Child Mortality

Child Mortality: Though the current Child Mortality rate dropped by 59% since 1990, from 93 deaths per 1000 live births in 1990 to 38 in 2021, Child Mortality is still one of the major challenges to the World. According to the Latest data for 2020, the Child Mortality rate of Somalia is 114.6%, leading top in this list, followed by Nigeria (113.8%), and Chad (110%). Among the continents, the Child Mortality rate of Africa is the highest in the world at 74 deaths per 1000 live births, and it is 14 times higher than the total Child Mortality rate of Europe and North America.

In this article, you will read about child mortality, its causes, steps to handle it, and the child mortality rate in India.

What is Child Mortality?

Child mortality refers to the death of infants or young children before reaching a certain age, typically measured as the number of deaths per 1,000 live births in a given population. It is a crucial indicator of a society’s health and well-being, often expressed as the under-five mortality rate, which calculates the probability of a child dying before the age of five. Child mortality rates are influenced by factors such as access to healthcare, nutrition, sanitation, and socioeconomic conditions. Reducing child mortality is a global public health goal.

Child Mortality Rate Definition

Child Mortality Rate, also known as Under-5 Mortality Rate, refers to the number of deaths of children under the age of five per 1,000 live births in a given year or a specific period.

Child Mortality Rate in India

As per the Lancet Global Health Survey 2000 – 2015 in India there were 25·12 million live births and out of that ‘1·20’ million under-5 deaths occurred (the mortality rate was 47·81 per 1000 live births). There was a distinct difference in child mortality, from 29·7 deaths per 1000 live births in the southern region to 63·8 deaths in the northeast.

Causes of Child Mortality (Under 5)

In India, the leading causes of child mortality are often related to preventable factors. Common contributors include:

• Malnutrition: Inadequate access to proper nutrition can lead to stunted growth and increased vulnerability to diseases.
• Infectious Diseases: Diseases like pneumonia, diarrhea, and malaria remain significant contributors to child mortality, often exacerbated by poor sanitation and lack of access to healthcare.
• Lack of Immunization: Preventable diseases like measles and polio can lead to child mortality if vaccination coverage is inadequate.
• Poor Maternal Health: Complications during pregnancy and childbirth can impact the health of both mothers and newborns.
• Limited Access to Healthcare: Insufficient access to quality healthcare services, particularly in rural areas, can delay or prevent timely medical interventions.

Addressing these factors requires a comprehensive approach involving healthcare improvements, nutritional interventions, vaccination campaigns, and increased access to quality healthcare services. The two most significant causes of death were premature birth complications and pneumonia. While Diarrhoea was the third leading cause in the Northeast region which had the highest under-5 mortality.

State-wise Child Mortality Rate in India

• Half of all under-5 deaths occurred in three states: Uttar Pradesh, Bihar, and Madhya Pradesh. 
• Assam had the highest under-5 mortality rates with 73.1 per 1,000 live births, Madhya Pradesh (67.1 per1000 livebirths), and Odisha (64·1 per 1000 livebirths), on the other hand, the lowest rates were in Goa (9·7 per 1000 livebirths), Kerala (12·5 per 1000 live births) and Tamil Nadu (21·7 per 1000 live births).

According to UNICEF Neonatal Mortality rate (NMR) globally in 2018 was 18 deaths per 1000 live births while in India it was 23 deaths per 1000 live births so per day approximately 7000 newborn deaths.
It is a global concern that the NMR is declining at a very slow pace.

Worldwide substantial measures have been taken to control the Child mortality rate. As a result, the global under-5 mortality rate has dropped by 60% since 1990, from 93 deaths per 1000 live births in 1990 to 37 in 2020. However, out of 5 million Child mortality under 5 years globally in 2020, Nigeria and India solely account for almost one-third of all deaths.

