
• Measles vaccination coverage increased from 56% in 2000 to 93% in 2023.
• This has contributed to a 97% reduction in measles-related child deaths over the period.
About Child Mortality
• Definition:
Child mortality refers to the death of a child before reaching five years of age.
• WHO Measurement:
The under-five mortality rate (U5MR) is the probability that a newborn child will die before reaching age five, based on age-specific mortality rates observed in a given year or period.
Major Causes of Child Mortality (Especially in India)
• 1. Preterm Birth Complications:
• Leading cause of neonatal and infant deaths in India.
• Includes respiratory, immune, and feeding challenges among premature babies.
• 2. Pneumonia and Diarrhea:
• Remain major infectious killers of children under five.
• Often associated with lack of timely medical intervention, poor hygiene, and inadequate nutrition.
• 3. Malnutrition:
• Directly weakens the immune system, making children more vulnerable to infections and disease.
• Often linked with poverty and inadequate maternal nutrition.
• 4. Inadequate Healthcare Access:
• Rural, tribal, and remote regions suffer from shortages of medical personnel, infrastructure, and supplies, limiting timely care for sick children.
Key Government Initiatives to Reduce Child Mortality in India
• 1. Janani Suraksha Yojana (JSY):
• A conditional cash transfer scheme promoting institutional deliveries among poor pregnant women.
• Encourages safe childbirth with financial incentives, particularly in rural and low-income settings.
• 2. Janani Shishu Suraksha Karyakram (JSSK):
• Provides free and cashless delivery services, including caesarean sections, in public hospitals.
• Ensures free drugs, diagnostics, diet, transport, and blood transfusions for pregnant women and sick newborns.
• 3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA):
• Offers free antenatal checkups by specialists on the 9th day of every month.
• Helps in early detection of high-risk pregnancies, ensuring proper monitoring and safe delivery.
• 4. Universal Immunization Programme (UIP):
• Covers 11 vaccines to protect children against 12 preventable diseases, including measles, polio, tetanus, and rotavirus.
• Forms the backbone of India’s child survival strategy.
• 5. Rashtriya Bal Swasthya Karyakram (RBSK):
• Screens children from birth to 18 years for 32 health conditions including defects, deficiencies, and developmental delays.
• Establishes District Early Intervention Centres (DEICs) for timely treatment and referral.
Addressing Malnutrition in Children
• Integrated Child Development Services (ICDS):
• Provides supplementary nutrition, preschool education, and healthcare services through Anganwadi centers.
• Pradhan Mantri Matru Vandana Yojana (PMMVY):
• Offers cash benefits to pregnant and lactating women for their first live birth to support nutrition and health-seeking behavior.
• POSHAN Abhiyaan & POSHAN 2.0:
• Aims to reduce stunting, underweight, and anemia in children and women.
• Promotes convergent nutrition action plans, behavior change campaigns, and data-based monitoring.
Infant Mortality Rate
Infant Mortality Rate (IMR) is defined as the ‘number of deaths of children under the age of 1 year per 1000 live births for a given year.’
• In accordance to the UN Millenium Development Goals (MDG), the goal was to cut down child mortality rate by two-thirds from 1995 till 2015.
• In India it declined considerably at the rate of almost 57%. The IMR came down from 80 infant deaths per 1000 live births (in 1995) to 33 deaths per 1,000 live births (in 2017: according to SRS bulletin 2019).
IMR has 2 components:
• IMR: infants dying within 1 year of birth and,
• Neonatal Mortality Rate (NMR): It is defined as the ‘number of deaths during the first 28 completed days of life per 1,000 live births in a given year or period’.
• Globally according to the UNICEF, NMR was 18 deaths per 1000 live births (in 2018), where as in India, NMR was 23 deaths per 1000 live births (approximately 7,000 newborn deaths every day).
• The decline in NMR is at a very slow pace both globally and in India. It is almost one-third of the rate of decline of IMR.
Response of States: Health being a state subject, puts the onus of patient’s effective care on State government. States respond to the issue on the basis of the availability of the human and financial resources, and also the commitment they have towards the cause.
• Responsible behaviour of the States and matching contribution from the Centre and the States (for capacity building & infrastructure overhauling) is the need of the hour.
• For example, in the case of Nipah outbreak in Kerala, when it took place for the first time, there happened certain deaths but the government of Kerala took proactive measures for preventing similar outbreaks in the future. Hence, quick and timely response by the system played a dominant role in saving many lives.
Role of Centre: Centre must provide feasible (doable) models and allot sufficient funds to the states so as to fulfill the financial demands of the state.
• In this regard, the Centre has established Special Newborn Care Units (SNCUs) at district hospitals and sub-district hospitals with an annual delivery load of more than 3,000 to provide care for sick newborns.
• All types of neonatal care except assisted ventilation and major surgeries are provided here. It is a separate unit in close proximity to the labour room which is managed by adequately trained doctors, staff nurses and support staff to provide 24×7 services.
Government Initiatives
• India Newborn Action Plan (INAP): It was launched in 2014 to make concerted efforts towards attainment of the goal of “Single Digit Neonatal Mortality Rate” and “Single Digit Still-birth Rate”.
• National Health Mission (NHM): The National Rural Health Mission (NRHM) that started in 2005 to provide accessible, affordable and quality health care to the rural population (especially the vulnerable groups) actually improved the health system in the country. Prior to that health infrastructure in the country was very weak.
• It is being implemented by the Ministry of Health & Family Welfare. The government in 2013 launched the National Urban Health Mission (NUHM) making it as a sub-component of an overarching National Health Mission (NHM), with NRHM being its another sub-mission.
• Its main programmatic components include health system strengthening in rural and urban areas for- Reproductive-Maternal-Neonatal-Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.
• Schemes like Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK), Pradhan Mantri Matru Vandana Yojana (PMMVY) etc. were started to promote institutional deliveries so as to reduce the prevalence of IMR.
Source: https://www.business-standard.com/india-news/un-lauds-india-s-efforts-in-mitigating-childhood-mortality-stillbirth-125032900799_1.html