CURRENT STATUS OF CHILD HEALTH IN INDIA

Neonatal health is undoubtedly one of the most significant world problems. The advanced countries
launched neonatal intensive care programs in late 60s' and early 70s' which have resulted in the survival
of fetuses of very low gestation However in India, we are still struggling to get minimal care facilities for
our neonates. The neonatal mortality rate (NMB) in our country is 5-6 times higher than the developed
nations In India, over one-third of all newborn infants are low birth relationship: weight (LBW), of these
one-third are preterm and two-thirds are born term (small for date) and nearly 70% of neonatal tuation
of the mortality occurs among LBW infants.

to tackle adverse elements. Globally, the child has been defined as one below the age of 18 years. That
characterization widens the scope of child health. Traditionally, pediatricians have been mostly
concerned with problems of the younger child and the neonate. Various issues during the adolescent
period and the transition to adulthood also need to be addressed by pediatricians.

Causes of Child Mortality in India

The major causes of child mortality in India as per the SRS reports (2010-13) are: Prematurity & low birth
weight (29.8%), Pneumonia (17.1%), Diarrheal diseases (8.6%), Other non-communicable diseases
(8.3%), Birth asphyxia & birth trauma (8.2%), Injuries (4.6%), Congenital anomalies (4.4%), Ill-defined or
cause unknown (4.4%), Acute bacterial sepsis and severe infections (3.6%), Fever of unknown origin
(2.5%), and all other remaining causes (8.4%)

Causes of Infant Mortality

The major causes of infant mortality in India as per the SRS reports (2010-13) are: Prematurity & low
birth weight (35.9%), Pneumonia (16.9%), Birth asphyxia & birth trauma (9.9%), Other
noncommunicable diseases (7.9%), Diarrhoeal diseases (6.7%), Ill defined or cause unknown (4.6%),
Congenital anomalies (4.6%), Acute bacterial sepsis and severe infections (4.2%), Injuries (2.1%), Fever
of unknown origin (1.7%), and all other remaining causes (5.4%).

INTRODUCTION
With more than a third of its population below the age of 18, India has the largest child population in
the world.

India contributes to more than 20 per cent of the child deaths in the world. In India about 1.83 million
children die

annually before completing their fifth birthday-most of them due to preventable causes. This explores
the levels of health, nutrition, education and social security of children, and government policy and
action on child rights. Socio-economic disparities have plagued India since time immemorial. From the
exploitation of peasants by Zamindars in the Mughal era to concentration of wealth and influence today,
the plight of the lower strata of society has always been in stark contrast to the affluence of the upper
class. However, the changing moral zeitgeist is

revolutionizing the outlook of the haves towards the have-nots.

Today, several charity-funded non-profit organizations are working alongside government agencies to
bring some stability to the accelerating imbalance in the Indian society. Addressing issues related to
under-privileged children is an important subset of such activities. Appropriate grooming in the
formative years is helping empower the young generation with the skills and knowledge to take control
of their lives. However, while the potential exists. with even a modest financial aid from the
bourgeoning upper/upper-middle class, to transform primary education, health, and sanitation among
children in India, there is a concerning lack of interest, trust and urgency in the situation at hand.

It is surprising how most of the urban population is unaware of the devastating state of affairs prevalent
just outside their protected cities.

India has made some significant commitments towards ensuring the basic rights of children. There has
been progress

in overall indicators:
Infant mortality rates are down. Child survival is up.

Literacy rates have improved School dropout rates have fallen.

But the issue of child rights in India is still caught between legal and policy commitments to children on
the one

hand, and the fallout of the process of globalisation on the other.

Over the last decade, countries across the world have been changing their existing economic models in
favour of one driven by the free market, incorporating processes of liberalisation, privatisation and
globalisation. The direct impact of free trade on children may not leap to the eye, but do know that
globalised India is witnessing worsening levels of basic health, nutrition and shelter. Children are
suffering as a result of social sector cutbacks/policies and programmes and development initiatives that
deprive communities and families of access to and control over land, forest and water resources they
have traditionally depended on..

