|Demand of the question|
Introduction. Contextual Introduction.
Body. Discuss various reasons for the high child mortality rate in India. Discuss some measures to control child mortality in India.
Conclusion. Way forward.
Despite significant progress in recent years, India continues to have considerable issues with child mortality. India’s under-five mortality rate is the highest in the world. Around 1.3 million newborns die every year in the country during or immediately after delivery. According to the national Health Ministry, India’s current newborn mortality rate stands at 29 per 1,000 live births. High child mortality has been a long term issue in India due to various reasons like poor maternal health and poverty in families.
Reasons for the high child mortality rate in India:
- Poverty: A major factor that leads to a high rate of infant mortality is poverty. 21.9% of Indians are below the poverty line (BPL). Poor people are unable to get good healthcare services. They tend to get babies delivered at home through local nurses known as dais and quack doctors. This endangers a child’s life and often leads to infections due to unhygienic conditions in which the baby is delivered.
- Malnutrition: Low birth weight is the leading cause of neonatal death, which drives up the under-five mortality rate. Low birth weight can be caused by many factors. Foremost among these are poor nutritional intake during pregnancy and a lack of healthcare, both before and during the birth.
- Access to healthcare: Increasing access to affordable healthcare is critical to prevent child mortality. In India, there are great disparities in the levels of access to healthcare. The allopathic doctor-patient ratio at 1:1445, which is lower than the prescribed ratio of 1:1000 by WHO. This is notable between urban and rural regions of the country. Lack of access to healthcare both during and after the pregnancy have severe consequences to the health of the child and lead to deaths.
- Air pollution: India’s children are at severe risk of health issues due to air pollution. Around 93% of children are regularly exposed to air pollution levels considered dangerous to their health according to the World Health Organization (WHO). High levels of pollution are exposing India’s children to risks that may not contribute to mortality in early life, but cause lifelong conditions that significantly reduce their life expectancy.
- Illiteracy: Education still remains low on priority in rural areas. According to Comprehensive National Nutrition Survey data, 53% of the mothers surveyed had no education at all. Only 20% of mothers of preschool children, 12% of mothers of school going children and 7% of mothers of adolescents had completed 12 years of schooling. Thus, new mothers and pregnant women lack the basic fundamentals of pregnancy as well as post baby care. With no knowledge about immunisation of children, it exposes children to greater risk of diseases leading to morality.
- Sanitation: Another major reason is that many women do not have sufficient access to clean water, nutritious food and regular medical assistance. This endangers the life of the child and mother and exposes them to risk of infections.
- Gender discrimination: The health of the girl child is neglected as they are seen as burden. Due to this many girls die due to malnutrition and/or infectious diseases. Meta-preference for sons leads to neglect of girls and their immunisation exposing them at higher risk.
Measures to control child mortality in India:
- Awareness: Education campaigns to aware mothers of importance of institutional delivery, exclusive breast feeding, immunisation, home care for diarrhoea are needed. All these should create awareness among family members to provide support to women during pregnancies and deliveries.
- Gender sensitisation: The issue of neglect of the girl child is much broader and needs interventions beyond health. Focus should be on addressing the social norms and cultural practices. There is an urgent need to ensure equitable access to care for the newborn girl.
- Nourishment: Low birth weight can be prevented if the mother is well-nourished. Mothers should be taught about the importance of breastfeeding. National food security scheme should include more nutritious food to pregnant ladies at subsidised prices.
- Quality healthcare: Addressing gaps in quality of health care is the need of the hour in India. Hospitals should ensure that the critical products to save the newborns are available. Capacity building of healthcare providers to train doctors, nurses and ANMs auxiliary nurse midwives for early diagnosis and care of the mother during pregnancy and delivery is important.
- Sanitation: Swachh Bharat campaign is a noble effort for improving sanitation in India. Efforts must be made to make and keep hospitals, surrounding areas Swachh. It is important that rural people must be motivated to use toilets built under Swachh Bharat. Further, quacks and local nurses dais must be trained and educated about the importance of sanitation.
- Community involvement: Communities at local level must be involved with an aim to target immunisation of newborns and mother. Female education and involvement is a must and they must be taught about the importance of immunisation programmes.
- Improving climate conditions: Rural people must be educated about the harm of firing woods openly for food preparation. Simultaneously, they must be encouraged to use LPG. Ujjwala Yojana is a good initiative but its penetration must be increased. Further, refilling of LPG cylinder must be subsided.
SDG goal 3 calls for an end to preventable deaths of newborns and children under 5 years of age. The investment on ensuring holistic nutrition under the POSHAN campaign and national commitment to make India open defecation-free by 2019 are steps that will help in accelerating progress further. The uptake of the Janani Suraksha Yojana and NRHM needs to be ensured across the states it could address some of the variations in IMR across India.