India needs 'giant leap' to meet 2030 targets in reducing child mortality rates

August 2, 2018, International Institute for Applied Systems Analysis

IIASA researchers have found that almost half of the districts in India are not on track to reduce the mortality rates of newborns and meet the target set out under Sustainable Development Goal 3 (SDG3) for 2030, while a third will not meet the target for under-five mortality rates.

India still has the world's highest number of deaths among children under five and newborns, around 1.1 million per year. The new study, by IIASA researchers Jayanta Bora and Nandita Saikia, is the first to evaluate neonatal and under-five at a level in India, as well as a state level, with respect to SDG3. They aimed to provide information to help policymakers and health professionals set better objectives to reduce childhood mortality.

"The state-level mortality rate does not reflect the inter-district variation in neonatal or under-five . While some districts of a particular state may already have achieved the SDG3 target 15 years in advance, some districts will not achieve this even by the 2030 target time," says Bora. "Mortality rates vary enormously across the districts."

Under SDG3, "Ensure healthy lives and promote well-being for all at all ages," all countries should aim to reduce to 12 deaths per 1,000 live births per year, and under-five mortality to a maximum of 25. Saikia and Bora used data from India's National Family Health Survey, a survey of the full birth history of Indian women aged 15-49, carried out most recently in 2015-16, and used the data from the previous round conducted in 2005-06 to model future trends.

They found that the various measures employed in India have cut the number of deaths of under-fives by around half in in the past 23 years, from 109 deaths per 1,000 live births in 1990 to around 50 in 2013, but this is still double the target. The number of neonatal deaths remains around 2.4 times higher than the target, at around 29 deaths per 1,000 live births.

The picture, however, is very complex. For example, the under-five mortality rate for boys in the South West district of Delhi is 6.3 per 1,000 live births, well within SDG3 targets. However, in Rayagada in Odisha, the mortality rate is 141.7. The researchers found that just 9 percent of districts in India overall have so far reached the SDG3 targets for neonatal mortality, with 14 percent reaching the targets for under-five mortality.

The vast majority of the worst performing states on mortality rates are in the poorer states of north-central and eastern India, although there are some high-risk districts in richer, more developed states such as Andhra Pradesh and Gujarat. Almost all districts in the most populous states of Uttar Pradesh, Bihar, Madhya Pradesh, and Chhattisgarh will fail to achieve the SDG3 goal on neonatal mortality. In Uttar Pradesh, the research showed that not a single district would meet the target for under-five mortality.

There is also some variation between genders. The female neonatal mortality rate is below that of males, which is expected as this is the global trend. However, this is not the case with under-five mortality, indicating gender discrimination, something discussed in earlier research by Saikia.

Much of the variation is likely due to socioeconomic and geographic disparities. District-level female literacy rates vary from 24-89 percent while urbanization ranges from 0-100 percent. There are also large differences in the implementation of mortality reduction schemes and the accessibility and availability of healthcare.

"Since about 52 percent of districts are lagging behind when it comes to neonatal mortality rates, neonatal health should be prioritized. At the same time, district-specific, instead of state-specific, programs should focus on the most vulnerable population subgroups," says Bora.

One of the main barriers identified by Saikia and Bora is the inadequate operational management of the available mother and child healthcare services, which they say the government should focus on, particularly in the lowest-performing districts, which may be in richer and more advanced states, not just in struggling, poorer states like Uttar Pradesh. Chhattisgarh and Uttar Pradesh will need particular help, however. More education for girls and mothers in less developed communities in poorer, rural areas should also be a priority, while NGOs could help by providing community-based awareness programs for all parents. State governments should focus on improving public health facilities and ensure they are properly staffed.

"It is important to note that India experienced the highest reduction in mortality rate in the period 2005-2016. Therefore, to achieve the SDG-related mortality goals at the district level, it needs to intervene more rigorously than ever," says Saikia. "The majority of Indian districts need to make a giant leap to reduce their neonatal and under-five mortality rates."

Explore further: Gender discrimination results in the deaths of extra 239,000 girls per year in India

More information: Jayanta Kumar Bora et al, Neonatal and under-five mortality rate in Indian districts with reference to Sustainable Development Goal 3: An analysis of the National Family Health Survey of India (NFHS), 2015–2016, PLOS ONE (2018). DOI: 10.1371/journal.pone.0201125

Related Stories

Gender discrimination results in the deaths of extra 239,000 girls per year in India

May 15, 2018
A new study has found that there is an average of 239,000 excess deaths per year of girls under the age of five in India, or 2.4 million in a decade, and excess female child mortality is found in 90 percent of districts in ...

Increase in proportion of births at gestational age 39 to 40 weeks

May 14, 2018
(HealthDay)—From 2007 to 2015 there was an increase in the proportion of births at gestational age 39 to 40 weeks, and perinatal mortality at this gestational age decreased, according to a study published online May 14 ...

Sex bias kills 240,000 infant girls in India yearly: study

May 15, 2018
Almost a quarter-of-a-million girls younger than five die in India every year due to neglect resulting from society's preference for sons, a gender discrimination study found on Tuesday.

India has avoided 1 million child deaths since 2005, new study concludes

September 19, 2017
India has avoided about 1 million deaths of children under age five since 2005, driven by significant reductions in mortality from pneumonia, diarrhea, tetanus and measles, according to new research published today.

2013 to 2015 infant mortality rate varied by state and race

January 4, 2018
(HealthDay)—The infant mortality rate varied by state, from 4.28 to 9.08 per 1,000 live births in Massachusetts and Mississippi, respectively, in 2013 through 2015, according to a January data brief published by the U.S. ...

Death rates in newborns remain shockingly high in Africa and India

August 30, 2011
Neonatal mortality -- deaths in newborns, aged 3 weeks and under -- has declined in all regions of the world over the past two decades but in 2009, more than half of all neonatal deaths occurred in five countries—India, ...

Recommended for you

Siblings of children with autism or ADHD are at elevated risk for both disorders

December 10, 2018
Later-born siblings of children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at elevated risk for both disorders, a new study led by Meghan Miller, assistant professor in the ...

RSV study reveals age when infants are most vulnerable to asthma

December 5, 2018
New research suggests a maternal vaccination against RSV should be augmented with active immunisation in a child's first two years to reduce the onset of asthma.

The powerful impact of real-world learning experiences for kids

December 4, 2018
Real-world learning experiences, like summer camps, can significantly improve children's knowledge in a matter of just days, a new study suggests.

Mediterranean diet during pregnancy associated with lower risk of accelerated growth

December 4, 2018
The Mediterranean diet is characterised by a high content of fruits, vegetables, olive oil, legumes and nuts. This healthy diet pattern has been associated with lower obesity and cardiometabolic risk in adults, but few studies ...

Global review reports on administration of children's antibiotics

December 4, 2018
Researchers analyzing the sales of oral antibiotics for children in 70 high- and middle-income countries found that consumption varies widely from country to country with little correlation between countries' wealth and the ...

New review highlights importance of good sleep routines for children

December 3, 2018
Sleep hygiene, which includes practices like providing a cool and quiet sleeping environment or reading before bed time to help kids unwind, is increasingly popular among parents looking to ensure their children get a good ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.