The negative fallout is visible:

i. Children are being deprived of even the scarce social benefits once available

They are displaced by forced and economic migration

Increasing the number of children subsisting on the streets More and more children are being trafficked
within and across borders

Rising numbers of children are engaged in part-or full-time labour

V.
Ground Realitics

. With more than one-third of its population below 18 years, India has the largest young population in
the

world. Only 35% of births are registered, impacting name and nationality.

One out of 16 children die before they attain the age of 1, and one out of 11 die before they are 5 years
old.

35% of the developing world's low-birth-weight babies are born in India. 40% of child malnutrition in the
developing world is in India.

• The declining number of girls in the 0-6 age-group is cause for alarm. For every 1,000 boys there are
only 92

females even less in some places.

• Out of every 100 children, 19 continue to be out of school. . Of every 100 children who enrol, 70 drop
out by the time they reach the secondary level.

Of every 100 children who drop out of school, 66 are girls.

• 65% of girls in India are married by the age of 18 and become mothers soon after.

• India is home to the highest number of child labourers in the world.

• India has the world's largest number of sexually abused children, with a child below 16 raped every
155th minute, a child below 10 every 13th hour, and at least one in every 10 children sexually abused at
any point i

time.

SURVIVAL

The very survival of the Indian child is a matter of concern. Around 2.5 million children die in India every

year, accounting for one in five deaths in the world, with girls being 50% more likely to die.

Eighty-seven children of every 1.000 born still have the probability of dying between birth and 5 years of
age

According to a report on the state of India's new-borns, the health challenges faced by a new-born child
in India are bigger than those experienced by any other country. Although India's Neonatal Mortality
Rate (NMR) witnessed a significant decline in the 1980s (from 69 per

1,000 live births in 1980 to 53 per 1,000 live births in 1990), it has remained static since then(only
dropping. four points from 48 to 44 per 1.000 live births between 1995 and 2005

FOOD INSECURITY: MALNUTRITION AND STARVATION

One in every three malnourished children in the world lives i India. Child malnutrition is generally caused
by a:

. Combination of inadequate or inappropriate food intake Gastrointestinal parasites

Other childhood diseases

• Improper care during illness.

The major cause is lack of public health services in remote and interior regions of the country, poor
access to subsidised healthcare facilities, declining State expenditure on public health, and lack of
awareness about preventive child theare

According to the Planning Commission, 50% of below the poverty line (BPL) families are out of the
purview of the targeted public distribution system. The very method of identifying the poor using the
official poverty line defined a an absolutely low level of income corresponding to the expenditure
required to purchase the bare minimum of

calories, is contentious. Therefore, in reality, many more people are living in food insecurity.

Ironically, the Supreme Court of India has had to intervene to ensure that children in this country get
adequate and

nutritious food the most basic of rights for all citizens to stay alive and healthy.

TO BE BORN A GIRL: PLUMMETING SEX RATIO

The very existence of the girl-child is under threat. Defying the normal male-female balance, the higher
survival

capacity of girl babies, and greater life expectancy of women to men prevalent in human populations,
the female
male balance in India has been adverse to females for at least 100 years.

While the overall female-male ratio for all ages rose slightly from the 1991 figure of 927 females per
1,000 males to 933 females per 1.000 males in 2001, the juvenile sex ratio in the 0-6 age-group fell from
945 girls per 1,000 boys to 927 girls per 1.000 boys. This is a decline of 18 points in just one decade! The
Government of India, in its report to the UN Committee on the rights of the Child said: "Every year, 12
million girls are born - 3 million of whom do not survive to see their 15th birthday. About one-third of
these deaths occur in the first year of life and it is estimated the every sixth female death is directly due
to gender discrimination."

Sex-selective abortion, more commonly known as focticide, and what appears to be a re-emergence of
infanticide, is taking a heavy toll, even as neglect of survivors' of this weeding out process persists.

Unlike all the other social evils attributed to poverty, the killing of female foctuses through sex-selective
abortion cannot be attributed to poverty and ignorance. Indeed, it is the economically affluent states of
Punjab, Haryana, districts of Gujarat, and Delhi that have the dubious distinction of having more people
who can pay for expensive tests to help choose male children over females. Census figures based on
2001 data from 640 cities and towns across

26 states and union territories reveal that posh metropolitan India, with 904 girls per 1,000 boys, has a
lower sex rati

for children below 6 years than overcrowded slums where there are 919 girls per 1,000 boys. The capital
city Delhi

has 919 and 859 for slum and non-slum areas respectively. Clearly it is those who can "afford to choose,"
who use th

technology to do so.

