Six states - Kerala, Tamil Nadu, Maharashtra, Punjab, Himachal Pradesh and West Bengal are likely to achieve their millennium development goal (MDG) 4, which aims to reduce under-five mortality (U5MR) by two thirds, by 2015.

This is one of the conclusions of ‘The Infant and Child Mortality India’ report released by the National Institute of Medical Sciences (NIMS), Indian Council of Medical Research (ICMR) and the UNICEF India.

The study provides evidence on key social and economic determinants of U5MR. It highlights the impact of maternal education on child survival. It says the impact is high and significant when mothers have had at least 8 years of schooling. The report also highlights the fact that births to adolescent mothers are at a significant greater risk of dying in childhood so are those born within 2 years of the previous pregnancy. The report further point out that maternal malnutrition (under nutrition) as well as obesity imposes a greater mortality risk on the off-springs.

Economic status is found to have a strong and significant association with child survival. The progress in child survival in India has been equitable between 1981 and 2005, while U5MR has declined across all economic groups, the drop was much higher among the low standard of living index (SLI) households (37.5%), than those born in high SLI (10.7%).

“We require a comprehensive approach that includes not only increasing coverage of key child survival interventions, but also improving quality of perinatal care, promoting education of girls beyond primary, delaying the age at marriage and childbirth and ensuring adequate spacing between births”, stated Louis-Georges Arsenault, UNICEF India Representative.

In terms of environmental determinants, the study suggests that children living in households with access to unsafe source of drinking water were at greater risk of death. Neonatal, post-neonatal and child mortality is also higher for children in households that do not have access to a flush or pit toilet.

Analyses of data from the sample registration system and three rounds of national family health surveys conducted in the years 1992-93, 1998-99 and 2005-06 indicates that following the rapid decline in the seventies, U5MR stagnated in the nineties and then started declining again in the last decade. It fell to a level of 118 in 1990 to 93 in 2000 and 59 in 2009. Though U5MR has always been lower in urban than in rural areas, the decline in urban areas has been slower than in rural areas in the last two decades, narrowing the gap.

According to Professor Arvind Pandey, the Director of NIMS, the report is an important planning tool. “The results of this study underscore the need for addressing wider determinants of child mortality to achieve MDG-4 and not restrict to addressing only the direct causes.”

Child mortality is an indicator of a country’s socio-economic development. It has been a priority for the Indian government over the last few decades. However, at the current pace, it is unlikely to achieve the Millennium Development Goal (MDG) 4 unless the related socio-economic, maternal and demographic, and environmental determinants are urgently addressed.