India still to go a long way in curbing infant mortality

India still to go a long way in curbing infant mortality

New Delhi: Human Rights Day is perhaps a good occasion to assess just how fit is our country for its children. In the absence of a wellness index, the kind used in developed nations, a statistical review like Unicef’s “Progress for Children, a world fit for children" provides valuable indicators to countries like India, which contribute to 21% of the global burden of child deaths .

Not surprisingly, the world is watching how India’s 430-million-strong child population is faring. The well being of its children will be critical to its meeting of millennium development goal 1 (MDG 1), which targets halving, between 1990 and 2015, the number of people who suffer from hunger. With malnutrition being the underlying cause of up to 50% deaths and 8.3 million infants having low birth weight (less than 2,500 grams), the target is far from being met and therefore reason enough for issues related to child survival being taken up much more strongly by heads of state and governments.

On the eve of the reports’ release in New York, Dr Gianni Murzi, Unicef India Representative in New Delhi, said that in 1960, an estimated 20 million children under the age of five were dying every year. For the first time in 2006, these numbers fell to a below 10 million figure. But sadly, the major contributors of these 9.7 million child deaths were still from the South Asia region (3.1 million) with 2.1 million from India alone. Additionally, 20% children in India are wasted (acute malnutrition), 43% are underweight and 48% are stunted (chronic malnutrition), making the MDG1 target on malnutrition in India a tough challenge to meet.

Even if the government’s numerous flagship programmes have resulted in some progress in education, gender equality and child protection with school enrolments going up, there being lesser number of drop outs and an improvement in child mortality figures, the possibility of children graduating to healthy adolescence and adulthood are still rife with uncertainties.

Skilled attendance at the time of delivery in India stands at 47%, which is better than some developing countries, but it still places a lot of new borns at risk. Interventions like initiating breast feeding within the first hour of child birth continues to be a dismal 23.4%, an indicator that can be pushed up.

Though the world (including India) is on track for achieving the MDG on safe drinking water, more global action is required to meet the MDG target on sanitation. In 2004, 2.6 billion persons globally and an estimated 700 million in India did not use improved sanitation facilities.

According to Lizette Burgers, chief of water and sanitation, Unicef, India, “Improving sanitation could in a single stroke address multiple health related fatalities. India is far from fit. Diarrohea and worm diseases are a direct manifestation. Human and animal excreta lying in the proximity of children makes them extremely vulnerable to disease. When micro epidemics of diptheria or malaria break out in small pockets, it depresses malnourishment levels further, in severe cases, adding to the mounting number of child mortalities"

While complimenting the government for expanding coverage by having sanitation programmes running in nearly 570 districts, she said initiatives like the Clean village award is making a difference, results of which would be visible in 2008, which is the year for sanitation.

According to the National Family Health Survey, about one-third of underweight children under the age of five in the world reside in India. The states with the highest number are Madhya Pradesh, Jharkhand and Bihar followed by Guajarat, Orissa, Chattisgarh, UP and Meghalaya. Disparities on underweight prevalence between states is also very high, so while you have Tamil Nadu with 30% underweight children, MP has 60%. The challenge according to Murzi will be not just on reaching these 9.4 million children but in ensuring quality antigens as they cross over to the partial immunization stage.

The focus will have to be on the youngest lot of children because by far they are the worst impacted by malnutrition and are often left out of economic growth and social development.