Abrogating Child Mortality in India

Mohammed Thousif Ahmed.G.

Software Application(B.sc), Thiruthangal Nadar College
Selavayal_600 051, Tamil Nadu, India.
tahmed98@yahoo.com

Abstract—The objective of the paper is to focuses on
infant and child mortality in India and we propose a
flexible duration system to decline child mortality rate
and betterment in individual, socio economics and
environmental characteristics. Childhood is a
significant stage of life and deprivation during this
period can have a long-term adverse impact on the
wellbeing of children. Reduction in infant and child
morality is likely the most important of the millennium
development goals, as children are the most important
assets of a nation. child mortality can be reduced
substantially, particularly by improving the education
of women, provide a skilled birth attendant in the
community for the women, preventing malnutrition
can reduce mortality from several diseases
simultaneously. Efforts to promote even modest
nutritional improvements such as small changes in
feeding behavior will also have a beneficial impact on
mortality rates over time. However, the present study
Documents show the slowing decline in infant mortality
rates in India; a departure from the longer-term
trends. The major causes of childhood mortality are
also reviewed and strategic options for the different
states of India are proposed that take into account
current mortality rates and the level of progress in
individual states. The slowing decline in childhood
mortality rates in India calls for new approaches that
go beyond disease, programme and sector-specific
approaches.
However, recent data indicate that the decline in
child mortality rates is slowing. In this study we
examine, inter alia, the trend in infant mortality rates
since 1981. The data support the hypothesis that the
decline in child mortality rates is slowing, and we
suggest factors that could be important when
formulating child health. Policy in India over the
next decade The key objective of our model is to
identify the relevant mortality determinants at
different ages of a child, which is important for
designing effective public policies for reducing child
mortality. We are particularly interested in
socioeconomic and environmental characteristics,
such as mother’s education, source of drinking
water, sanitation facility, type of cooking fuels,
access to electricity, and availability of medical
services. In low-income countries these health inputs
absorb a large share of the household expenditure
(Pritchett and Summers 1996). Our empirical model
can be used to identify households with high child
mortality risks, which can be useful for targeting
resources and policy towards such house-holds. We
also provide some indication of the health benefits of
possible public programs targeted at improving
household’s health related resources.

Keywords—infant and child mortality, socio economics Ι Ι. INFANT MORTALITY RATE (IMR)
and environmental characteristics, low birth weight, In India, approximately 1.72 million children
malnutrition, education of women, skilled birth die each year before reaching their first birthday.
attendant.
Infant mortality has declined significantly in India
from 129 in 1970 to 68 in the year 2000 Fig.3.
Ι . INTRODUCTION Though, the Infant Mortality Rate (IMR) is
decreasing at an annual rate of 2.11 per cent from the
In 1998, about 2.5 million under-5-year-olds
early seventies, the decadal rate (compounded
died in India, the highest total of any country (1).
annually) is decreasing at a slower rate when
India’s health goals for the year 2000 included
compared between 1981-91 and 1991- 2001. The
reducing the national mortality rate for children
slow pace of education in the IMR is a major worry
under 5 years of age to less than 100 per 1000 live
for the country’s development. To that extent its
births; the infant mortality rate to less than 60 per
performance when compared to other Southeast and
1000 live births; and the parental mortality rate to
East Asian countries is poor. While the expected fall
less than 85 per 1000 live births. Between the mid-
in IMR is at 47 based on the current rate, it is still
1980s and early 1990s, significant progress was
above the millennium development goal of 28 per
made toward these goals and national targets
1000 live births by 2015.
appeared to be within reach, despite large disparities
in mortality levels, rates of decline and child health
determinants among the various Indian states.
 The Indian government has expressed a
strong commitment towards education for all,
however, India still has one of the lowest female
literacy rates in Asia. In 1991, less than 40 percent of
the 330 million women aged 7 and over were literate,
which means today there are over 200 million
illiterate women in India. This low level of literacy
not only has a negative impact on women’s lives but
also on their families’ lives and on their country’s
economic development. Numerous studies show that
illiterate women have high levels of fertility and
Source: Source: World Bank 2004, mortality, poor nutritional status, low earning
Fig 1: Infant Mortality Rate (IMR) potential, and little autonomy within the household.
The country has observed a continuous decline in A woman’s lack of education also has a negative
IMR. It stood at 192 during 1971, 114 in the year impact on the health and well being of her children.
1980 and 58 in 2005. The decline in IMR has been For instance, a recent survey in India found that
noticed both for the male and female child during the infant mortality was inversely related to mother’s
period. However, the rate of decline is more educational level .
pronounced in the case of male as compared to
female (Table 1).
Country Adult literacy Youth literacy
YEAR Infant Mortality Rate Infant Mortality Rate rate rate
by Sex by Rural-Urban
( Per 1000 live births) (Per 1000 live births) China 93.3 98.9

