“Thirty years ago, the world made a commitment to protect and fulfil children’s rights as enshrined in the Convention on the Rights of the Child. Among the most fundamental of these rights is the right of every child to survive.” So reads the introduction of the latest Levels and Trends in Child Mortality, a joint report of UNICEF and the World Health Organization (WHO), lending an insight into child and maternal mortality worldwide.
The news, in part, is good: there are fewer child and maternal mortality deaths, with child mortality rates being halved and maternal mortality declining by a third since the turn of the century. However, there is still one death every eleven seconds among newborns and pregnant women – translating to 6.2 million deaths of children before the age of fifteen worldwide in 2018 and 295,000 women’s deaths during pregnancy and childbirth in 2017.
Child deaths are overwhelmingly accounted for by the deaths of children under the age of five: 5.3 million such lives were lost, of which almost half occurred in the first month. India is a world leader in these figures: it is one of just five countries which accounted for fifty percent of under-five deaths in 2018, the others being the Democratic Republic of the Congo, Ethiopia, Nigeria, and Pakistan. In fact, India and Nigeria alone accounted for one-third of under-five deaths that year.
“Significant numbers of India’s children and mothers are dying…no matter the reduction, it is clear that child and maternal mortality is still a public health challenge necessitating a robust response.”
This is not to say India has not made progress. As the report points out, India’s under-five mortality rate is 37 deaths per 100,000 births as of 2018; in 1990, the figure stood at 126 deaths per 100,000 births. This translates to an annual reduction rate of 3.5 percent. Its neonatal mortality rate has declined also, from 57 deaths per 100,000 live births in 1990 to 23 deaths per 100,000 live births in 2018.
Nonetheless, significant numbers of India’s children and mothers are dying. 882,000 children under five and 143,000 children between the ages of five and fifteen died in 2018. No matter the reduction, it is clear that child and maternal mortality is still a public health challenge necessitating a robust response.
“Most children under five die due to preventable or treatable causes such as complications during birth, pneumonia, [diarrhoea], neonatal sepsis and malaria,” UNICEF notes. Interventions such as sanitation and immunisation can address some of these issues. In India, efforts are underway to improve these indicators such as the Swachh Bharat Abhiyan (Clean India Mission) to address poor sanitation – including in healthcare facilities – and the Universal Immunisation Programme to foster vaccination, immunising against conditions such as rotavirus.
Yet there are still miles to go. Vaccine-preventable diseases kill almost 60,000 children under five every year. Diseases such as malaria, sepsis and diarrhoeal diseases continue to incur a high death toll among the country’s children. And while Swachh Bharat has led to improvement in sanitation standards and increased access to toilet facilities, issues remain including “improper treatment of waste to poorly functioning toilets to the continued reliance on manual scavengers.” In an index of 180 countries ranked on their performance on sanitation last year, India secured the 145th spot.
“India’s progress on child and maternal health is reason to celebrate, but not to be complacent…Accelerating rollout of interventions such as vaccines, affordable healthcare, nutritional support, and sanitation among others are needed – and India must take note of such recommendations, for the sake of its mothers and its children.”
For India, malnutrition is a major issue when it comes to child and maternal health. Malnutrition was responsible for almost seventy percent of child deaths in the country in 2017 – 706,000 child lives were lost in total. The country registers a high prevalence of conditions such as stunting, anaemia, and wasting which hinder progress towards ensuring child development. Anaemia is common among women of reproductive age. These issues are exacerbated by inequalities between states when it comes to their performances on child health, with progress varying between states and union territories at different levels of economic development.
India’s progress on child and maternal health is reason to celebrate, but not to be complacent. “The unfinished business of ending preventable child deaths looms large,” the report notes. Accelerating rollout of interventions such as vaccines, affordable healthcare, nutritional support, and sanitation among others are needed – and India must take note of such recommendations, for the sake of its mothers and its children.
“Millions of babies and children should not still be dying every year from lack of access to water, sanitation, proper nutrition or basic health services,” asserts Dr Princess Nono Simelela, Assistant Director-General for Family, Women and Children’s Health at WHO. “We must prioritize providing universal access to quality health services for every child, particularly around the time of birth and through the early years, to give them the best possible chance to survive and thrive.”
“Levels and Trends in Child Mortality 2019” can be accessed here.