- Under 5 mortality rate in India has dropped by 72.8% between 1990 and 2019
- In last 3 decades, neonatal mortality rate has fallen by 62.1%
- Exclusive breastfeeding during first six months can prevent deaths: Experts
New Delhi: The number of global under-five deaths dropped to its lowest point on record in 2019 – down to 5.2 million from 12.5 million in 1990, according to the ‘Levels and Trends in Child Mortality’ report 2020 by the United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Lauding the decline in child deaths and asking governments to pay attention to health, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said, “The fact that today more children live to see their first birthday than any time in history is a true mark of what can be achieved when the world puts health and well-being at the centre of our response.”
On September 9, UNICEF and partners in the UN IGME released a report on the trends in child mortality rates across the world over the past three decades (1990-2019). The report highlights the scope of under-five and neonatal mortality and the progress made towards meeting the targets set under Sustainable Development Goals (SDG) by 2030.
Here Are The Top 5 Findings Of The Report On Levels and Trends in Child Mortality
- Global Decline In Under-five Mortality: Almost a 60 per cent drop in under-five child mortality was recorded. Over the last three decades, the under-five mortality rate declined fastest from 2000 to 2009. Globally, the annual rate of reduction in under-five mortality doubled from 1.9 per cent in 1990-1999 to 4.0 per cent in 2000-2009, before slowing slightly to 3.4 per cent in 2010-2019.
- India’s Under-five Mortality Rate: The under-five mortality rate (deaths per 1,000 live births) in India has dropped from 126.2 in 1990 to 34.3 in 2019. The country registered a 4.5 per cent annual rate of reduction in under-five mortality between 1990 and 2019. In terms of absolute numbers, under-five deaths in India dropped from 34 lakh in 1990 to 8.24 lakh in 2019. India still needs to work towards achieving the sustainable development goal (SDG) of reducing under-5 mortality to at least as low as 25 per 1000 live births by 2030.
- In 2019, India And Nigeria Accounted For Almost A Third Of Under-Five Mortality Deaths: The global burden of under-five deaths weighs most heavily on just two regions – sub-Saharan Africa and Central and Southern Asia. These two regions alone accounted for more than 80 per cent of the 5.2 million global under-five deaths in 2019, but they only accounted for 52 per cent of the global under-five population. Nearly half (49 per cent) of all under-five deaths in 2019 occurred in just five countries – Nigeria, India, Pakistan, the Democratic Republic of the Congo and Ethiopia. Nigeria and India alone account for almost a third of these deaths.
- World Sees A 52 Per Cent Decline In Neonatal Mortality: Neonatal mortality rate is defined as the probability of dying between birth and 28 days of age, expressed per 1,000 live births. Globally, newborn mortality is not decreasing as quickly as mortality among children aged 1 to 59 months. Since 1990, the global neonatal mortality rate declined by 52 per cent; down from 37 deaths to 17 deaths per 1,000 live births in 2019. Overall, the number of neonatal deaths dropped from 5 million in 1990 to 2.4 million in 2019.
- Despite A Drop In Neonatal Mortality Rate, India Is Far From Achieving The Sustainable Development Goal: From 15.7 lakh neonatal deaths in 1990 to 5.22 lakh deaths in 2019, India has come a long way in protecting neonates. But, India has a high neonatal mortality rate of 21.7 deaths per 1,000 live births against the sustainable development goal (SDG) of 12 deaths per 1000 live births. While in the year 1990, it was 57.4 deaths per 1,000 live births, neonatal mortality dropped to 46.4 in 1999 and 33.2 in 2009.
Study’s Observations And Recommendations On Findings
Globally, infectious diseases, including pneumonia, diarrhoea and malaria, remain a leading cause of under-five deaths, along with preterm birth and intrapartum-related complications. As per the report, access to basic lifesaving interventions such as childbirth delivery care, postnatal care, vaccinations, and early childhood preventative and curative services to address these causes is critical.
A recent analysis across 118 low-and middle-income countries (LMICs) showed that severe disruptions to the delivery of basic lifesaving interventions along with increases in wasting could result in millions of additional under-five deaths in as little as six months, alerts the findings of the report.
