A JOINT study by the UNICEF and the National Institute of Medical Statistics (a division of the Indian Council of Medical Research) on the levels, trends and determinants of infant and under-five mortality has concluded that at the current pace, India is unlikely to achieve the Millennium Development Goal (MDG) targets or the child survival goals of the Twelfth Plan. This, despite there being a consistent decline in the infant mortality rate (IMR) and the under-five mortality rate. In fact, the rate of decline in the current decade has been higher than in the previous one. A worrisome finding is that there has practically been no decline in the early neonatal mortality rates, which is considered an indicator of the quality of perinatal care. It hovers around 30 per 1,000 live births.
Six States, however, are likely to reach the MDG goals: Tamil Nadu, Kerala, West Bengal, Maharashtra, Punjab and Himachal Pradesh.
The study points to a direct correlation between the years of schooling a mother has received and the chances of survival of her child. Children born to mothers with at least eight years of schooling had a 32 per cent lower chance of dying in the neonatal period and 52 per cent lower chance of dying in the post-natal period than children born to illiterate mothers.
Other determinants of child mortality are the age of marriage of women and maternal nutrition. Children born to adolescent mothers were found to be at a higher risk of dying. Neonatal mortality of children born to mothers with a low body mass index was higher than of those born to mothers with a normal BMI. The study also reveals that children born in Scheduled Castes and Scheduled Tribes were at high risk. A positive outcome has been the decline in the under-five mortality rates across economic groups. The rate of decline has been the highest among households with a low Standard of Living Index, though the reasons need to be explored further. Neonatal mortality rates (NNMR) in such households had not declined at all.
A shocking finding is the slower decline in the NNMRs for girl children. Globally, girls are known to have lower mortality than boys in the neonatal period and because of that the IMR among girls has been lower than among boys since 1981. But in recent years, a slower decline in the NNMR among girls has made the IMR of girls equal to that of boys. The diminishing of the biological advantage that girls have is a matter of serious concern.
In the context of rising food inflation, a conclusion of the report that there is evidence of reduction in social and economic inequalities over the last two to three decades is debatable.
T.K. Rajalakshmi
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