Almost all government health policies seem to have an underlying family planning agenda. Health
activists say that with its emphasis on population control, the Rural Health Mission is no different. Over
the years it has become quite clear that if people are forced to limit the size of their families, they shall
do so at the cost of the girl baby, even it means that they have to "import" brides from outside their
states or communities.

Commenting on the serious decline in the 0-6 sex ratio in India, leading demographer Ashish Bose says
that the government's policies are all wrong. The two-child policy has got mixed up with female
foeticide. Government slogans like "Betiya beta, donoekhain ("Girl or boy, both are equal') make little
sense.

If India closes the gender gap betwee girls and boys aged 1-5 years, 1.3 lakh lives will be saved and,
overall, the child mortality rate will go down by 5%.

There is no guarantee that the girl-child who escapes foeticide, infanticide and is in the 0-6 age-group
will escape the

cycle of deliberate neglect that may even result in death because she is less fed, less encouraged to
explore the world more likely to be handed jobs to do and given less healthcare and medical attention.
Out-patient data from hospitals in northern Indian cities shows lower admissions of girl-children, and
girls who are in a more serious condition than boys when brought for treatment. An August 2004 spot-
check at one hospital showed 25,538 hoy-children and 12.64 girl-children in the OPD) records, 3,822
boy-babies as against 3,160 girl-babies born in hospital, and 1.954 boy children admitted to a paediatric
ward as compared to 1,091 girls.

ELEMENTARY EDUCATION

While enrolment levels propelled by the flagship SarvaShiksha Abhiyan show an increase, levels of
retention in schools remain a matter of concern.

• There has been a marginal improvement in the percentage of students who stay in school until Class 5-
from

61.2% to 62% but this is way below the global average of 83.3%.
There is a sharp decline in the enrolment ratio at the upper primary level. Also, the dropout rate
increases

cumulatively as it proceeds towards higher levels..

Although showing improvement, the enrolment of girls is still below that of boys. The dropout rate for
girls too is higher.

Children belonging to scheduled castes and scheduled tribes continue face discrimination in schools and

have lower enrolment and higher dropout rates.

• Despite the promise of education for all, 46% of children from scheduled tribes and 38% from
scheduled

castes continue to be out of school, as against 34% in the case of others.

• This is not surprising considering the discrimination that these children face at school. The same can
be said

of the discrimination faced by disabled children.

The Constitution of India fails to even recognise education as a right for those aged 15-18 years.

Many children drop out after the elementary level. Indeed, the system is designed to push children out
of education -- there is a lack of adequate school infrastructure, the quality of education is poor, the
educational system is gender-unfriendly, disabled-unfriendly, caste-discriminatory and violent because
of a high degree of corporal punishment.
A Model Education Bill has been developed and circulated to the states for adoption into state law.
There will thus b no central legislation on education, only state legislation since education is a state
subject. If states decide to adopt th Model Education Bill as it is, they will be eligible for 75% assistance
from the Centre for education programmes. Bu if they modify the Model Bill in their formulation of the
state education law, they will only be eligible for 50% of central government assistance. The Model
Education Bill is not available for public scrutiny, posing serious question about the government's
accountability and transparency.

CHILD LABOUR AND RIGHT TO EDUCATION: A CONTRADICTION

India has the highest number of child labourers in the world.

Census reports clearly point to an increase in the number of child labourers in the

between 7 and 14 years of age, toil for 14-16 hours a day in cotton seed production across the country.
Ninety perce

of them are employed in Andhra Pradesh alone.

country, from 11.28 million in 1991 to 12.59 million in 2001. Reports from the MV Foundation in Andhra
Pradesh reveal that nearly 400,000 children, mostly girls

According to Yamina de Laet of the International Chemical, Energy and Mine Workers' federation
(ICEM), children aged 6-14 years represent 40% of the labour force in the precious-stone-cutting sector.
Rescue operations in Mumbai and Delhi in 2005-2006 highlight the employment of children in zari and

embroidery units.
Although the number of children employed in the agricultural sector, in domestic work, roadside
restaurants,

sweetmeat shops, automobile mechanic units, rice mills, Indian Made Foreign Liquor (IMFL) outlets and
most such

sectors considered to be non-hazardous' is unknown, there is ample evidence to suggest that more and
more childre

are entering the labour force and are being exploited by their employers.

