Millennium Development Goals (MGDs) are the goals set at the United Nations by the governments in the year 2000.Here eight main goals are agreed by the UN which they try to achieve by 2015. The 8 MDGs are Eradicate Extreme poverty; Achieve Universal Primary education; Promote Gender Equality and Empower Women; Reduce Child Mortality; Improve Maternal Health; Combat HIV/AIDS, Malaria and other Diseases; Ensure Environmental Sustainability; Develop a Global Partnership for Development.Child Mortality is an important MDG since it affects the improvement in the living standards of a country. It also affects the public health activity. Reducing the child mortality rate worldwide and particularly in the developing nations has been a key globe issue. Almost all countries showed significant improvement in tackling child mortality. Since the last 20 years, even one-third of the underdeveloped countries are successful in bringing down the child mortality by 40 percent .
The Objectives of this study is to define and discuss the influencing factors of Child mortality in India. The outline and variation in the last 20 years along with the various policies are discussed as well.
Child Mortality is defined by WHO as-
“Probability of a child born in a specific year or period dying before reaching the age of five, if subject to age-specific mortality rates of that period”.
The Birth as well as Death data derived from the registration/ surveys are used for calculating the mortality rates.
3. Causes and Trends in under-5 mortality in India
In order to achieve the MDG 4, it needs to bring down the Child mortality rate to 39 per thousand live births by the year 2015. Unfortunately, the current rate of advancement is inadequate to achieve this target . In the early 1970s, the yearly Nationwide Child mortality reporting System called Sample Registration System (SRS) was established. It focuses on the registration of Births and Deaths in the country and estimation of Child Mortality indicators. The major reason for child mortality changes considerably along with the age of the child. During neonatal period, the deaths are due to complications during delivary, Low Birth Weight or Premature birth. Later on, infections and other medical conditions constitute the death. In India, Malnutrition, diarrhoea, measles and pneumonia are the familiar reasons for Child death.
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The SRS report revealed the various causes of Child deaths in India. Perinatal conditions, Respiratory infections and Diarrhoea are the main causes of Child deaths. They constitute 33.1%, 22, 0% and 14% respectively. Other causes of death include unintentional injuries (3.2%), Nutritional deficiencies (2.8%), and Malaria (2.7%). In general, Respiratory infections, Diarrhoea, Malaria and Unintentional injuries contributes more for child deaths in Rural areas whereas Perinatal causes and congenital abnormalities are more in Urban areas. The figure below shows the top 10 causes of Child deaths in India .
4. Child Deaths in India
Fig: 4.1 Top 10 causes of Child deaths in India 
As the age progresses, the possibility of death diminishes. In India, the level of child health inequalities varies from State to state. However, it is meaningful in comparing the level of Health inequalities among the States which provides us an apparent picture of the Indian States.
Even though Rajasthan had an increase in Child mortality between 1992 and 1999, it experienced an above-average decline of mortality between 1998 and 2006. Southern states like Kerala and Tamil Nadu are showing constant above-average advancement in Child Survival. In low economy States like Bihar, Orissa and Rajasthan, the Child death rates are very high compared to the rich states like Tamil Nadu and Maharashtra according to the 2005-06 survey. It is difficult to compare these changes on the basis of economy of a state because Kerala, which is not a rich state, has the lowest Child mortality rate in the country.The graph below depicts the Child mortality rates in selected States in India.
4.1 Child mortality rates in India
Fig 4.1.1 under five mortality rates (%) in selected states in India
The trend shows that the Perinatal and Infant mortality Rates are slowing down and remaining stagnant since the 1990s.The figure below shows the trends in Infant and Neonatal Mortality rates in India .
4.2 Infant and Neonatal Mortality rates in India
Fig 4.2.1 Infant and Neonatal Mortality rates in India
The Studies shows that proximate issues (like medical care and non medical factors), Maternal issues (like age, birth intervals and parity), and House & Community level issues (like housing, Sanitation and water) constitutes the reasons for the reduction in speed of decline in Child mortality rate.
5. Child mortality Health Policies in India
The main Child health policies of India includes Integrated Child Development Services (ICDS) (1975) , Child Survival and Safe Motherhood (CSSM) programme (1992) . And Reproductive and Child Health (RCH) programmme (1997) .The National Health Policies aimed at reduction in the Child Mortality Rates. In 1885, a Universal Immunization Programme (UIP) was introduced. It included Pulse Polio Immunisation (PPI) (Vaccination against Poliomyelitis), DPT vaccine (Vaccination against Diphtheria, Pertussis and Tetanus) and BCG (Bacillus Calmette-Guerin- Vaccination against Tuberculosis) . Appreciable improvement was acquired initially since it covered about 90% population. In 1886, The National Technology Mission (NTM) took over UIP and equipped to be functional in all the districts of the country by the year 1990.
