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LATEST NEWS UPDATES | Why children remain at risk-Leela Visaria

Why children remain at risk-Leela Visaria

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published Published on Nov 23, 2012   modified Modified on Nov 23, 2012
-The Indian Express

As the 2015 target for achieving millennium development goals adopted in 1990 approaches, the time has come to take stock of various countries’ performances and identify areas that need more attention. The Unicef recently released a report which categorically stated that India will not be able to achieve the goal of an under-five mortality rate (U5MR) of 42 by 2015. The report further stated that only six of the 29 states — Kerala, Tamil Nadu, Maharashtra, Punjab, Himachal Pradesh and West Bengal — are likely to attain the goals of an infant mortality rate (IMR) of 26 per 1,000 live births and U5MR of 42 by 2015. The report has been greeted with despair, evident in the discussions on why India is not poised to achieve these goals.

One of the millennium goals set for India is to reduce the U5MR by two-thirds between 1990 and 2015, that is, from 109 in 1990 to 42 by 2015. According to the sample registration system (SRS) estimates available for 2010, the figure is 61, suggesting a decline of about 44 per cent in 20 years. With five years to go from 2010, unless the pace of decline accelerates substantially, India would be a long way from the goal.

It is important to put the situation in perspective. In 1990, both IMR and U5MR in the six states set to meet the goals were significantly lower than the national average. So for these states to reach the national goal was relatively easy. If the millennium goal for the U5MR is accepted, then Maharashtra, Punjab and Himachal Pradesh are nowhere near their individual goals of a two-thirds decline in child mortality. Kerala is a historical exception in the league of Indian states, with an IMR and child mortality similar to that of many developed countries. The declines in Tamil Nadu and West Bengal are impressive; the rest of India could learn from them when it comes to providing healthcare for the young.

States such as Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh and Orissa, with child mortality rates exceeding 125 in 1990, have a long way to go before they reach the targeted 42. The initial high levels, combined with sluggish improvement in infant and child mortality, has meant that these states are nowhere near their individual goals of a two-thirds decline. These states need to put health care measures in place and make them accessible to all in order to lower infant and child mortality.

It is important to note that besides the six states, urban areas across the country have met the millennium development goals for infant and child mortality. According to the 2010 SRS estimates, the U5MR in urban India had already come down to 32. So the good news is that for nearly 50 per cent of India’s population, the millennium goal of U5MR of 42 has been achieved. But who are the remaining children, where do they live and what ailments do they die of?

Besides rural children in most Indian states, those living in the urban areas of Madhya Pradesh, UP, Rajasthan, Bihar and Orissa also experience high mortality. Healthcare delivery in the urban areas of these states must be strengthened. The prevention and cure of ailments that cause infant and child mortality are well known, proven for their efficacy and affordable. Concerted efforts are needed to provide both treatment and preventive measures for diseases such as pneumonia, diarrhoea and tuberculosis, some of the major causes of child mortality. No child in today’s world should die from diseases preventable through vaccines. It should be the responsibility of the state to ensure that every child is immunised.

It is equally important to address the factors responsible for low birth weight, which make babies susceptible to childhood ailments. Maternal malnutrition, anaemia and the youth of the mother are some of the significant risk factors, which often operate at the household level but cannot be ignored. In addition to expanding community-based interventions or advocating newborn care at the household level, there must be regular monitoring to assess the impact of such measures.

It is well established that infant and child mortality is high among children born to mothers who belong to disadvantaged social groups. Unless concerted efforts are made to provide such groups with adequate services, the goal will remain elusive. The fact that India accounts for a quarter of the 1.7 million under-five deaths across the world, and that within India, a quarter of those deaths occur in UP must jolt us out of our slumber. The uneven progress between regions in healthcare services and delivery needs urgent attention, but any solution must factor in India’s diversity and size.

The writer is the director of the Gujarat Institute of Developmental Research, Ahmedabad

The Indian Express, 23 November, 2012, http://www.indianexpress.com/news/why-children-remain-at-risk/1034915/0


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