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Despite efforts to improve maternal and child health, the latest report released by UNICEF shows India had the highest number of deaths of children under five years of age last year. World Health Organisation (WHO) India Representative Nata Menabde, however, says that given the size of the population, absolute numbers will always be high in case of India. This should not overshadow the fact that the country has made significant progress in the field of health.
Social activist Ranjana Kumari says that the poor condition of maternal health and nutrition are to blame for the high mortality of children under five years old. "High mortality among children is linked to maternal health directly. Most women do not get sufficient nutrition, and the child is born weak. We also have high maternal mortality rates," she says. "Because of lack of nutrition, the child's immunity is low. Even though the government has many schemes, there are leakages. For example, we have the Janani Suraksha Yojana which provides facilities for institutional delivery. But primary health centres are not in good condition, " she says, stressing that the quality of the public health system has a role to play in the statistics revealed in the UNICEF report.
The UNICEF report, released Thursday in New York, says almost 19,000 children less than five years of age die every day across the world. India tops the list of countries for 2011, with the highest number of such deaths at 16.55 lakh. As per the report, even as overall child mortality in the world has gone down, under-five deaths are increasingly concentrated in sub-Saharan Africa and South Asia. In 2011, 82 percent of under-five deaths occurred in these two regions, up from 68 percent in 1990.
In 2011, about half of global under-five deaths occurred in just five countries: India, Nigeria, the Democratic Republic of the Congo, Pakistan and China. Though on the top of list in terms of absolute numbers, in terms of child mortality rate, India ranks 49th with 61 deaths per thousand children in 2011. Sierra Leone has the highest child mortality rate of 185 per thousand.
"There has been lot of improvement in last couple of years, with interventions like the National Rural Health Mission. In most areas, India will hopefully come close to the MDGs (Millennium Development Goals)," WHO's India Representative Menabde said at a press conference here. The MDGs are eight international development goals that all member states of the UN agreed to achieve by 2015. One of the MDGs is to reduce under-five mortality rate of 42 per 1,000 live births by 2015.
According to projections by WHO, India will reach 52 percent by that year, missing the target by 10 percentage points. "India may not achieve the MDG, but will come close to the target. It is important to maintain the pace even after the time period of the MDGs, so that the projections can be achieved," Menabde said. According to the UNICEF report, China reported 2.49 lakh deaths of under-5 children last year, followed by 1.94 lakh by Ethiopia and 1.34 lakh each by Indonesia and Bangladesh.
Uganda with 1.31 lakh such deaths and Afghanistan with 1.28 lakh deaths held the ninth and 10th position in the list of 10 top countries reporting under-five children deaths.On the positive side, however, the report shows that the overall number of under-five deaths worldwide has decreased from nearly 12 million in 1990 to less than 7 million in 2011, and the rate of the decline has been steadily increasing. "The rate of decline in under-five mortality has drastically accelerated in the last decade - from 1.8 percent per year during the 1990s to 3.2 percent per year between 2000 and 2011," the report says.
For the overall drop in child mortality, the report credits improvements in nutrition, access to vaccines and treatment, better post-natal care and the use of insecticide-treated mosquito nets. It also says that long-term strategy to improve girls' education has had a positive role in reducing child mortality.
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