Sixty-one years since Indian independence,
a plethora of sops, schemes, programs, projects and a complete ministry
dedicated to the child — and yet over 2 million children did not live
to see their fifth birthday in 2006, accounting for one-fifth of the world’s children who died before turning five. India is home
to 20 percent of the world’s under-fives. What this means is that
the global attainment of the health-related Millennium Development Goals
(MDG) depends on New Delhi’s achievements in this respect.

India has pledged itself to the health-related Millennium Development Goals (MDGs) for 2015. And child survival – reducing
child mortality, also referred to as MDG 4 – poses one of the most serious
challenges to these goals. It requires reducing the global rate of under-five
deaths by two-thirds by 2015 from the 1990 levels. The death
rate should be 30 deaths per 1,000 live births to meet the target.

While there has been a sure decline in the number of infant deaths in
the Asia Pacific region, having come down to around four million in 2006
from 6.7 million in 1990, India alone, that year, accounted for half
the number (2.1 million). Since 1960, the country has managed to reduce
the death rate from 236 deaths per 1000 live births to 76 per 1,000
live births, and a growing economy has enabled
India to reduce the under-five mortality rate by one-third. Yet despite
the fact that the country is witnessing an economic boom, the growth restricted to small pockets of the country. Sixty percent
of the under-five deaths occur in just five states — telling a poignant story of the fight to survive. An
Indian child’s chance of celebrating the fifth birthday clearly depends
on the state or community it is born into.

The urban-rural divide and
several other socio-economic factors evidenced in the disparate Infant
Mortality Rate (IMR) — like the gap in the rural and urban IMR rates of
64 and 40, respectively; between boys and girls of 56 and 61, respectively;
and in states ranging from 76 in central state of Madhya Pradesh to
14 in the southern and literacy high state of Kerala — are the disparities
in society reflected in the under-five deaths, and also indicate a strong link between poverty and child mortality.

The country’s economy is growing at an average
rate of nine percent a year, but still, two out of every five children in
India are malnourished. Accompanying the economic boom is the shift
to privatization of many essential services which has only widened the
gap when it comes to accessibility of even very basic facilities. As the affluent demand better services, there has been a further
deterioration in the availability and quality of government facilities.
And since the MDGs are related to improving health, nutrition, water
and sanitation, education and child protection, gender equality and
women’s empowerment, it is hardly surprising that the child mortality
is a direct manifestation of the lack of these. More than 50 percent of this
country’s under-five deaths are associated with malnourishment and
anemia, while another 30 per cent are caused by pneumonia. Further,
an estimated nine percent of children are suffering from diarrheal
diseases; in absolute numbers a figure that is even higher than that
in Afghanistan.

That South Asia, as a region, spends
only 1.1 percent of its Gross Domestic Product (GDP) on public health
expenditure, much below the world average of 5.1 percent, also reflects
trends in the region. While the Indian budget did reflect a fifteen
percent increase in the health sector, it still remains at a mere
one percent of the GDP.

A new study by Save the Children
compares child mortality in a country to its national income per person,
clearly placing India behind poorer neighbors like Bangladesh and Nepal
when it comes to cutting child deaths. Of the 41 countries ranked depending
on how well they are using their resources to boost child survival rates
India stands at a low 16, behind both Bangladesh and Nepal, who are in
the top ten.

The entrenched discrimination against
the girl child, evidenced in various forms of medical and technological
misuse over the years (and the insidious transformation of older practices
of infanticide to what came to be commonly termed as ‘feticide’
in more recent years), also finds itself reflected in many communities
in discriminatory child-rearing practices. What this means is that
gender inequalities in the country determine access to food and medicine.
Moreover, the poor health of the pregnant mother, also a manifestation
of the status of women even in the marital homes with regard to diet
and access to medical or health care facilities, also directly impacts
the newborn. Lack of knowledge
or information on child rearing and nutrition also play a part. With one out of every
three women being underweight in India, it leads to low-weight babies
who are more likely to die in infancy. The largest absolute number of
newborn deaths in the world occurs in South Asia and India contributes
around one quarter of the global total. It is hardly surprising then
that South Asia is also the only region in the world where when compared
to males female life expectancy is lower. So not only is the location
that determines the chances of survival for children in the country
but also their gender. Being born a girl carrying higher risks as
it raises the chance of premature death between the ages of one and
four by about one-third. Again it is hardly surprising that the region
also has a massive gender imbalance in population numbers, with around
50 million more men than women.

With maternal mortality closely linked
to child mortality – since the chances of survival of a child significantly
reduces if the mother has died due to childbirth related complications
– it really is the health (or the ill health) of the mother that is
also a crucial issue. To combat this issue the
Government of India relies on its Integrated Child Development Scheme
(ICDS) which has been running for over 30 years. But the MDG goals would
require the government to re-evaluate its flagship program for mother
and childcare, started in 1975, which provides health and nutrition
education for mothers of infants and young children, along with other
services, such as supplementary nutrition, basic health and antenatal
care, growth monitoring and promotion, preschool non-formal education,
micronutrient supplementation and immunization. The services delivered
through a network of around 700,000 community (anganwadi) workers
has had limited effectiveness due to a variety of factors, ranging from
downright corruption and mishandling of the allocated funds, the limited
skill and knowledge of anganwadi
workers themselves to a lack of supervision, vacancies and flaws in
program policy itself, reflected in the inadequate focus on the young
children. Even today the maternal mortality remains between 300-500
deaths per 100,000 births, which means 75,000 to 150,000 women die every
year in India during childbirth.

It has been interventions of
local organizations, especially women’s groups, working at the grassroots
level within the communities that have been able to make any inroads
in these orthodox structures. Working within the cultural ethos and
cultural context these groups have built on the established structures
within communities that extend to other areas of development, including
education and credit, as well as health. And in more recent months hoping
to tap into the potential of the access and community confidence these
grassroots workers (like midwives) enjoy within the communities the government
has adopted strategies to exploit their presence.

The UNICEF in collaboration with the center has launched a five year action plan which
would use a grant of $700 million for child protection, education and
nutrition and protecting children from AIDS. This 2008-2012 Country
Program would jointly focus on India’s infant and maternal mortality
rates amongst other things. With both maternal and infant mortality
so closely tied to societal practices, age-old customs and traditional
roles that place less of a premium on the education and health of the
girl child, the wife or the mother any effort to reverse this trend
would also require a change in the status of women both in their paternal
and marital homes with equal access to the most basic human needs; and
where the chances of survival of the infant remain equal irrespective
of the socio-economic background or geographical location of the community
it is born to.