This sentiment – that being the centric role played by children in their country’s future – has been laid bare in the latest report released by Save the Children in their centenary year. The report highlights the progress that has been made in pursuit of a world where the welfare of children is universal and robust. It also proclaims how much more must be done to realise this.
“A generation ago, a child was twice as likely to die before reaching age five, seventy percent more likely to be involved in child labour and twenty percent more likely to be murdered,” the report begins. This, in itself, is encouraging. Quantified, this translates (in part) to 4.4 million fewer child deaths every year; 94 million fewer children forced into child labour; and 115 million fewer children deprived of education.
Health indicators have improved, the report suggests. “Millions of children are alive and thriving today because of medical and technological advances” brought about in the century since Save the Children first opened its doors in London in April 1919, the report states. It highlights the use of vaccines in the fight against diseases such as polio and smallpox which incurred devastating death tolls throughout the 20th century, but have since been eliminated and eradicated entirely. India has successfully eradicated both diseases (even though controversies surrounding poliovirus vaccines are ongoing).
Yet, still, Save the Children notes that one in every four children lack the experience of childhood in any meaningful sense of the word – “a time of life that should be safe for growing, learning and playing.” While progress undoubtedly has been made, more is needed to ensure the children of the world are happy, healthy, and able to realise their complete potential.
How does India fare?
In an index of 176 countries, India places 113th. Save the Children assigns each country a score between one and 1,000. Since 2000, India’s score has improved by 137 points: it scored 632 in 2000, compared to 769 in 2019. A score between 760 and 769 is indicative of some children missing out on their childhood whereas a score between 600 and 759 suggests many children are missing out on their childhood. This suggests India has fared well in improving the lives of a great number of its children. However, it is important to examine the scores and what this translates to in practise.
Measured across six health and development-related indicators, India scores as follows
Its under-five mortality rate is 39.4 for every thousand live births
Among children aged 0-59 months, the prevalence of stunting is 38.4 percent
20.2 percent of primary and secondary school-age children are out of school
11.8 percent of children aged between five and seventeen are engaged in child labour
15.2 percent of girls aged fifteen to nineteen are married or engaged
The adolescent birth rate is 24.5 for every thousand girls between the ages of fifteen and nineteen
On a seventh indicator – extreme violence, measured across two factors – the percentage of India’s population forcibly displaced by conflict is a solid zero. Meanwhile, its child homicide rate is 1.3 for every 100,000 children between birth and the age of nineteen.
“The study highlights vaccinations as an example of a major medical advancement. However, in India, outbreaks of vaccine-preventable conditions occur regularly. Every year, vaccine-preventable diseases kill 60,000 Indian children under the age of five.”
India earns particular praise from Save the Children for its progress in reducing its number of child brides. The report states that, globally, there are eleven million fewer married girls and three million fewer teen births. It is singled out along with Burkina Faso, Malawi and Sierra Leone for “recently [creating] legislation addressing the basic right of children not to be married at an early age”, indicative of a trend of empowering women and young girls which extends to “improvements in…child protection.” This, the report notes, ensures greater dignity and wellbeing for women. It is also a cost-effective measure: “investing in education programs for girls and increasing the age at which they marry can return $5 for every dollar spent.”
It cannot be denied that the health of India’s children is a subject worthy of evaluation, particularly given the multiple crises threatening it.
The study highlights vaccinations as an example of a major medical advancement. However, in India, outbreaks of vaccine-preventable conditions occur regularly. Every year, vaccine-preventable diseases kill 60,000 Indian children under the age of five. A mere eighteen percent of Indian children receive the full three-dose course of diphtheria, pertussis, and tetanus vaccine. Just one-third receive the full course of the measles, mumps, and rubella (MMR) vaccine.
In the example of measles, Health Issues India reported this year that 2.9 million Indian children missed out on the measles vaccine in the past eight years. This means India is home to the second-highest number of children unvaccinated against measles in the world, behind only Nigeria. The implication of this is being witnessed in measles outbreaks. This year, India reported 7,246 confirmed cases of measles to the World Health Organization (WHO) in just three months. This pours cold water on long-standing targets to eliminate the disease by next year.
“Inequality between the states tempered achievements such as reducing child mortality from 2.5 million deaths in 2010 to 1.2 million deaths in 2015. Poorer states record higher child mortality rates compared to their more affluent counterparts – indicative of a broader inequality crisis that plagues Indian healthcare.”
In terms of stunting, India is home to 46.6 million children afflicted with the condition. Globally, progress has been made with 49 million fewer stunted children according to the Save the Children report. India has shown progress in reducing the prevalence of the condition but its stunting burden is still high, at 30.9 percent. This reflects a malnutrition crisis which has led to India often being referred to as the world’s hunger and malnutrition capital.
Child mortality continues to be a major issue, even as India makes progress. In 2017, the under-five mortality rate had fallen by 66 percent compared to 1990. Nonetheless, the child mortality rate of 39 deaths per 1,000 live births stood higher than targets outlined under the Sustainable Development Goals (SDGs) of 25 deaths per 1,000 live births.
Earlier this year, it was reported that India topped the world rankings for child mortality in 2015. Inequality between the states tempered achievements such as reducing child mortality from 2.5 million deaths in 2010 to 1.2 million deaths in 2015. Poorer states record higher child mortality rates compared to their more affluent counterparts – indicative of a broader inequality crisis that plagues Indian healthcare. The implication is that, to meet SDG child mortality targets by 2030, a “giant leap” is needed to reduce both newborn and under-five deaths.
Even on strengthening female empowerment, India is lacking in many respects. Healthcare in the country is dogged by a significant gender gap: women in India disproportionately suffer the effects of inaccessible, poor-quality healthcare, as well as the lack of availability of contraceptive and reproductive healthcare, an ever-worsening sex ratio, and sex discrimination which incurs a considerable death toll.
Going forward, it is clear that India must capitalise upon the findings of the Save the Children report and other pieces of evidence. The report includes a number of recommendations which can help India to strengthen the health of its children. Embracing development assistance, particularly when it comes to the provision of vaccines; pursuing the empowerment of women and girls and addressing inequities in healthcare and development; and moving towards universal health coverage (UHC) are all suggested as means of making child health better and ensuring each young person can live a life where their full potential is realised and their security and welfare is ensured.
The Save the Children report, “Changing Live in Our Lifetime: Global Childhood Report, 2019” can be accessed here.