According to the report, meeting the SDG target on under-five mortality would save the lives of almost 11 million children. However, based on the current trends, 53 countries will miss the target for under-five mortality (25 or fewer deaths per 1,000 live births).
When it comes to achieving the target of reducing neonatal mortality, 60 countries are expected to miss the goal. Also, based on the current trends, 24 million newborns would die between 2020 and 2030, and 80 per cent of these deaths would occur in sub-Saharan Africa and Southern Asia.
Accelerating progress in approximately 60 countries to achieve the SDG target on neonatal mortality would save the lives of 5 million newborns from 2020 to 2030, states the UN report.
Suggesting ways to prevent neonatal deaths, the report states,
The focus should be on maintaining high coverage of quality antenatal care, skilled care at birth, postnatal care for mother and baby, and care of small and sick newborns to address the main causes of neonatal mortality globally. These causes are preterm birth, intrapartum-related complications (birth asphyxia or lack of breathing at birth), infections and birth defects. Safe and widespread delivery of these interventions can avert child deaths indirectly caused by COVID-19 disease through reduced access to essential health services.
Experts View On India’s Child Mortality Status
According to Dr Ketan Bharadva, President, Infant Young Child Feeding (IYCF) Chapter of the Indian Academy of Paediatrics (IAP), the improvement is encouraging but to prevent more child deaths he suggested focussing on different parameters and said,
Preventable child deaths means tackling the issues of infectious diseases with vaccination, medical care, sanitation and clean water, clean pollution free air, and nutrition. There is still a lot to be done to reach all corners of the country with all these to a tune of more than 80 per cent coverage.
Talking to NDTV about reducing under-five mortality rate, Dr Arun Gupta, Paediatrician and Central Coordinator of Breastfeeding Promotion Network of India (BPNI), emphasises on mother and child health and early breastfeeding. He said,
We need to ensure that breastfeeding happens within the first hour of the birth and a child is exclusively breastfed for the first six months. Breastmilk can prevent numerous diseases and in turn deaths. If a mother chooses formula feeding then she needs to be empowered and supported.
Dr Ketan Bharadva also highlighted the importance of breastfeeding and said,
If more than 90 per cent newborns can be breastfed within first hour of life, the neonatal mortality can still be reduced by 20 per cent more. Human Milk Banks are being promoted. Certain causes of neonatal mortality like complex congenital anomalies and inborn errors of metabolism are quite far from being overcome due to the need for hi-fi costly medical care.
According to Dr Gupta, the main cause of under-five deaths is lack of support to women. He believes India needs to ramp up efforts when it comes to promoting and educating women about breastfeeding. For the same, he recommends spending on women who are trained in nutrition, newborn care and basic hygiene. He said,
These women can take charge of 50-60 villages and mentor ASHA and Anganwadi workers and provide technical assistance.
Dr Bharadva also told that neonatal mortality essentially depends on maternal and neonatal care including nutrition of both. According to him, 500 NICUs (neonatal intensive care unit) or 1700 SNCU (special newborn care units) are too less to cover the vast population of India. He also stressed on maintaining gains in child survival through continued provision of essential health services to women and children.
Dr Sujeet Ranjan, Executive Director, The Coalition for Food and Nutrition Security (CFNS), also emphasises on the link between health of newborns and mothers and said,
In India, there has been a paradigm shift in the approach towards health care; we have adopted the Reproductive, Maternal, New-born, Child Health and Adolescent Health Strategy. New-born health occupies centre-stage in the overall strategy as all the inter linkages between various components have the greatest impact on the mortality and morbidity rates of a new-born. The approach should recognise that newborn health and survival is inextricably linked to women’s health across all life stages. It should emphasise inter-linkages between community outreach and facility-based services. Promoting equity, gender, quality of care, convergence partnership and accountability can make a big difference.
Dr Sujeet Ranjan also talked about improving the quality of foods, feeding practices, and the nutrition situation of children in the first two years of life to break the intergenerational cycle of malnutrition. He explained,
If this critical opportunity is missed, child malnutrition will continue to self-perpetuate, malnourished girls will become malnourished women, who give birth to low birth weight infants, who suffer from poor nutrition in the first two years of life. The best opportunity to break this vicious inter-generational cycle is to concentrate efforts on improving the nutrition of infants and young children from conception through the first two years of life.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.