The Social Jurist, HAQ: Centre for Child Rights and M V Foundation have filed a joint PIL with the
Supreme Court of India challenging the validity of the Child Labour Act in the wake of the constitutional
guarantee to right to education for children in the 6-14 age-group.

In the meantime, vide a notification in the official gazette dated October 10, 2006, the Centre has
expande the list of hazardous occupations banning employment of children under 14 years as domestic
help or in restaurants and the entertainment industry.

Government Action

Over the last few years, the government has taken a number of measures related to children. The most
important has

been the setting up of a full-fledged Ministry of Women and Child Development as against the
Department of Wome

and Development that used to function as part of the Human Resource Development Ministry.

Among the policy and law initiatives that were undertaken was the formulation of the National Charter
for Children 2003, the National Plan of Action for Children 2005, and enforcement of the National
Commissions for Protection of
Child Rights Act 2006.

Parliament has recently passed the Prohibition of Child Marriage Bill 2006, which enhances punishment
for those involved in these practices, and people abetting or attending child marriages. It also declares
all child marriages null and void.

Only a recognition of children as individuals with rights can pave the way for future action. In the
absence of this, al efforts will be sporadic, addressing only some symptoms and not the root cause of
the problems that affect the children of this country.

Causes of Neo-natal Mortality

The major causes of neonatal deaths as per Sample Registration System Report (2010-13) are
Prematurity & low birth weight (48.1%), Birth asphyxia & birth trauma (12.9%), Neonatal Pneumonia
(12.0%), Other noncommunicable diseases (7.1%), Sepsis (5.4%), Ill defined or cause unknown (5.0%),
Congenital anomalies(4.0%), Diarrhoeal diseases (3.1%), Injuries (0.9%), Tetanus (0.5%) and all other
remaining causes (0.9%)

Every child is born with a development potential that is determined by genetic and environmental
factors. It is the duty

and responsibility of everyone (parents, community, civil society

and the governments) to ensure that he/she achieves that. Whereas

pediatricians are chiefly involved with care of the sick child and

health related issues, they must also be cognizant of various other

factors that affect child health and development and make efforts

to tackle adverse elements.

Globally, the child has been defined as one below the age of

18 years. That characterization widens the scope of child health.

Traditionally, pediatricians have been mostly concerned with

problems of the younger child and the neonate. Various issues

during the adolescent period and the transition to adulthood also

need to be addressed by pediatricians.

GLOBAL PERSPECTIVES OF CHILD HEALTH

The WHO defines health as “a state of complete physical, mental

and social well-being and not merely the absence of disease or

infirmity”. However, most low- and middle-income countries

would be satisfied with abolition or at least control of common

diseases and provision of adequate nutrition. Early development,

education, care and protection are crucial for children. Various

aspects of child health are vastly different between affluent

countries and economically poor countries, which account for

the majority of the world’s population. Understandably, there is

a small proportion of underprivileged children in rich countries

as well, and affluent population in the developing nations.

Availability of proper health care, economic status and education

greatly impact child health and development. It is estimated that

75 countries having low- and middle-income account for more

than 95% of maternal and child deaths (UNICEF, 2010). A lack

of financial protection for the costs of health care and failure to

avail of the facilities wherever available are chiefly responsible for

these and need to be identified and appropriately addressed by

different countries (Lancet, 2013).

Child Health in Affluent Nations

The economically developed, educated countries have almost

eliminated common infections and preventable diseases and

nutritional deficiency. Improved sanitation and hygiene, provision

of safe water, universal application of immunizations, and

availability of health care have resulted in a vastly improved health

status of the child population. However, various socioeconomic

factors have led to emergence of fresh challenges. Besides, there is

a risk of importing diseases, such as malaria, dengue fever and viral

infections, from travelers from other countries.