Infectious diseases, pneumonia, diarrhoea and malaria, pre-term birth complications, birth asphyxia and trauma, and congenital anomalies remain the leading causes of death for children under 5 years. India needs to understand, the major cause of concern and evaluate carefully the complications involved in providing health services to secluded interior regions.

To combat Child Mortality, it is important to incorporate basic lifesaving infrastructures such as skilled delivery at birth, postnatal care, breastfeeding and adequate nutrition, access to vaccine-preventable deaths, reduce geographical disparities, and treatment for common childhood diseases. 

Steps Taken by the Government to Tackle Child Mortality

Considering India’s highest mortality rate in 1997 the Indian government designed the Reproductive and Child Health (RCH) programme under the National Health Mission (NHM) to reduce infant, child, and maternal mortality. 

• The Reproductive and Child Health (RCH – I) Programme 1 was launched on 15th October 1997. 
•  The second phase of the RCH programme 2 (RCH – II) was launched on 1st April 2005. 
  It was launched with three main objectives 
  • To Reduce the overall fertility rate
  • Control Infant mortality rate 
  • Stop the maternal mortality rate 

• The National Population Policy (NPP) of the year 2000 included frameworks for reducing the infant mortality rate to below 30 per 1000 live births. Then in the year 2002, the eradication of polio by 2005 and reducing maternal mortality rate to 100 by 2010 were in the schedule of National Health Policy 2002. 
  In the tenth five-year plan (2002-2007) target was set to bring down the Infant Mortality rate (IMR) from 91 per thousand live births to 45, minimise the Maternal Mortality Rate (MMR) to 2 per thousand lives birth, and reduce the child mortality rate to 90 during the plan period. 
• And the 11th five-year plan (2007-2012) included schemes to reduce Infant Mortality Rate (IMR) to 28 per 1000 live births. It also addressed the issue of malnutrition among children of age groups 0–3.
• The twelfth Five-Year Plan (2012-17) covered the ongoing concern of underweight or undernourished children’s decline in nutritional level.  From the expected rate of  29% by 2015, and 27% by 2017 they launched targeted strategies for undernourished children under 3 years to reduce the percentage of undernourished children to 26% by 2015. And further, maintain the pace to arrive at the nutrition level of 23% by 2017.

Hence several initiatives have been taken by the Government including National Health Mission (NHM – 2005 -2017), Millennium Development Goals (MDGs) and Sustainable Development Goals (2016-2030). Millennium Development Goals (MDG) at the United Nations General Assembly was embraced by India in September 2000. And India made considerable progress in ending poverty and other deprivations. But India is still lagging on targets more rigorous and persistent efforts are required to meet the global target. 

• India further attached itself to the United Nations 2030 Agenda for Sustainable Development Goals (SDG) to reduce the Child mortality rate under 5 years. It was assented to by the United Nations world over leaders in 2015.
• The Sustainable Development Goals (SDGs) have 17 global goals and are a part of the United Nations 2030 Agenda for Sustainable Development.
  It was adopted by the United Nations in 2015 and child development and well-being is one of its goals. SDG Goal 3.2.1 is to end preventable deaths of neonatal and under-5 children by 2030. It has two targets:
  • Reduce newborn mortality to at least as low as 12 per 1000 live births in every country.
  • Reduce under-5 mortality to at least as low as 25 per 1000 live births in every country. 

As per SDG 195 nations aligned with it must set their targets and develop strategies to reduce child mortality.India needs to accelerate its progress substantially to achieve the target by 2030. More focused efforts and better strategies are needed.

