"The current Infant Mortality Rate (IMR) of India, as per the Sample Registration System (SRS) 2013, is 40 per 1,000 live births while the Under-5 Mortality Rate (U5MR) as per SRS 2012 is 52 per 1,000 live births.

"At this current rate of decline it seems it will be difficult for India to reach the target of less than 39 per 1,000 live births by the end of 2015," UNICEF's Health Specialist in India, Dr Gagan Gupta said.

Though India accounts for the highest burden of Under-5 deaths in the world, there has been a faster decline in its reduction as compared to the global fall, he added.
"Globally the U5MR reduced by 49 pc from 90 per 1,000 live births in 1990 to 46 per 1,000 live births in 2013, while India achieved a reduction of 59% in the Under-5 mortality from 126 in 1990 to 52 in 2012, which is higher than the global decline," Gupta said, citing the Levels and Trends in Child Mortality Report 2014, estimates developed by the UN Inter-agency Group for Child Mortality Estimation.

"Neo-natal deaths account for 56 pc of Under-5 deaths in India which is much higher than the global average of 44 pc. The progress in reduction of neo-natal mortality has been slow," he noted.

In fact, four states - Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan - account for half of the Under-5 deaths in India, Dr Gupta said.

Assam with 75 per 1,000 live births tops the chart among states having Under-5 mortality above the national average of 52, followed by Madhya Pradesh (73), Odisha (68), UP (68), Rajasthan (59), Bihar (57) and Chhattisgarh (55), he said.

However, as per SRS report, Andhra Pradesh has shown 17 pc decline in the Under-5 mortality between 2009 and 2012 and Rajasthan has shown 20 pc decline during the same period, Dr Gupta added.

Quoting the above mentioned report, Gupta said that in India every year, 1.34 million children die before completing five years, of which 7,48,000 die within the first month of their life. "This means more than 2,000 newborn die each day in India," he said.

The UNICEF, Dr Gupta said, has also played a key role in evidence generation through Special Newborn Care Unit (SNCU) which showed that despite free care there are more male admissions in SNCUs as compared to females.

SNCUs are effective to address problems of low-birth, pre-term deliveries simulating the environment of the womb. A baby is provided warmth, protected from infection and carefully fed to ensure for proper development of its body parts which have stopped growing on account of premature delivery.

According to Dr Gupta's suggestions, India, in order to achieve a reduction in the Under-5 deaths, should focus on reducing neonatal deaths, which account for 56 percent of total such deaths, by integrating quality maternal care with newborn care.

"In addition, addressing forgotten killers like pneumonia and diarrhoea will be critical besides improving immunisation coverage to address mortality due to vaccine-preventable diseases. As under-nutrition is an underlying factor in 45 percent of Under-5 deaths addressing adolescent and maternal nutrition will also be critical," he added.

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