Several problems are particularly important in rich countries,

but are of increasing concern in low- and middle-income

countries. The latter are facing the double burden of infections and

communicable diseases as well as noncommunicable diseases and

lifestyle related disorders.

Obesity and Metabolic Syndrome

Obesity has assumed epidemic proportions in affluent countries.

The number of overweight children in the USA has reportedly

doubled in children and quadrupled in adolescents over the past

30 years. In 2012 more than one-third of children and adolescents

were obese. Obesity is also a problem in developing countries in

Africa, China and India. About 5% of school children are reportedly

obese. Severe obesity is associated with the metabolic syndrome,

type 2 diabetes mellitus and nonalcoholic fatty liver disease.

Obesity also leads to hypertension and renal disease and joint

problems. Sedentary habits, and excessive consumption of food

containing carbohydrate, fats and salt have become the norm

and very difficult to modify. Childhood obesity is an important

contributor to adult obesity and diabetes.

Substance Abuse and Sexually Transmitted Diseases

There is a high incidence of substance abuse in adolescents, which

is reflective of the family and societal mores. There is a high rate

of mortality from drug abuse related automobile accidents and

overdosage. The USA has some of the highest rates of sexually

transmitted diseases (STDs) in the industrialized nations. In a

study by Center for Disease Control, one in four girls between

the ages of 14 and 19 was found to have at least one STD caused

by human papillomavirus, chlamydia, herpes simplex virus,

or trichomonas. Substance abuse (alcohol, tobacco, cannabis,

opiates, glue sniffing) is common in children in India and appears

to be increasing, especially in street children and adolescents.

Child Health Status in Developing Countries

Child health in developing countries is greatly influenced by

poverty, illiteracy, misinformation and traditional adverse beliefs.

A lack of availability of safe water, poor sanitation and hygiene,

environmental pollution and overcrowded living conditions play

important roles in the prevalence of diseases and disability. Large

family size, denial of proper health care and education adversely

affect child development. Among the small, affluent proportion

of the population, lifestyle diseases and other problems seen in

developed countries are also being increasingly encountered in

economically poor countries. There are large differences in child

health status in urban and rural communities, the latter comprising

70% of more of the population. Modern medical care facilities are

mostly confined to big and small cities. Various health parameters,

such as maternal and infant mortality rate (IMR), under-5 mortality

in regions within a country, where literacy rates are high and health

care provided, are closer to those seen in affluent countries. Thus

national statistical information or even regional data within a

country need to be carefully evaluated and stratified according to

demographic and socioeconomic profile.

Maternal and Perinatal Care and Infant Mortality

Maternal undernutrition and small stature are closely related to

low birthweight babies. The mortality rates are high in such babies

since expert perinatal management is often not available.

Infant Mortality

Infant mortality rate (IMR) is regarded as an indicator of the level

of health in a country. There has been a consistent decline in IMR

in India from around 80 per 1,000 livebirths in 1981 to 40 in 2014;

the current IMR remains high as compared to developed countries.

The national figure is high chiefly due to poor performance in large

northern states (>50 in MP, Odisha, UP). More than two-thirds of

infant deaths occur before 1 month of age, in the neonatal period.

The decline in IMR is sharper in urban areas and is influenced by

maternal factors such as nutrition, anemia, age below 18 years, birth

spacing, level of education and overall socioeconomic conditions.

There has been a small or no decline in early neonatal mortality

rate, an indicator of the quality of perinatal care, which remains

at 30. Table 1 shows the IMR in certain developed countries and

those with low- or middle-income population.

Immunizations

In most countries, vaccinations against common diseases are freely

available. However, adequate routine vaccination coverage varies

widely. Ignorance, suspicions and misinformation of the benefits

of protection from such procedures among illiterate communities

hinder universal application of vaccinations and continued

morbidity and often serious complications from preventable

diseases.

Common Early Childhood Illnesses

In underprivileged communities, rural and urban, common

illnesses, such as diarrhea, upper respiratory infections, skin

infections, are often accepted as parts of growing up and proper

medical attention is not provided. Such recurrent episodes

adversely impact nutrition and growth.