Measures to Tackle the Child Mortality Rate

Here are some of the measures to tackle the child mortality rate:

• Emphasis has been to increase the number of infrastructures and distribution of facilities for neonatal care such as
  • More Special New Born Care Units, 
  • Newborn stabilisation Units (NBSUs)
  • Newborn Baby Care Corners (NBCC)
• Health care providers are trained regularly by organizing training programs for Doctors and Nurses for early detection and diagnosis of ailments in children under the National Rural Health Mission NRHM, Integrated Management of Neonatal and Child illness (IMNCI) or Navjat Shishu Suraksha Karyakram (NSSK). 
• Management of malnutrition among children is carried out, as it is one of the effective ways to reduce Child Mortality.
  • Large-scale establishment of a Nutritional rehabilitation centre (NRC) to keep under control any severe malnutrition conditions.
  • Promote and encourage breastfeeding to reduce neonatal mortality.
  • Home Based Newborn care (HBNC) through community health activists of ASHA or Accredited Social Health Activists. The number of newborns across the country visited by ASHA in 2014-2015 was 65 lakhs which increased to 98.25 lakh in 2015-16.
• Ministry of Health & Family Welfare adopted National Deworming Day (NDD) strategy in 2015 to fight against soil-transmitted helminths (STH) infections. It was the most prominent preschool and school-based deworming program in the world. It was having reached millions of children in three rounds. 
• To eradicate Child mortality under 5 years due to diarrhea, Intensified Diarrhoea Control Fortnight (IDCF) was implemented in 2014. Mass awareness and distribution for the use of ORS and Zinc during diarrhea were carried out. 
• To manage anaemia in children National Iron Plus Initiative (NIPI) was launched covering all age groups of children, with the main focus on children between 6 to 59 months of age. It involves distributing across the states/UTs Iron Folic Acid (IFA) supplementation in the form of syrup and tablets. 
• Immunisation programmes such as Universal Immunization Programme (UIP) have been implemented against many life-threatening diseases such as Tuberculosis, Diphtheria, Pertussis, Polio, Tetanus, Hepatitis B, and Measles. 
  • And with the objective of fully immunising children who are either unvaccinated or partially vaccinated “Mission Indradhanush” was launched.
  • Measles-Rubella Campaign was aggressively carried out in select States for children from 9 months to 15 years of age to eliminate Measles by 2020. 

India has made remarkable progress in its immunization programs to the extent it achieved the polio-free nation status in 2014 and eradicated maternal and neonatal tetanus in 2015.

Recent Statistics and Data on Child Mortality Rate in India

The recent data about child mortality rate is as follows:

• The current infant mortality rate in 2022 is 27.695 deaths per 1000 live births, there is a minor decline of 3.74% from 2021. The Last year 2021 it was at 28.771 deaths per 1000 live births, a 3.61% decline from 2020. 
• Whereas in the year 2020 it was 29.848 deaths per 1000 live births, a 3.48% decline from 2019. And in 2019 deaths were 30.924  per 1000 live births, a 3.36% decline from 2018. If you look at these four years’ data there is a noticeable increase in the decline in the infant mortality rate for India.
• To realize the Sustainable Development Goals (SDG) target by 2030 all the states collectively must initiate and implement these programs in their respective regions. All the healthcare providers and state authorities must observe their commitment to improving Child health and reducing morbidity.

FAQs on Child Mortality

1. What are the leading causes of child mortality?

The primary causes include infectious diseases like pneumonia, diarrhea, and malaria, as well as complications during childbirth and malnutrition.

2. How has child mortality changed over time?

Globally, child mortality has significantly decreased in recent decades, thanks to improved healthcare, vaccinations, and nutrition programs.

3. What are the most effective ways to reduce child mortality?

Vaccination campaigns, access to clean water, proper nutrition, maternal healthcare, and education are crucial in reducing child mortality rates.

4. How does child mortality differ between developed and developing countries?

Developed countries generally have lower child mortality rates due to better healthcare infrastructure, education, and socio-economic conditions compared to developing nations.

5. What role do healthcare systems play in addressing child mortality?

Strong healthcare systems with accessible services, skilled healthcare professionals, and preventive measures play a pivotal role in reducing child mortality.

6. Is infant mortality hereditary?

While certain genetic factors may influence susceptibility to certain conditions, infant mortality is primarily influenced by environmental factors, healthcare quality, and socio-economic conditions.