Despite significant progress in recent years, India continues to have considerable issues with child mortality. Issues such as low birth weight cause high death rates among newborns. Meanwhile, the country’s under-five mortality rate is the highest in the world.
Northern areas of India, especially those with high ethnic minority populations, seem to have a persistent problem with high neonatal and infant mortality. However, different studies point to very different levels in neighbouring, broadly comparable districts.
Infant mortality, poverty and nutrition
A major factor believed to influence the rate of infant mortality is poverty. Official estimates place 21.9 percent of Indians below the poverty line (BPL). Other estimates take into account that 67 percent of the population benefit from a government scheme to provide heavily subsidised wheat and rice to those in poverty.
This may indicate that a large portion of the population is only technically considered above the poverty line due to subsidised food expenditure. With mainly simple carbohydrates providing the bulk of the diet provided, the nutritional value of the individual’s diet is very low.
Authors of the Million Death Study suggest low birth weight is the leading cause of neonatal death, which drives up the under-five mortality rate. Low birth weight can be caused by many factors. Foremost among these are poor nutritional intake during pregnancy and a lack of healthcare, both before and during the birth. These risk factors tend to affect BPL populations.
These issues are often more prevalent in rural areas, where access to healthcare is minimal. A unique start-up, created by M Senthil Kumar, a tech worker based in Madurai has set out to address this issue. The creation of the start-up is a kit — named SaveMom — that can monitor several vital health parameters of pregnant women in remote rural villages, all the while sending the data back as a live feed to the relevant health professionals. Such innovations by Indian start-ups could be invaluable to reducing infant mortality.
Obesity and malnutrition
The high numbers of malnourished individuals is sharply contrasted by the rise in western-style junk food in India’s urban areas. Rather than causing complications due to low weight, obesity is becoming a crisis in India. Malnutrition is a concept typically applied to those that do not eat enough. However, an individual can be both obese and suffer from malnutrition. While calorie consumption may be high, nutrient intake from junk food is low, and so the individual may be malnourished in a sense that they lack a certain mineral or vitamin.
Poverty and maternal healthcare
A UNICEF report notes that ‘newborn deaths are difficult to address with a single drug or intervention – they require a system-wide approach.’ It identifies ‘increasing access to affordable healthcare’ and ‘improving the quality of that care’ as being ‘critical’. In India, there are great disparities in the levels of access to healthcare. This is notable between urban and rural regions of the country and between states at different levels of economic development.
Madhya Pradesh is often identified as an example of an area of lacking healthcare infrastructure. Around 24 million people – roughly a third of the state’s population – live BPL. 21 percent of the population are tribal and seventeen percent are part of the scheduled caste population. Madhya Pradesh Principal Secretary for Women and Child Welfare JN Kansotia has claimed that targeting these isolated communities could alleviate the high infant mortality rate within the state.
The State of the World’s Mothers – Save the Children Report states that, “If all newborns in India experienced the same survival rates as newborns from the richest Indian families, nearly 360,000 more babies would survive each year.” It also states that India has the highest number of maternal deaths a year, though this is calculated by total number rather than as a percentage of the population.
Lack of access to healthcare both during and after the pregnancy can have severe consequences to the health of the child. Without regular check-ups, the health of both mother and child are at risk. This is worsened by the lack of medical assistance during the birth itself. In isolated rural areas with limited access to healthcare, this is a common occurrence.
Simple interventions such as feeding a newborn with breast milk within 6-8 hours of birth is essential as it was found to potentially reduce the infant mortality rate by over 10% annually. This was revealed by a study conducted by the National Family Health Survey (NFHS-3) in 2011.
Study: Capital of India has highest infant mortality rate among other metros
A 2012 survey found that Delhi has the highest infant mortality rate of the then-four Indian metros. The report, titled ‘Ending Newborn Deaths, Ensuring Every Baby Survives’ was released by Save the Children. It states that Delhi’s infant mortality rate (IMR) was as high as thirty out of every thousand live births. Delhi’s IMR is higher than those of Mumbai (20), Chennai (15) and Kolkata (20). According to data from 2012, of the children who died before their first birthday in Delhi, 64% died within the first 28 days of their birth.
By 2014, data suggested the rate of infant mortality in Delhi had been reduced to twenty deaths per thousand live births. However, this downward trend appeared to be negated by data in 2015 suggesting an increase to 23 per 1000 births.