Mal Femal Total Rural Urba To Sri lanka 90.8 98.0

e e n tal
Burma 89.9 94.4
1980 113 115 114 124 65 11
4 india 66 82
1985 96 98 97 107 59 97
1990 75 81 80 86 50 80 Table 2: statistics of literacy rate among several countries
1993 73 75 74 82 45 74
Additionally, the lack of an educated population can
1996 71 73 72 77 46 72 be an impediment to the country’s economic
2000 67 69 68 74 43 68 development. The Indian government’s commitment
2003 57 64 60 66 38 60 to education is stated in its constitution with an
article promising “free and compulsory education for
2005 56 61 58 64 40 58
all children until they complete the age of 14” (The
Source: Ministry of Health and Family Welfare, 2007. World Bank, 1997b).
Table 1: Infant Mortality Rate by sex and by residence
Youth
literacy
On account of child health interventions, rate
india
Burm a
the infant mortality rate in the country has gone
Sri lanka
down from 114 in 1980 to 58 in 2005. While looking Adult
China
at the IMR of the country, it is observed that there is literacy
rate
a continuous decline both in rural as well as in urban
areas although urban areas of the country are 0 50 100 150
bserving rapid decline in IMR as compared to rural
areas attributing this change to better health care
facilities easily accessible in urban areas.

