Child Mortality

• Household food insecurity and Illiteracy specially in women. Children in the poorest households are nearly twice as likely to die before the age of five as those from the richest, as well as those whose mothers lack any secondary or higher education.
• Lower access for girls to effective prevention and treatment health services are likely responsible for the marked gender differences in mortality.
• Poor access to health services. In 2017, 2.9 million children in India under one year of age had not been vaccinated with the first dose, according to UNICEF.
• Lack of availability of safe drinking water. within India, large disparities between states on health indicators such as infant mortality show high levels of inequality in access to healthcare and sanitation levels.
• Early marriages of girls. High rates of anaemia (affecting 50% of pregnant women nationally), low nutrition levels (23% of mothers are underweight) and over-burdened government and private health facilities are part of the challenge in delivering healthy children.
• Teenage pregnancies resulting in low birth weight of the new-borns.
• Poor breastfeeding practices
• Poor complementary feeding practices
• Ignorance about nutritional needs of infants and young children and repeated infections further aggravate the situation.
• Number of other factors such as environmental, geographical, agricultural, and cultural including various other factors have contributive effects resulting in malnutrition.
• In India, the first dose of measles vaccine is given at nine-12 months of age and the second dose is given at 16-24 months of age through the national immunisation programme. But it appears that millions of children in India do not receive measles vaccine through routine immunisation activities.

The steps being taken by the government to further combat infant mortality and increase vaccine coverage under the National Health Mission are as under:

• Promotion of Institutional deliveries through cash incentive under Janani Suraksha Yojana (JSY) and Janani Shishu Suraksha Karyakaram (JSSK) which entitles all pregnant women delivering in public health institutions to absolutely free ante-natal check-ups, delivery including Caesarean section, post-natal care and treatment of sick infants till one year of age.
• Strengthening of delivery points for providing comprehensive and quality Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Services, ensuring essential newborn care at all delivery points, establishment of Special Newborn Care Units (SNCU), Newborn Stabilization Units (NBSU) and Kangaroo Mother Care (KMC) units for care of sick and small babies. Home Based Newborn Care (HBNC) is being provided by ASHAs to improve child rearing practices.
• India Newborn Action Plan (INAP) was launched in 2014 to make concerted efforts towards attainment of the goals of “Single Digit Neonatal Mortality Rate” and “Single Digit Stillbirth Rate”, by 2030.
• Early initiation and exclusive breastfeeding for rest six months and appropriate Infant and Young Child Feeding (IYCF) practices are promoted in convergence with Ministry of Women and Child Development.
• Village Health and Nutrition Days (VHNDs) are observed for provision of maternal and child health services and creating awareness on maternal and child care including health and nutrition education.
• MAA-Mothers’ Absolute Affection programme in August 2016 for improving breastfeeding practices (Initial Breastfeeding within one hour, Exclusive Breastfeeding up to six months and complementary Breastfeeding up to two years) through mass media and capacity building of health care providers in health facilities as well as in communities.
• Universal Immunization Programme (UIP) is being supported to provide vaccination to children against many life threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B and Measles. Pentavalent vaccine has been introduced all across the country and “Mission Indradhanush” has been launched to fully immunize children who are either unvaccinated or partially vaccinated;
• Measles Rubella Campaign is being undertaken in select States for children from 9 months to 15 years of age with the aim of eliminating Measles by 2020.
• Name based tracking of mothers and children till two years of age (Mother and Child Tracking System) is done to ensure complete antenatal, intranatal, postnatal care and complete immunization as per schedule.

• Achieving the ambitious child survival goals requires ensuring universal access to safe, effective, high-quality and affordable care for women, children and adolescents.
• Measures should be taken to ensure early registration of pregnancies, and for early detection of high risk cases, improving institutional deliveries, providing skill development training to health staff.
• Education campaign should be taken up to aware the mother of the merits of antenatal care, institutional delivery, importance of exclusive breast feeding, immunization, home care for diarrhoea; all these are meant to create awareness among family members to provide support to women during pregnancies and deliveries.
• India continues to show impressive decline in child deaths. 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.
• Mortality rates among children and young adolescents are not only key indicators for child and young adolescent well-being, but, more broadly, for sustainable social and economic development.
• SDG goal 3 calls for an end to preventable deaths of newborns and children under 5 years of age and specifies that all countries should aim to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births by 2030.
• Tackling the diseases and conditions associated with the quality of care around the time of childbirth will help tackle newborn deaths. This will depend on strengthening health services and ensuring more births take place in hospitals and are attended to by trained staff.