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| India’s record is shameful | | Child Mortality, Development is meaningless if we cannot ensure the health of our children. | | Sunita Vakil | 10/4/2010 10:18:24 PM |
| Despite a sustained period of high growth, child mortality remains a shameful paradox in an India that aspires to occupy a larger global economic space. Unfortunately, we have an astonishingly bad record of child and infant care in India, which is home to the highest number of children dying before they are five. Half of these children die even before they are 28days old, that’s a quarter of such deaths worldwide.
The governments, both central and state, have been proclaiming time and again that health and education are their top priority. But year after year UNICEF’s “state of the world’s children” report paints a grim picture. This year’s report, released some days back, is no different and the indices for India remain as shocking as ever. This once again reminds us of the vast gulf that separates official claim and reality. The latest UNICEF report that records 17.26 lakh under five deaths with a mortality rate of 66 in India, paints an acutely embarrassing picture of infant and child mortality in the country. The shocking statistics once more proves that India faces a major challenge in healthcare. There is no gain saying that although we have made impressive strides in many areas such as space exploration, information technology and stem cell research, we have been unable to check under five mortality.
At the same time, there has been some slow and lopsided progress. The rate dropped from 116 deaths per 1000 children under 5 in 1990 to 69 per 1000 children in 2008. But it is still a long way from the national target of 39 deaths for every 1000 births. This has also been pointed out by the latest United Nations under five mortality estimates which recognize the unusual challenge India faces in child survival warning that the modest improvement is insufficient. “India is making insufficient progress under five mortality is at least 40 deaths per 1000 live births and the average annual rate of reduction is at least 10% but less that 4 % ”. Indeed, the recent study by UNICEF highlights the fact that child mortality is the biggest challenge that India needs to overcome to achieve the millennium development goals. And since India is a fervent advocate of UN development goals, it now seems a distant dream that we can achieve the required target. And, this despite the existence of a planned economy coupled with a much touted local administrative mechanism.
Nonetheless, the report states that the child mortality rates have declined in the rest of the world as they have fallen from 12.4 million in 1990 to 8.1 million in 2009. It further notes that all regions except Sub Saharan Africa, Southeast Asia and Ocenia have seen reductions by at least 50%. The Unicef figures show that under five deaths are concentrated in just a few countries. About half of global under 5deaths in 2009 occurred in India, Nigeria, Congo, Pakistan and China. The report says that sub Saharan Africa has staggeringly high rate of child mortality where one in 8 children dies before their fifth birthday. South Asia has the second highest rate where 1 in 14 children in the same age group dies. The real shock lies in the fact that India’s child mortality rate is worse than that of less developed countries like Sri Lanka and Bangladesh.
It is a tragedy that India has failed to translate its spectacular economic success into a better quality of life for its most precious asset, its children. Such alarming levels of child mortality are a paradox because they stubbornly survive a surging economy and various targeted intervention programmes. The riddle deepens since India hasin place the Integrated Child Development programme as well as other schemes for more than 32 years. We all take pride in being a country with one of the youngest populations in the world but have fallen woefully short of providing basic health care for the poorest children. Research indicates that some states in India including Orissa, Rajasthan and Bihar have Child Mortality rates that are among the worst in the world. Moreover, the prevalence of child deaths is not the same within India. There are huge disparities among various states, income groups, tribal groups and castes. For example, the under 5 mortality rate in Kerala is 16 per 1000 live births, in Goa 20 per 1000 Live Births, in U.P 96, in M.P 94 and in Rajasthan it is 85 respectively. Also among highest earners it is 33 deaths per 1000 live births and among lowest earners 92 deaths per thousand live births. It is speculated that low income is also major factor behind the prevailing child mortality rate in the country. The very fact that in 2008, more than 530,000 died from poor households as compared with 178,000 from financially better ones amply illustrates the point.
Clearly the loss of so many young lives is unacceptable and more so when many of these deaths are preventable. It is a sad commentary on the state of affairs that despite robust economic growth, child mortality numbers for India are certainly disgraceful. Though there are no simple explanations for India’s alarming Child Mortality Rate, a slew of factors like the rising number of urban poor, a crumbling healthcare system and floundering welfare schemes definitely contribute to the rising infant and child deaths. Other major causes are inadequate neonatal care, insufficient breastfeeding, malnutrition, low immunity and high incidence of communicable diseases. Poor maternal education and some social customs are also believed to have contributed to the shameful trend. Breastfeeding the baby within an hour of birth is said to markedly increase its chance of survival since breast milk contains vital nutrients and antibodies that are beneficial for a baby’s immunity. But some traditional India customs discourage such life saving practices. Most women in India are made to deliver children in poorly hygienic places like a cowshed or any other out house structure. This harks back to old traditions that consider labour as an unclean process. Not surprisingly, we have failed to make a substantial dent in child mortality rates. It is therefore necessary to expand the reach of education so that more women become aware of health related problems and their solutions. A recent survey by the Global Movement for children revealed that 80% Indians were unaware of the large number of children dying every year in the country. And to top it all, Pneumonia and diarrhea are still the biggest killers.
What is shocking is that a majority of under five deaths can be prevented. There is much the government can do to check such a catastrophe with low cost interventions. Poverty can longer be an excuse for inaction. There are several affordable measures that the govt. can take to reduce child deaths by nearly 90%. Since malnutrition, diarrhea and Pneumonia have been found to be the major cause of under five deaths, these can be easily and cheaply treated. Better neo and antenatal care could also reduce the CMR by up to 70%. Availability of safe, potable water to the entire population of the country could contribute in a big way to infant mortality. Findings suggest that the fall in child mortality across the world was achieved by inexpensive measures like immunization, breastfeeding, Vit.A supplementation and provision of safe drinking water. Our neighbours and some Sub-Saharan nations have proven that development can be achieved even in the poorest environments. There is therefore no room for lame excuses. Much more needs to done to prevent the unnecessary deaths of children in our country.
Having said that, How serious are we in ensuring that our young ones have at least a fighting chance of survival? India has the resources, both financial and human, to address once for all the challenge of child mortality. There are a myriad of policies and schemes for the welfare of children. The Integrated Child Development Scheme has been in place since 1975. Then there are other programmes like the Midday Meal Scheme and Supplementary Nutrition Programme. But the slip between the cup and the lip is implementation and accountability. Indeed, efficiency in implementation could have prevented many deaths. Contributory factors like poor education, ignorance, low socio-economic status and political factors too need to be addressed. It is for the government to take note of the UNICEF report and start working to guarantee the most basic human right, the right to survive a thrive- to all of India’s children.
The writer is a Delhi based senior journalist and political analyst.
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