India's two-thirds of under-5 deaths occur among newborns in first 28 days: Report

By Rajiv Shah
Top global NGO Save the Children’s latest report marking its 100 years of existence, “Changing Lives in Our Lifetime: Global Childhood Report 2019” has said that, while there is “much child survival progress to celebrate around the world, the job is nowhere near done”, India has scored poorly on this score. Especially focusing on deaths in early infanthood, the report, even as refusing to provide comparative figures, says, death rates of children in the first days after birth in India “have remained stubbornly high.”
“In India”, it says, “The latest figures indicate that close to two-thirds of all under-5 deaths (605,000) occur among newborns in the first 28 days of life”, even though pointing out that “the number of Indian children dying after the first month and before age 5 has fallen by 70 percent since 2000 – from 1.3 million to 384,000 – but the number of newborn deaths has declined by only 52 percent.”
At the same time, providing comparative figures, the report says that under-5 mortality rate (deaths per 1,000 live births) in India is 39.4, which is higher than five of its neighbours, Sri Lanka 8.8, China 9.3, Bhutan 30.8, Bangladesh 32.4, Nepal 33.7, and. Two of the neighbours perform worse than India – Pakistan 74.9 and Myanmar 48.6.
Blaming this on poorest children being “still vulnerable to ill-health”, according to the report, “Lack of universal health coverage, inadequate diets and unsafe water still put the most disadvantaged children at the highest risk of death in almost every country.” Thus, globally, “An estimated 5.4 million children still die before their fifth birthday each year. At a time when the knowledge and technology to save lives is available, 15,000 child deaths each day is unacceptable.”
Suggesting India’s relative lag, the report states, “In South Asia, Bangladesh, Bhutan, India and Nepal have achieved great reductions in child mortality since 2000. Bangladesh’s child death rate is down 63 percent, Bhutan’s is down 60 percent, Nepal’s is down 59 percent and India’s is down 57 percent.”
The report further finds that while India may have “greatly reduced child marriage through legal reforms, programmes to educate and empower girls, and public awareness campaigns”, the progress is much slower in India than all the South Asian countries.

The report’s End of Childhood Index, which scores countries calculating on a scale of 1 to 1,000, measures the extent to which children in each country experience “childhood enders” such as death, severe malnutrition, being out of school and shouldering the burdens of adult roles in work, marriage and motherhood.
Thus, a high score 940 or above would mean that few children miss out on childhood, while a score of 379 or below would mean nearly all children missing out on childhood, the report states.
Referring to the progress of India vis-à-vis other neighbouring countries between 2000 and 2019, the report says, “In South Asia, Bhutan achieved a 194-point increase, rising from 617 to 811, mostly by getting more children into school… Bangladesh’s score rose 153 points, from 575 to 728, primarily because of improvements in child survival. Nepal’s score is up 142 points, from 543 to 685, due mostly to decreases in mortality, malnutrition and teen births. And India’s score is up 137 points, from 632 to 769, largely because of improvements in child health and survival.”
Only Pakistan failed to as well as India – its score improved from 540 to 626, a rise of 86 points during the period in question.

The report states, India’s improvement is part of several countries – including Burkina Faso, Malawi and Sierra Leone – coming up with legislation “addressing the basic right of children not to be married at an early age. Practitioners have found that coordinated investments in education, health, poverty reduction, water and sanitation (i.e., “whole systems” approaches) can have a much greater impact on improving the lives of children than interventions from individual sectors.”

It adds, “India’s comprehensive approach to tackling child marriage, for example – including policy reforms and investments in education, livelihoods and community mobilization for change – has been the key to its success.”
The report continues, “Rising education rates among women and girls have been critical to improvements in child health in Bangladesh and child protection in Afghanistan and India. Female legislators also tend to increase foreign aid, particularly for education and health. At the grassroots level, women and girls are leading efforts to end child marriage in India, Indonesia, Lebanon, Mexico, Pakistan, Senegal and other countries.”

The report says, “Almost all the children saved from stunting live in Asia. Mongolia and Kyrgyzstan have cut their stunting rates by an impressive 76 and 64 percent, respectively. China’s 54 percent reduction means there are nearly 8 million fewer stunted children in that country.” However, it regrets, “Progress in populous India” was less dramatic (30 percent decline)”, though it has “resulted in 23 million fewer stunted children.”
The only major gain India has achieved, according to the report, is in child marriage, which are “down 51 percent since 2000 (from 30 to 15 percent) and 63 percent since 1990.” On the other hand, as for other countries, “Afghanistan has cut its rate by 44 percent (from 29 to 16 percent). Bangladesh, Nepal and Pakistan have each cut rates by more than one-third since 2000.”
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