Status of women is central to reducing child mortality in India, report says

BMJ 2012; 345 doi: (Published 15 November 2012) Cite this as: BMJ 2012;345:e7794
  1. Sophie Arie
  1. 1London

The Indian government has published figures that confirm that it is failing to make enough progress in reducing child mortality and urgent action is needed to address the socioeconomic, maternal, demographic, and environmental causes.

The report adds insights into the problem after a UN cross agency report in September showed that India accounts for nearly a quarter of deaths among children under 5 years of age worldwide, with 1.7 million per year.

The Infant and Child Mortality India Report, produced jointly by India’s National Institute of Medical Sciences, the Indian Council of Medical Research, and Unicef, found that under 5 mortality fell by almost 50% from 188 to 66 deaths for every 1000 births between 1990 and 2009. But the rate is not falling quickly enough to meet the millennium goal rate of 39 deaths for every 1000 births by 2015.

Rates vary enormously from state to state within India, with the highest, 88, in Uttar Pradesh, and only six of the country’s 28 states with rates low enough to be likely to reach the millennium goal.

“Accelerating child survival calls for new approaches to child mortality that go beyond disease programme and sector specific approaches,” said V M Katoch, director general of the Indian Council of Medical Research and secretary of the Department of Health Research.

The study highlights the fact that education could play a major part in further reducing the child mortality rate.

“While we kind of knew this, this report is really saying that the status of women is fundamental to this problem,” Pavitra Mohan, a health specialist with Unicef India, told the BMJ.

When mothers have had at least eight years of schooling, analysis of some data shows that their children are 20% less likely to die before 5 years of age and 30% less likely to die in the first month than when the mother is not educated. Children born to adolescent mothers are at a significantly greater risk of death before they reach 5 years of age than others, as are those born within two years of a previous pregnancy.

Early neo-natal mortality has declined more slowly than mortality at other stages, meaning that the proportion of infants dying in the first 7 days of life rose from around 66% in the 1970s and 1980s to 75% in the 1990s. Education of the mother appears to have a particular impact on early neonatal survival rates.

Education levels vary hugely between different states. For example, in Rajasthan more than 70% of mothers are illiterate, whereas in Kerala that figure is only 4%.

On a positive note, the report shows that the mortality rates have declined more quickly among groups with a lower standard of living than in those with a higher standard of living, narrowing the inequality gap.

The findings are based on data from the country’s Sample Registration System during 1978-2010 and from three rounds of National Family Health Surveys conducted in the years 1992-93, 1998-99, and 2005-6.


Cite this as: BMJ 2012;345:e7794