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5.1 Integrated Child Development Services (ICDS)
India’s ICDS is the biggest integrated Childhood programme which was introduced in 1975. It has over 40,000 centres all over the country. UNICEF joining with the World Bank assisted in commencing the ICDS and is still providing technical as well as financial supports. At present it covers more than 23 million children less than 6 years of age . ICDS targets at regulating the health & nutrition as well as development of children. Besides this it provides preschool education for children 3 to 6, educating mothers and giving additional feeding for children and pregnant women. It provides anganwadi/ childcare centres . During the past years, ICDS was successful in meeting their aims and objectives. The government of the country reorganized it for making it commonly accessible for providing more opportunity for all children in the country .
5.2Child Survival and Safe Motherhood (CSSM) programme
The Universal Immunisation Programme (UIP) introduced in 1985 was an opening so that it covered all children and mothers. This motivated the starting of an advanced programme known as Child Survival and Safe Motherhood (CSSM) programme obtaining financial supports from UNICEF and World Bank.The main aims of CSSM was, Widening the UIP so that it can cover all pregnant women and Children between the age of 9 months and 3 years. It also introduced Oral Rehydration Therapy Programme aimed at minimising the child mortality due to diarrhoea . CSSM programme is completely a National Family Welfare Programme which supplies vaccines, ORS packs, Cold chain apparatus, medicines etc. to all the states of the Nation. Besides this, funds are also provided for proper execution of the programme .
5.3Reproductive and Child Health (RCH) programmme
The RCH programme launched in 1997 aimed at providing excellent services which help to achieve the population firmness by improving the quality of reproductive life. The focus area of the RCT was management and anticipation of unwanted pregnancies, maternal care and Child Survival schemes for children . RCH aims in broadening immunisation, child care, and delivary care. More focus given for enhancing neonatal care on every aspect. Another aim of RCT is the abolition of Polio virus by bringing in Hepatitis in UIP pack.
6. Challenges faced by the country in improving child mortality
There are relations between the Health of the Mother and the condition of the Child. Maternal features plays important role in birth outcome as well as child survival. Poor nutritional status, lower literacy rates, early marriage and child bearing, less antenatal care, lack of access to the health services are some of the most important maternal factors influencing Child mortality . In order to reduce child mortality, proper maternal care should be taken.
It is another challenge faced by the country. Poor children are in danger compared to the others. The risks include inadequate water & sanitation, air pollution etc. Comparatively, they will be undernourished so that there will be more chance for severe disorders . Another fact is that, access to quality treatments and facilities are not gained by these groups of Children. So the Child survival extremely depends on the Socio-economic inequalities starting from exposure, resistance, care taking till the proper intervention. Due to these factors poor children are more likely to die .
Urban and Rural residence also plays role in Child mortality. In India, like other developing countries, the living circumstances are poorer in rural areas than the Urban. Along with that, the health care facilities will be of poorer quality. These variations in rural and urban areas definitely affect the child mortality .
Membership in Religion and Caste
The membership in Religion and Caste is another challenge for the child mortality. This will be due to the living manner based on customs and beliefs. The tradition followed by the scheduled caste or scheduled tribes is known to affect many aspect of Child life in India . In the country, it is found that the Child mortality is more among the Hindu caste/tribe group which is followed by Hindu Non-caste/tribe group, Muslims and Other religions . At the state level this is not true.
7. Chances of attaining MDG 4 by 2015
By 2015, India needs to reduce its Child Mortality to 39 per 1000 live births in order to achieve the MDG 4. According to the present rate of progress the target will not be achieved by 2015(4). On the other hand, there is uneven decrease in neonatal infant and child mortality. So, MDG 4 can be achieved by the country by an extra acceleration of the reduction in child mortality rate. This should be chiefly in Uttar Pradesh, Andhra Pradesh, Madhya Pradesh, Bihar and Rajasthan (5). Focus should be given for implementation of the policies in the proper manner by extending the coverage of skilled persons to support mothers, treatment for pneumonia, diarrhoea and community protection programmes. So, by improving the performance in all the areas, MDG 4 can be achieved in India.
In India, up to the year 2000, Child mortality has reduced significantly. Factors like maternal and Child health policies are considered to be played the major role in bringing down these rates . But now in the country, more child deaths are recorded per year compared to all other countries so that they are not going to meet up with the goal if the trend is continuing like this . Considerable reductions in Child mortality can be achieved in the country only if additional strengthening is given to National as well as community level Health Systems. New approaches should be introduced for pacing the Child mortality reduction rate. So, the Govt. of India should re-evaluate the Nation’s present goals and move ahead with better plans for developing the Child Health . Ongoing child health plans and policies like abolition of Vaccine- preventable child diseases and the other definite treatments related to children should be re considered for making changes . MDG4 in the country can be only achieved if crucial act is taken in order to speed up the child mortality reduction rates. It should be done by spotlighting the most affected states namely, Uttar Pradesh, Madhya Pradesh, Bihar, Rajasthan and Andhra Pradesh . Numerous socioeconomic factors also have considerable effect on Child mortality. It will be impossible to improve the socioeconomic status of each and every family in the country within a short period of time. But, by targeting high risk families, the Child Survival can be advanced by the information gained from the family health programmes. Vaccination against tetanus should be given to pregnant women, which will significantly reduce the neo-natal deaths. Family health programmes should be strengthened here as well so that basic health care services can be gained by all pregnant women.
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