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Insights into Editorial: India’s under-5 mortality of girls exceeds that of boys

Insights into Editorial: India’s under-5 mortality of girls exceeds that of boys

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Context:

According to the ‘Levels and Trends in Child Mortality’ report by the United Nations (UN) inter-agency group for child mortality, India is among the few countries in the world where, in 2018, the mortality under-5 years of girls, exceeded that of boys.

The global report states that in 2018 fewer countries showed gender disparities in child mortality, and across the world, on average, boys are expected to have a higher probability of dying before reaching age-5 than girls. But this trend was not reflected in India.

The SDG Goal 3 is to end preventable deaths of new-borns and under-5 children by 2030. There are two targets:

  • Reduce new-born mortality to at least as low as 12 per 1 000 live births in every country (SDG 3.2); and
  • Reduce under-five mortality to at least as low as 25 per 1,000 live births in every country (SDG 3.2).

UN Inter-agency Group report: Levels and trends in child mortality report:

  • This report is the UN Inter-agency Group for Child Mortality Estimation estimates on child mortality among children under age 5 and children aged 5-14.
  • Despite progress over the past two decades, in 2017 alone, an estimated 6.3 million children and young adolescents died, mostly from preventable causes. Globally, the majority of child and young adolescent deaths occur at the youngest ages, with the risk of dying highest in the first month of life.
  • While the chances of survival have increased for all age groups since 2000, progress was uneven.
  • The largest improvements in child survival for children under 5 years of age occurred for children aged 1−4 years – mortality in this age group dropped by 60% from 2000 to 2017.
  • Post-neonatal mortality, or mortality among children aged 1−11 months, declined by 51%, neonatal mortality declined by 41% and mortality among children aged 5−14 declined by 37% over the same period.
  • The largest gains in the survival chances for children aged 1−4 have occurred primarily since 2000.

Reasons for under 5 Mortality:

Most children under 5 die due to preventable or treatable causes such as complications during birth, pneumonia, diarrhoea, neonatal sepsis, and malaria.

By comparison, among children between 5 and 14 years of age, injuries become a more prominent cause of death, especially from drowning and road traffic.

Within this age group, regional differences also exist, with the risk of dying for a child from sub-Saharan Africa 15 times higher than in Europe.

Globally, in 2017, half of all deaths under 5 years of age took place in sub-Saharan Africa, and another 30% in Southern Asia.

In sub-Saharan Africa, 1 in 13 children died before their fifth birthday. In high-income countries, that number was 1 in 185.

Risk of dying is higher in girl child:

  • In some countries, the risk of dying before age 5 for girls is significantly higher than what would be expected based on global patterns. These countries are primarily located in Southern Asia and Western Asia.
  • According to India’s 2017 Sample Registration System (SRS) the States with the highest burden of neonatal mortality are Madhya Pradesh, Odisha and Uttar Pradesh, with 32, 33 and 30 neonatal deaths per 1,000 live births, respectively. India’s neonatal mortality rate is 23 per 1,000 live births.
  • Also States and Union Territories, Jharkhand, Bihar and Uttarakhand showed the largest gender gaps in under-5 mortality.
  • The burden of child mortality is determined both by the mortality rate (the proportion of children who die) and by the estimated population of any given State (total number of annual births).
  • In this sense, Uttar Pradesh is the State with the highest number of estimated new-born deaths in India, both because of the high neonatal mortality rate and because of the large cohort of births that occur every year in the State,” noted information released by UNICEF (United Nations Children’s Fund).

Five countries: Half of under-5 deaths:

According to the report, half of all under-5 deaths in 2018 occurred in five countries: India, Nigeria, Pakistan, the Democratic Republic of the Congo and Ethiopia. India and Nigeria alone account for about a third.

Estimates indicate that the majority of child mortality cases in India are attributable to deaths during the neonatal period.

The major causes of neonatal mortality are pre-term birth, intrapartum related events, and neonatal infection.

In the post-neonatal period, the major direct causes of death are diarrhoea and pneumonia.

The report adds that despite the tremendous progress in child survival that has been made over the past two decades, one child or young adolescent died every five seconds in 2018.

Globally, 85% of deaths among children and young adolescents in 2018 occurred in the first five years of life, accounting for 5.3 million deaths, of which 2.5 million (47%) occurred in the first month of life, 1.5 million (29%) at age 1-11 months, and 1.3 million (25%) at age 1-4 years.

An additional 0.9 million deaths occurred among children aged 5-14 years.

Conclusion:

It is urgently required to further accelerate progress in preventing child deaths.

Current trends predict that close to 10 million 5- to 14-year-olds, and 52 million children under 5 years of age, will die between 2019 and 2030.

Almost half of these under-5 deaths will be new born whose deaths can be prevented by reaching high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick new born.

Way Forward: Solutions that save lives, reduce child mortality:

According to the World Health Organization, six solutions to the most preventable causes of under-5 deaths include:

  • Immediate and exclusive breastfeeding
  • Skilled attendants for antenatal, birth, and postnatal care
  • Access to nutrition and micronutrients
  • Family knowledge of danger signs in a child’s health
  • Improved access to water, sanitation, and hygiene
  • Immunizations

These solutions are among the various interventions World Vision employs in its work to promote maternal and child health.

The state and central governments works with communities to train and equip midwives and local health workers; with governments and corporate partners to provide supplies and resources to clinics and hospitals; and with parents to teach best practices in the care and nurture of their young children.

We need to ensure children grow up healthy in their communities, with access to basic health services, adequate nutrition, and disease prevention.