Fig 2: statistics of literacy rate among several countries

The National Policy on Education, which was

updated in 1992, and the 1992 Program of Action
III.EDUCATING WOMEN
both reaffirmed the government’s commitment to
improving literacy levels, by providing special
attention to girls and children from scheduled castes
and scheduled tribes.
“Three Out of Five Girls Attend School Versus
Three Out of Four Boys”
Women education in India is quite complex because
of the following factors
1. Gender Gaps in University Education
2. Inadequate School Facilities
3. Barriers to Education
4. Gender Bias in Curriculum Still Exists
Although literacy rates in India are low, there
has been a concerted effort to encourage girls to
attend school, which should lead to higher literacy
rates in the future. In 1992-93, 75 percent of boys
and 61 percent of girls aged 6 to 10 years were
attending school. As with literacy measures, there
are large differences in school attendance by state. In
six states, over 85 percent of girls aged 6 to 14 were
attending school. Not surprisingly, these states also
had female literacy rates that were above the national
average. In all states except Bihar, Rajasthan, and
Uttar Pradesh, more than half of the girls aged 6 to
14 were attending school. Although Bihar has the
lowest enrollment for both boys and girls, there was
still a large gender gap, with only 38 percent of the
girls attending school compared to 64 percent of the
boys (International Institute for Population Science
IV.MALNUTRITION
The nutritional status of women and children is
particularly important, because it is through women
and their off-spring that the pernicious effects of
malnutrition are propagated to future generations. A
malnourished mother is likely to give birth to a
lowbirth- weight (LBW) baby susceptible to disease
and premature death, which only further undermines
the economic development of the family and society,
and continues the cycle of poverty and malnutrition.
Although child malnutrition declined globally during
the 1990s, with the prevalence of underweight
children falling from 27% to 22% (de Onis et al.,
2004a), national levels of malnutrition still vary
considerably (0% in Australia; 49% in Afghanistan)
(WHO, 2003). The largest decline in the level of
child malnutrition was in eastern Asia where
underweight levels decreased by one half between
1990 and 2000. Underweight rates also declined in
south-eastern Asia (from 35% to 27%), and in Latin
America and the Caribbean the rate of underweight
children decreased by one third (from 9% to 6%)
over the last 10 years. In contrast, south-central Asia
still has high levels of child malnutrition, even
though the rate of underweight children declined
from 50% to 41% during the 1990s. In Africa, the
number of underweight children actually increased
between 1990 and 2000 (from 26 million to 32
million), and 25% of all children under five years old
are underweight, which signals that little changed
from a decade earlier. The projection for 2005 is that
the prevalence of child malnutrition will continue to
decline in all regions but Africa, which is dominated
by the trend in sub-Saharan Africa
V. HIGH-RISK FERTILITY BEHAVIOUR
Mother’s age at birth, birth order, and the interval
between births have a strong influence on infant and
child mortality. In theory, parents can increase the
chances of their children’s survival by controlling
these proximate determinants. For the purpose of the
present analysis, a birth is classified as high risk if it
has one or more of the following characteristics: (i)
mother’s age is less than 18 years, (ii) mother’s age
is more than 34 years, (iii) previous birth interval in
less than two years, and (iv) birth order is more than
three. the percentage of births and the percentage of
currently married women that fall into different child
survival risk categories. It also shows the relative
magnitude of each risk and different combinations of
risks.
death associates with malnutrition
hiv
4%
measles
ari
5% hiv
18%
diarrhoea
measles
15% diarrhoea
others
malaria
malaria
perinatal
25%
10%
others
perinatal ari
23%
Fig:3 death associates with malnutrition
A total of 46 percent of births in the last five years
are in an avoidable risk category These births have
nearly twice the risk of dying as births that are not in
any high-risk category. Forty percent of currently
married women fall in an avoidable risk category.
The avoidable risk category is further subdivided
into two groups that are associated with either single
or multiple high-risk behaviours. Thirty-five percent
of the births and 23 percent of currently married
women are in a single high-risk category that has an
elevated risk of 72 percent. Eleven percent of the
births and 17 percent of currently married women are
in a multiple high-risk category, which has an
elevated risk of 182 percent. Thus, infant and child
mortality can be reduced substantially in India by
postponing marriage and using contraception to
space and limit births.
VI. OPTIONS FOR REDUCING BARRIERS TO
CHILD MORTALITY
Gaps & barriers Possible policy options:
in child
mortality:
1. Focus attention on states with
1. The IMR high U5M levels and/or poor
performance elative performance and/or a
gaps reduction in IMR declines.
evelop state specific strategies
(including advocacy, incentives
strategies, and increased
mmitment among stakeholders).
2. Apply managerial approaches
at the tate level to identify the
main lementation ottlenecks in
the ealth system and the most
critical and feasible solutions.
3. Introduce more efficient,
integrated strategies for
prevention and anagement of
hildhood illness at the
community and facility levels.
1. Introduce or hance integrated
2. The approaches to childhood illness
neonatal with emphasis on neonatal care
/perinatal and referral services.
determinants
2. Introduce or expand a
standard approach to the
management of pregnancy and
safe delivery; develop strategies
for how to increase demand for
and use of antenatal services and
access to safe deliveries.
1. Improve female education and
3. The maternal nutrition and increase use of
determinants health services before, during
and
after pregnancy and delivery.
2. Expand successful
eproductive health initiatives and
evelop feasible strategies for
increasing antenatal and delivery
services.
4. The gender 1. Provide supplemental feeding
gap and basic health services to all
children, with particular
attention to young girls.
VII. CONCLUSION
The “maternal and child health and nutrition cycle”
approach recognizes that:
1. Maternal health and nutrition outcomes are
key determinants to birth outcomes;
2. birth outcomes are key determinants for
child mortality, health, and development
outcomes; 3.Childhood health, nutrition and
development outcomes are key
determinants for adolescent health,
nutrition, and development;
3. adolescent health influences maternal
mortality, health, and nutrition outcomes;
and,
4. The cycle continues.
Socioeconomic, environmental, behavioral, health,
and nutrition factors influence this cycle (Simon,
1999). The challenges for the child health and
development community in the next decade Will be
to jointly address the most important determinants
and gaps with affordable, cost-effective, feasible,
and culturally appropriate interventions that take into
account both demand and supply factors, and to
involve local communities in the identification of
needs and priorities. child health policies are needed
that take into account state-specific epidemiological
and demographic patterns and key determinants. [6]. Frongillo EA Jr., de Onis M, Hanson KMP (1997).
Socioeconomic and demographic
Such policies might include the following. factors are associated with worldwide patterns of stunting and
wasting of children. Journal of Nutrition, 127:2302−2309.
States with high U5M/IMR levels and slow rates of
decline need to: [7]. Gomez J, Ramos GR, Frenk S, Cravioto J, Chavez R,
Vazquez J (1956). Mortality in
1.Address priority maternal and child health second and third degree malnutrition. The Journal of Tropical
problems through strengthening of health systems Pediatrics, 2:77−83.
(including availability of drugs, monitoring and
surveillance); [8]. Johns T, Eyzaguirre PB (2000). Nutrition for sustainable
environments. SCN News,
2. Prioritize the essential elements of child health 21:25−29.
and nutrition services, including strengthening of the
immunization program and other preventive [9]. Pelletier DL (1994). The relationship between child
measures, as well as integrated approaches to clinical anthropometry and mortality in
developing countries: implications for policy, programs and future
management: ARI, malnutrition, diarrhea, and fever; research.
3. Develop and expand community prevention and Journal of Nutrition, 124(Suppl. 10):2047S−2081S.
treatment of childhood illnesses (including
strengthening of care seeking, compliance and
preventive behaviors at household level).
States that have reached lower levels of U5M/IMR
but are also experiencing a slowdown in U5M/IMR
reduction, need to:
4. sustain all of the programs outlined above;
5. emphasize improved referral services (including
obstetric emergencies);
6.emphasize effective strategies for
perinatal/neonatal mortality reduction (including
Comprehensive reproductive health services and
improving women’s nutritional status);
7. Implement early child development programs.
States with large proportion of urban poor need to:
8. Include policy options for innovative approaches
to heath services delivery, including increased
Access and use of quality services provided by
private providers and NGOs.

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