Air pollution and child mortality rates
India’s children are at severe risk of health issues due to air pollution.
Around 93 percent of children globally are regularly exposed to air pollution levels considered dangerous to their health. This is according to a report published by the World Health Organization (WHO). Such data suggests the dire prospect that the overwhelming majority of children on a global level are at elevated risk of developing a number of noncommunicable diseases (NCDs) that can be caused or exacerbated by air pollution.
In India’s metropolises the air pollution rates hold most of the top global positions for air pollution levels. Even rural environments often have high localised levels of air pollution due to factors such as crop burning and indoor wood stoves. High levels of pollution are exposing India’s children to risks that may not contribute to mortality in early life, but can cause lifelong conditions that may significantly reduce their life expectancy.
India’s infant mortality rate continues to fall
In 2017 it was revealed that India’s under five mortality rate had fallen by 66 percent since 1990. This is a considerable amount of progress, though still falls short of current goals. Currently the mortality rate stands at 39 deaths per 1,000 live births, far higher than the SDG of 25 deaths per 1000 births.
India has shown consistent reductions in mortality on a year by year basis, making the SDG goal a very real possibility in future years. In February 2012 India’s infant mortality rate (IMR) was found to have dropped by three points from 50 to 47 infant deaths per 1000 live births during 2010. The information was derived from the Sample Registration System (SRS) bulletin, December 2011 released by the Registrar General of India (RGI).
This shows that year upon year India is making strides towards reducing infant mortality. These reductions, however, are not even across all states, with some falling far behind others in the progress being made.
Madhya Pradesh has the highest under-five mortality rate of all states and union territories. “Despite efforts of the state government, the rank of Madhya Pradesh as compared to other states and Union territories has virtually remained unchanged over last 40 years,” said Alok Ranjan Chaurasia, a former professor of Institute of Economic Growth in Delhi.
Prevention and the need for vaccination
Around 3.6 million episodes of the disease occurred in children under five over the course of a year in India. This was revealed during the last large scale study of under five pneumonia, conducted in 2010. More recent records indicate 178,717 children below the age of five died due to pneumonia .Separate studies have also shown that three in twenty children carry the streptococcus pneumoniae bacteria, one of the most common causes of the infection. Pneumonia rates can be reduced considerably through the use of vaccination, this would in turn limit the capacity of the disease to contribute to the infant mortality rate.
The potential for vaccination to reduce infant mortality has already been demonstrated time and time again. Polio is the most clear example of this, its elimination in India sparing countless children from disability, or, in its worst case, fatality.
Measles cases have also been significantly reduced by vaccination drives. Between 2000 to 2015 the number of infant deaths associated with neonatal tetanus and measles fell by at least 90 percent. However, immunisation coverage in many areas remains low. This limits the benefits the entire population receive from vaccination.
Vaccination in India is run on a state by state approach, some states are taking it into their hands to ensure children are vaccinated. Kerala is to introduce a new policy that would require all children starting school to show that they have been vaccinated. Health Minister K K Shailaja claimed the move would fortify the health sector and make progress towards higher immunisation rates within the state. The state’s cabinet approved a draft of the new medical policy on Tuesday, February 20.
Similar policies are being implemented in Uttarakhand. Immunisation rates in the state fell by more than thirty percent in two years. Now the state is using stringent measures to drive immunisation rates upwards. Immunisation coverage fell to just 61.32 percent of children aged nine to eleven months in 2017-18. This was down from 99.3 percent coverage in the 2015-16 period. Due to this it has become mandatory by law that children are vaccinated before being admitted to schools, for fear of spreading otherwise preventable infections.
The future of infant mortality
With the anticipated “Modicare” — India’s potential new health insurance scheme — on the horizon, infant mortality rates could potentially alter significantly. The National Health Protection Scheme (NHPS) seeks to provide healthcare coverage to around 100 million economically vulnerable households.
The scheme will require a significant degree of funding, as it is on a scale that is entirely unprecedented, attempting to grant healthcare assistance to a population larger than most countries. The policy may potentially allow for far better healthcare for both expectant mothers and their children, however, one significant factor is overlooked.
The NHPS includes few provisions to tackle one of the most prevalent issues affecting Indian healthcare; infrastructure. While health insurance may be available to many in poverty following the release of Modicare, this does not guarantee them access to a doctor or healthcare facility. As such, the impact the scheme will have on infant mortality in India is entirely speculative, with benefits possibly being limited to urban areas.