Undernutrition

Information about the importance of breastfeeding and oral

rehydration management of diarrhea is widely known, and

the incidence of severe forms of undernutrition has markedly

decreased. However, milder forms remain very common. Although

the prevalence of stunting of linear growth of children younger

than 5 years has decreased during the past two decades, it is high

in South Asia and Sub-Saharan Africa. Globally, it affected at least

165 million children in 2011 whereas wasting affected at least 52

million. Specific nutrient deficiency of iron, iodine, vitamin A

and D are frequent and together with stunting adversely affect

attainment of full developmental potential. It is estimated that

various morbidities of undernutrition combined with suboptimal

breastfeeding may cause 3.1 million deaths annually (45% of all

child deaths in 2011).

Common Diseases, Still Widely Prevalent

A large number of diseases can be controlled with provision of

safe water, application of basic hygienic and sanitation measures,

vector control and immunizations. Unfortunately, these facilities

are inadequate in developing countries resulting in a very high

morbidity that adversely impacts child health.

Diarrheal Diseases and Other Waterborne Infections

Lack of safe water is responsible for a heavy burden of diarrhea

(cholera in several countries), dysentery, typhoid and hepatitis

A. Ensuring safe water and proper sanitation is very difficult in

overcrowded urban localities. Increasing migration to cities and

huge construction activities put heavy demands on water. In rural

areas access to water is often difficult. The costs and technological

limitations in providing safe water present formidable challenges.

However, information and functional education about the dangers

from unsafe drinking water and poor sanitation and harmful

traditional practices can be provided to the underprivileged

population, which would lead to changes in behavior and habits

and thus help toward control of several common diseases. Infant

and under-5 mortality rates are lower in communities with access

to safe water and improved toilets.

Tuberculosis

Tuberculosis continues to remain a very difficult public health

problem in India and many developing countries. Overcrowded

living conditions, delay in diagnosis, inadequate treatment (despite

provision of medications free of cost) and multidrug resistance

contribute to the high prevalence and considerable mortality from

tuberculosis (2 million every year, mostly in developing countries). In

India 3–4 million children have tuberculosis and about 94 million are

at risk of developing the disease. The annual infection rate is between

3% and 5%, which may be higher because of lack of early diagnosis.

Malaria

Malaria is an important cause of illness and death in many parts of

the world, especially Sub-Saharan Africa. About 600,000 children

in Africa die of malaria each year. Falciparum malaria is common

in several states in India and presents a particularly challenging

problem with difficulties in diagnosis and drug resistance. Mosquito control measures including the use
of medicated mosquito

curtains and larvicide agents have been employed. Global efforts

are being made to develop an effective malaria vaccine.

HIV Infection, Viral Hepatitis

A lack of institution of proper preventive measures continues

to be responsible for high incidence of HIV infections in many

developing countries particularly in Africa. Hepatitis B is also very

common as vaccinations are not widely available.

Early Development and Education

A stimulatory environment and opportunities for preschool

learning experiences are severely restricted for the majority of

children in developing countries. In India, the Right to Education

ensuring free of cost primary education was enacted in 2009.

School enrolments have increased but the proportion of school

dropouts remains very high. School infrastructure facilities are very

often inadequate and educational achievements remain limited. A

large proportion of poorly literate and physically underdeveloped

population cannot fully contribute to national development.

Child Abuse and Neglect, Child Labor,

Natural and Man-made Disasters

Over the past three decades, global concern has been raised over

the very complex problems of child abuse and neglect. Inadequate

care and lack of education hinder the child health status and

achievement of his/her developmental potential. The dimensions

of the various issues vary greatly in rich and poor countries. Physical

abuse, exploitation, child labor, child sexual abuse and trafficking

are particularly common in developing countries. Millions of

children in poor countries, who ought to be in schools, are working

in organized or nonformal work, often in hazardous conditions.

Child physical and sexual abuses are also of major concern in

Northern America and Europe. Children are highly vulnerable

during natural (floods, earthquakes) or man-made conflicts (wars,

internal conflicts). Besides the problems of diseases and nutrition,

their education and learning suffer and adversely impact their

long-term development.

