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The Lancet paper gives evidence of a gender bias marking under-five child mortality in India: for every 100 boys who died before the age of five in 2012, there were 130 deaths among girls. Photo: Hindustan Times (Hindustan Times)
The Lancet paper gives evidence of a gender bias marking under-five child mortality in India: for every 100 boys who died before the age of five in 2012, there were 130 deaths among girls. Photo: Hindustan Times

(Hindustan Times)

Poorer states seen missing under-5 mortality goal

A few richer states will achieve target by 2015, poorer states will not see substantial reduction till 2023

New Delhi: Some of India’s poorer states will fail to substantially reduce deaths among children under the age of five by 2015—a key target under the internationally-agreed Millennium Development Goals (MDGs).

And the scourge is growing in a small number of richer states too, says a new report by the medical journal Lancet.

Reducing under-five mortality by 30% by 2015 is a key MDG but many experts hold that India will miss the target. Now, the Lancet report released on Thursday captures the extent of inequity in India, linking it to the nation’s failure on this front.

While a few richer Indian states will achieve the target by 2015, poorer states will not see a substantial reduction in under-five mortality till 2023, the report said. To achieve the target, India will have to reduce this rate from the current 54 to 42 per 1,000 live births by 2015.

In 2012, 1.5 million children under the age of five died in India—a figure that is substantially lower than the 2.5 million who died in 2001.

Whether or not the world as a whole meets the target on under-five mortality (a 30% reduction) will depend on progress in the “sub-regions" of India, according to the report’s authors Prabhat Jha of the University of Toronto and Usha Ram of the International Institute for Population Sciences in Mumbai.

“India’s large population and its enormous variation in social circumstances, access to health services, and other correlates of under-five mortality mean that national statistics mask large local variation in sex-specific under-five mortality and how this changes over time," the authors said.

“Notably, the number of districts lagging behind has increased in the richer states of Andhra Pradesh, Gujarat, and Karnataka. Only in the states of Kerala and Tamil Nadu have all districts achieved MDG 4 (on under-five mortality)."

The academics found that nine poorer states—Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Odisha, Rajasthan, Uttarakhand and Uttar Pradesh—accounted for one million (71%) of the 1.5 million deaths of children younger than five years in 2012.

These states were also home to over half of all births in 2012.

The Lancet paper gives evidence of a gender bias marking under-five child mortality in India: for every 100 boys who died before the age of five in 2012, there were 130 deaths among girls.

“Such a large scale of inequities is a reflection not just on the poorer states, it is a reflection on overall health systems in India," said Abhay Shukla, an activist with the Indian chapter of non-governmental organization People’s Health Movement. “In most cases, the health system actually amplifies these inequities because there is a concentration of wealth in urban pockets with seven star hospitals, while the semi-urban and rural areas are poorly funded, poorly equipped and have poorly manned health facilities."

The study was conducted in 597 Indian districts between 2001 and 2012.

Overall, under-five mortality rates are falling in India—they fell at an average rate of 3.7% per year between 2001 and 2012, and just over a third (222) of the districts are on track to achieving the target of 42 or fewer deaths per 1,000 births.

The paper said that “the results show that an equal number (222, or 37%) of districts will achieve this target only after 2020. The results highlight startling inequalities between richer and poorer states in India—just 81 (14%) of districts account for over a third (37%) of deaths in children under five nationally, and nine poorer states have around half of all people and births in India, but nearly three quarters (71%) of all deaths in children under five. The results also show that deaths in children aged 1–59 months (i.e., those who survive the first month of life, but die before the age of five), deaths among girls exceeded those among boys by 25% in 303 states across India".

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