India has witnessed 66 per cent decline in the under-five mortality rate from 1990 to 2015 but most of the new-born deaths — 24 per cent of all — still occur in the country, according to a new UN report. With the reduction, India has met one of its Millennium Development Goal (MDG) targets of curbing by two-thirds the under-five death rate, according to the survery — Levels and Trends in Child Mortality 2017 — conducted by the UNICEF and released globally on Thursday.
The report acknowledged that there has been “a recent acceleration with a faster decline in reduction of mortality for the girl child in the last five years” but “the under-five mortality for girls in India remains 12.5 per cent higher than the boys”. Globally this is seven per cent higher for the boys. The UN report said there was a need for equitable access to health care for every girl child in India which “warrants an intensification of our combined efforts to bridge this gap and ensure an equitable access to health care for the girl child”.
“Even in the states that have met the MDG targets, there are persistent gender inequities. The right of a female child to care is often compromised due to cultural barriers and prevalent social norms.” The report highlighted that a major barrier in seeking healthcare for the girl child was the high out-of-pocket expenses. “To address this, the government has made free health-care an entitlement for every child, with the provision of free transport, drugs and treatment for every child till one year of age. Despite these efforts, female admissions in the special new-born care units are 41 per cent while male admissions are 59 per cent.”
Cultural barriers in seeking healthcare for the girl child also needed to be addressed, the report recommended. “The issue of neglect of the girl child is much broader and needs interventions beyond health, to also address the social norms and cultural practices. This would require working at the policy level and with key influencers in civil society, to create an enabling environment around the need to enhance the value of girls. “At the community level it would also involve building awareness and engaging communities around the discourse on this important issue.”
The report stressed that investment in the education of the girl child was crucial and acknowledged that Prime Minster Narendra Modi’s “Beti Bachao Beti Padhao” scheme could be used for addressing the prevailing negative social norms towards the girl child in India. The report also found that the maternal mortality ratio (MMR) has declined by 68 per cent during the MDG period while the global decline was more modest at 44 per cent.
However, the burden on accournt of MMR remained high due to wide variation among states and also at sub-state level. In states like Assam, Rajasthan, Uttar Pradesh, Bihar and Madhya Pradesh the maternal mortality ratio “is much higher — around 79 maternal deaths more, per 100,000 live births than the national average”. Globally the report said the number of children dying before the age of five was at a new low – 5.6 million in 2016, compared with nearly 9.9 million in 2000. But the proportion of under-five deaths in the newborn period has increased from 41 per cent to 46 per cent during the same period at the global level.
“Every day in 2016, 15,000 children died before their fifth birthday, 46 per cent of them – or 7,000 babies – died in the first 28 days of life.” It said most newborn deaths occurred in two regions: South Asia (39 per cent) and sub-Saharan Africa (38 per cent). “Five countries accounted for half of all new-born deaths: India (24 per cent), Pakistan (10 per cent), Nigeria (nine per cent), the Democratic Republic of the Congo (four per cent) and Ethiopia (three per cent).”