One hundred and eighty-nine United Nations member States

have pledged to achieve by 2015 several Millennium Development

Goals (MDG) that include, among others, eradication of extreme

poverty and hunger, universal primary education, and reduction

by half the proportion of people without sustainable access to safe

drinking water. However, in many countries these goals are not

likely to be met with in near future. MDG related to child health

will be discussed in the subsequent Chapter.

CONCLUSION

Health status of children is greatly influenced by multiple factors

that include availability of health care, socioeconomic status,

literacy and traditional beliefs, family size, sanitation and hygiene

and lifestyle habits. Within a country there are variations in health

parameters between rich and poor, and rural and urban. High

prevalence of many diseases, which have largely been eliminated

in affluent countries, contributes to ill-health and mortality

in children in middle- and low-income countries. A wider,

comprehensive approach is needed to identify the problems and

institute appropriate remedial measures.

The Child Health programme under the Reproductive, Maternal, Newborn, Child and Adolescent
(RMNCH+A) Strategy of the National Health Mission (NHM) comprehensively integrates interventions
that improve child health and nutrition status and addresses factors contributing to neonatal, infant,
under-five mortality and malnutrition. The National Population Policy (NPP) 2000, the National Health
Policy 2002, Twelfth Five Year Plan (2007-12), National Health Mission (NRHM - 2005 – 2017),
Sustainable Development Goals (2016-2030) and New National Health Policy, 2017 have laid down the
goals for child health.

Child Health Goals under SDG:

Goal 3.2: By 2030, end preventable deaths of newborn and children under 5 years of age, with all
countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5
mortality to at least as low as 25 per 1000 live births.

3.2 Health status of urban children

Ensuring children’s right to life requires early preventive

action and recognisition of the fact that most child deaths

are preventable. A continuum of care is needed, across

the life cycle linking the family, community, anganwadis,

health centres and facilities converging health and child

care services.28

3.2.1 Infant Mortality Rate (IMR)

Infant mortality is defined as infant (less than one year)

deaths per thousand live births. The level of mortality

is very high in the first few hours, days and weeks of

a child being born. The reasons for infant deaths at

the earlier and later stages of infancy differ to a certain

extent. Hence, infant deaths are carefully grouped in two

categories according to the age of death:

• Neonatal death: death ocurs before completing four

weeks of life.

• Post neonatal death: death occurs between 28 and

365 days.

Both of these taken together constitute the Infant Mortality

Rate (IMR). Early neonatal mortality rate (number of

infant deaths less than 7 days of life per 1000 live births)

forms an important component of the infant mortality rate

and more specifically of the neonatal mortality rate. Most

post neonatal deaths can be attributed to faulty feeding

practices, poor hygiene and communicable diseases

related to the digestive system such as diarrhoea and

enteritis, and respiratory system such as bronchitis and

pneumonia.29

IMR at the national level is 40 and varies from 44 in rural

areas to 27 in urban areas. Assam and Madhya Pradesh

have the highest IMR (54) and Kerala has the lowest IMR

(12). IMR for female infants is higher than male infants

across all states. During the last decade from 2001–03 to

2011–13, IMR at the national level declined by 33.3 per

cent. Among the bigger states, the decline varied from

52.9 per cent in Tamil Nadu to 22.3 per cent in Assam. In

the rural areas, decline in IMR varied from 52.9 per cent

in Tamil Nadu to 21.8 per cent in Assam. The decline in

IMR varied from 46.8 per cent in Maharashtra to 7.5 per

cent in urban areas of Assam. Neo–natal mortality at the

national level was 28 and ranged from 15 in urban areas

to 31 in rural areas. Among the bigger states, neo–natal

mortality ranges from 37 in Odisha to 6 in Kerala. The

percentage of neo–natal deaths to total infant deaths

is 68.0 per cent at the national level and varied from

56.4 per cent in urban areas to 69.9 per cent in rural

highest percentage (15.64%) of out of school children

in urban areas. The majority of children who are out of

school have never been enrolled in any school even

though the Right to Education (RTE) is in place. This is

closely followed by those who have dropped out after

successfully completing some class. