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Resource centre on India's rural distress
 
 

‘India lags in mom, child mortality fight’ by Subodh Varma


At the beginning of this millennium in year 2000, 189 countries and 23 international health agencies had pledged to reduce child under-5 mortality by two-thirds and maternal mortality by three-fourths by 2015. These were called the Millennium Development Goals (MDGs) number 4 and 5. With only five years left for the target year, a clutch of international health agencies and NGOs have come out with ‘‘Countdown to 2015 — Decade Report (2000-2010)”.

The report, which tracks progress made on these fronts, says that out of 68 priority (countdown) countries accounting for more than 90% of maternal and child deaths worldwide, only 19 countries were on track to meet MDG 4; 17 countries had reduced child mortality by half, while 47 countries had accelerated their progress on child mortality since 2000. At the same time, 49 countries are not on track to achieve MDG 4, while 12 countries (including some currently on track) have seen their progress slow since 2000. But reduction of maternal mortality (MDG 5) is showing fewer signs of progress, according to the report.

Set to appear in this week’s special issue of The Lancet, the report tracks 26 key parameters that determine infant mortality over a period of nearly two decades between 1990 and 2008. Across the 68 countries, child under-5 mortality fell from 90 deaths per 1,000 live births in 1990 to 65 in 2008, a 28% reduction.

Brazil and China are among the 19 countries that have averaged a rate of 4.4% reduction in under-5 child mortality since 1990, needed to meet the target in 2015. Brazil has made progress through reducing socioeconomic inequities and improving primary coverage to almost universal levels. China’s successful reduction of newborn and child mortality during the past two decades is a result of steady investments in reproductive health, primary care, and economic development. Other countries on track include Mexico, Peru, Nepal, Egypt, Malawi, and Turkmenistan.

India’s rate of under-5 mortality fell from 169 in 1990 to 69 in 2008, averaging an annual rate of decline of just 2.9%. This puts India firmly in the insufficient progress category. During the first decade of 1990 to 2000, infant mortality declined by just 2.1% annually in India, but it increased to 3.9% annual decrease between 2000 and 2008. Other countries in this category include Pakistan, Myanmar, Nigeria, Ethiopia, Iraq, Ghana and several other African countries.

A handful of countries have shown an increase in infant mortality rates over the period. These include Chad, Congo, Kenya, Zimbabwe and surprisingly, South Africa.

The report is pessimistic about reduction in maternal mortality saying that although coverage of skilled-delivery care increased in 12 countries, others had little or no improvement.

According to lead authors — Professor Zulfiqar Bhutta of Aga Khan University in Pakistan and Dr Mickey Chopra, UNICEF, New York, USA — coverage of interventions delivered directly in the community on scheduled occasions was higher than for interventions relying on functional health systems. Examples of such community interventions include vitamin A supplementation; vaccination against tetanus, whooping cough and diphtheria, and complementary feeding.

Services such as skilled attendant at birth, postnatal visits, antibiotic treatment continue to be the major obstacles to progress. Latest estimates from 2008 show that only 22% of the 68 countries met the WHO standard of 23 physicians, nurses, and midwives per 10,000 people needed to deliver essential health services.