Editorial: More than baby steps required

One more health-status indicator has recently been published, and as expected, India brings up the rear. Despite reducing under-five mortality from 2.5 million in 2001 to 1.4 million in 2012, India still holds the dubious distinction of having the highest number of deaths in the world in this vulnerable age group — 22 per cent. Further, the 2013 UNICEF report on infant mortality highlights our notorious track record. Of the 2.1 million deaths in the entire southern Asian region, India’s share alone is 1.4 million deaths. Being highly populous cannot be cited as a reason; the death rate, which refers to the number of deaths per one thousand live births, is much higher in India than a few South Asian countries. In 1990, Bangladesh and Nepal had death rates of 144 and 142 respectively, compared with 196 in India. But these two countries have performed dramatically by bringing down the rate of deaths to 41 and 42 respectively, and, as a result, surpassed India’s (56) in 2012. Even as these two countries are quite close to achieving the 2015 Millennium Development Goal for under-5 mortality (of less than 38 deaths per one thousand live births), India would be able to reach that distant goal only in the mid-2020s. Unlike India, these two countries are reaping the benefits of heavy investments they made in health-care systems in the last two decades. One need not look outside for lessons. By emulating the Tamil Nadu model, which has well equipped public health centres manned by doctors and well-trained staff present round the clock, India can beat down the under-five mortality rate.

Two-thirds of neonatal deaths occur in just 10 countries, and India accounts for more than a quarter of those. The well-being of the mother and the newborn in the first 24 hours is very critical. Nearly half of all newborn deaths globally occur during this time. With over three lakh newborn deaths, India ranks number one in terms of death on the very first day of birth. One of the major reasons for neonatal deaths is a lack of good delivery practices resulting in prolonged labour. This, in turn, results in birth asphyxia, the single-most important cause of mortality; even in Tamil Nadu, 16 per cent to 18 per cent of neonatal deaths are caused by this. Childhood anaemia is another critical area that needs immediate attention. Anaemia during the early years of life leads to repeated respiratory infection and makes the child more prone to diarrhoea. Even while steps are taken to address health issues, open defecation and the lack of clean drinking water — both of which have a direct link to the health of children — have to be tackled on a war footing.

Published in The Hindu on September 26, 2013