Ahead of the high-level UN summit to assess progress in the Millennium Development Goals later this month, a recent report says children from the poorest communities in India are three times more likely to die before they reach the age of five than those from high income groups.

The new global report titled 'A Fair Chance at Life' by international child rights organisation 'Save the Children' says reductions in child mortality in India and elsewhere in the world appeared to focus on children from better-off communities leaving children from the most disadvantaged backgrounds behind.

Of the 26 million children born in India every year, approximately 1.83 million children die before their fifth birthday in India. Half of these deaths occur within a month of the child being born (the neonatal period), says the report.

The under five mortality rate in Kerala is 14 deaths per 1000 live births. This stands at a sharp contrast to Madhya Pradesh at 92 per 1000, 91 per 1000 for Uttar Pradesh and 89 per 1000 for Orissa.

These inequalities are also marked in respect of newborn mortality rates. While the rate for Kerala is 7 per thousand, the comparable figures for Madhya Pradesh, Uttar Pradesh and Orissa are 48, 45 and 47.

In 2008, 5.3 lakh children under 5 died in the lowest income quintile in India in comparison to 1.78 lakh among the highest wealth quintile.

The rate of decline in under five mortality rate between 1997-98 to 2005-06 among the lowest income quintile is 22.69 per cent compared to 34.37 per cent among the high income quintile for the same period.

"The 41 per cent decline in child mortality over the last nearly two decades masks a dangerous expansion of the child mortality gap between the richest and poorest families in India," says Thomas Chandy, CEO, Save the Children.

"What these aggregate figures do not reveal are the huge inequities in mortality rates across the country, within States and between them, as well as between children in urban and rural areas," points out Chandy.

In the year 2000, world leaders committed themselves to eight Millennium Development Goals, including MDG 4 which calls for a two-thirds reduction in under-five mortality between 1990 and 2015.

India is a signatory to the original Millennium Declaration and has reaffirmed its support for the Millennium Development Goals, including MDG 4. Despite progress against the target, on the current trajectory, India will fall short of achieving it.

The under-five mortality rate has fell from 116 per thousand live births in 1990 to 69 per thousand live births in 2008. The current annual percentage of reduction of under 5 mortality in India is 2.25 per cent, whereas the required annual percentage of reduction to reach the MDG goal in this regard during the remaining seven years has to be 6.28 per cent, says the report.

According to the report, 90 per cent of these deaths are caused by pneumonia, measles, diarrhoea, malaria and neo-natal conditions that occur during pregnancy and during or immediately after birth.

The latter conditions are particularly significant when it comes to India's newborn deaths. Severe infections, asphyxia and premature births cause over 72 per cent of newborn deaths.

Maternal and child malnutrition is significant too in explaining the continuing high rates of child mortality in India. 48 per cent of India's children under the age of five are chronically malnourished, 20 per cent are acutely malnourished and 22 per cent of India's babies are born with low birth weight.

These rates of child malnutrition compare with some of the poorest countries in Africa. India?s rates of child wasting, for example, are three times higher than Ethiopia, says the report.

"As the country with the highest number of child deaths anywhere in the world, India has a particular obligation to demonstrate leadership on the issue. Every child has the right to survive and the Indian Government has an obligation to protect them," says Chandy.

"By demonstrating political will and the right policies, MDG4 can be achieved in India. The good schemes in place need to be matched by effective implementation. And there is enough experience in India proving that low-cost interventions can make the difference between life and death for a child," he adds.

Save the Children is an independent child rights organisation that works in India and in over 120 countries around the world. In India, Save the Children works in 10 states focusing on strengthening child rights in the key areas of inclusive education, child protection, health and nutrition and emergencies.