With India currently hosting a 24-nation Call to Action Summit to ‘end preventable child and maternal deaths’, the focus is on the normally neglected, ‘soft’ issue, which will actually determine whether or not India is going to be a tenable entity.
The country has undoubtedly made rapid strides. The maternal mortality ratio (MMR) figures have come down from 560 (per 100,000 live births) in 1990 to 190 in 2013, and infant mortality rate (IMR) from 88 (per 1,000 births) to 40. Stunting is down by an impressive 20% points in the last eight years. The government has put into place stand-alone programmes for adolescent girls, and the Mission Indradhanush to immunise every child.
At the same time, it is a harsh reality that India (along with Pakistan, Congo, Nigeria and Ethiopia) accounts for half of child deaths worldwide.
What gives a piquant twist to the story is that a country like South Sudan, racked by extreme poverty and civil war, has done better in improving its under-5 child mortality rate than India, which is a vibrant democracy and a surging economy. Equally troubling is the fact that 57% of under-5 Indian children who die, die within the first month of birth, many of them on the first day itself.
Malnourishment remains a critical and most preventable reason for child deaths, and unless addressed, there will be little ‘demographic dividend’ for India, or the realisation of a ‘Skilled India’ or ‘Make in India’ that Prime Minister Narendra Modi has promised. In some way, child malnutrition is even more critical than education, which comes later.
The cycle starts with the discrimination and deprivation of the girl child in millions of homes, her withdrawal from school the high levels of anaemia among adolescent girls and early marriage. If the average age of marriage in Bihar today is 17, in rural Bihar, girls would be getting married at 14-15, and have probably given birth to three babies by the time they are 21. But the issue does not figure in any of the party manifestos for the impending state election, forget it becoming a poll issue.
Early pregnancies, lack of enough contraceptive choices — our neighbours Nepal and Bangladesh give seven contraceptive choices in their public system, we offer only five, with an undue emphasis on sterilisation — inadequate care during pregnancies, the birth of weak and underweight children, and the cycle is complete.
There are now enough good practices honed the world over and successful pilots that can be replicated. The challenge is to scale them up.
The challenge is also to mainstream the issue, so that it does not remain the concern only of the experts. It all boils down to political will. The government may not have withdrawn from the social sector but its presence is increasingly receding — the recent budget cuts in health and education were proof of this. The states are now expected to pick up the baton and run with it, their share of the central taxes having increased from 32% to 42%, but so far the track record of only some of the states gives confidence of better days ahead.
Above all, the challenge is to evolve strategies which are not satisfied with ‘incremental’ gains, but go for a ‘quantum leap’ forward, and the creation of a ‘national movement’ to combat child malnutrition — for the sake of that child who closed her eyes all too soon when she had a right to live and live to her fullest potential.
Neerja Chowdhury is a senior journalist and political commentator. The views expressed are personal.