ATTAPPADI, India, May 4 2014 (IPS) – The death of a 10-day-old girl last November in the Attappadi tribal belt of Kerala, one of India’s best performing states in terms of human development indices, shows how the country’s battle against child mortality is far from won.

The infant’s mother, Saraswathy, a 20-year-old from the Kurumba tribe, was admitted to a government hospital, and delivered the next day. At 1.8 kg, the child was underweight. The mother was discharged but the infant was kept at the hospital, where she died.Experts say the strides taken by India in the 21st century mask its failure to contain infant deaths among the poorest.

Saraswathy told local health workers who visited her tribal area that she left the hospital because she was starving. “The mother was malnourished and this was her third delivery,” Nalini, a health worker, told the local media.

In 2013, over 50 tribal infant deaths were reported in the media from Attappadi, which falls in Palakkad district. This year three tribal infant deaths have been recorded from the area, district medical authorities said Apr. 24.

Experts say the strides taken by India in the 21st century mask its failure to contain infant deaths among the poorest. Planning Commission figures for 2011-2012 state that around 22 percent of India’s 1.2 billion population is classified as poor.

According to a report of the Registrar General and Census Commissioner of India, the country’s infant mortality rate (IMR) was 42 per 1,000 live births in 2012. IMR refers to the number of newborns who die before reaching one year of age.

Dr. S. Sachidananda Kamath, national executive member of the Indian Academy of Pediatrics, told IPS that a combination of causes like low awareness of health and reproductive rights, maternal anaemia and the burden of malnutrition carried over generations traditionally contribute to India s high child mortality rate.

“The IMR was 148 in 1971 and decreased to 44 in 2011. There has been a consistent decline in IMR. The rate of decline in the current decade is higher than in the previous one. For further reduction of IMR, we have to adopt different strategies for better child health care,” he said.

Health activists say the IMR varies among different states within India, but what is much less known is that within states like Maharashtra, Karnataka, Madhya Pradesh and Gujarat, there are wide and astonishing IMR variations.

Dr. Mohan Rao, professor at the Centre of Social Medicine and Community Health in Jawaharlal Nehru University, New Delhi, admitted that there were regional inequalities in health indicators such as IMR, U5MR (mortality rate of children under five) and MMR (maternal mortality rate).

“There are inter-state inequalities. Equally true are intra-state inequalities. What is not, however, receiving adequate attention is that the poor and the Scheduled Castes, Scheduled Tribes and Muslims among them bear the highest rates of ill-health and disease. And of course are neglected by the state,” he told IPS. Scheduled Castes and Scheduled Tribes are India’s most socially underprivileged communities.

A study by the international NGO Save the Children, published in 2014, finds that despite a decade of rapid economic growth, India accounts for an astounding 29 percent of the global deaths of newborns on their very first day of birth.

The report also highlights that equity is a critical factor the newborn mortality rate among the wealthiest 20 percent of India’s population is 26 per 1,000 live births, while among the poorest households it is 56 per 1,000 live births, with the infants dying in the very first month of life.

With 30 newborns dying per 1,000 live births, national capital Delhi, which has a large proportion of slums and poor areas, has the worst IMR among the four metropolitan cities that also include Chennai, Mumbai and Kolkata, the study says.

Such deaths can be prevented with better access to healthcare and the presence of qualified birth attendants, say experts.

Anuradha Gupta, Additional Secretary in the Ministry of Health and Family Welfare, said that though India has made a lot of progress in terms of child survival, there is a need to ensure that every child is saved.

“The country has made dramatic progress in bringing the under-five mortality from 114 in 1990 to 52 per 1,000 live births in 2012, a reduction of more than 54.4 percent, while the global reduction is at 44.8 percent,” she told a gathering in New Delhi in February.

However, dearth of funding could prove to be an obstacle.

Analysts calculate that by 2020, India needs more than 10 billion dollars for public health expenditure to meet the future health objectives for women and children, including slashing maternal and child mortality rates.
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A study by Indian and foreign academic institutes, published in the international journal Lancet in 2013, said child mortality in 597 districts of India was astonishing because it indicated that some parts of the country had not benefited from the government’s intervention to reduce under-five child mortality.

In 2012, 1.5 million under-five deaths were reported in 597 districts, of which 71 percent were in the nine poorer states, which accounted for half of India’s population, the study said.

Govindan Jayakumar, a health activist in Mangalore, told IPS that both private and public funding were essential to meet future health expenses, mainly targeting women and children.

“The government cannot meet all the expenditure in the health sector. Therefore, private philanthropy has a big role in the development of a vibrant healthcare ecosystem and in the enhancement of health delivery and support systems,” he said.

Doctors suggest that the promotion of institutional and safe deliveries along with increasing the coverage and quality of community-based interventions should continue.

Explaining the co-relation between infant and maternal deaths, Dr. Parameswaranpillai Jayadevan, a paediatrician at a government hospital in Kochi in Kerala, said the security of infants is equal to safe motherhood during the delivery period.

“India is not on track to reach the Millennium Development Goal-5 (MDG-5), which is to reduce the number of maternal deaths by 75 percent between 1990 and 2015,” he told IPS.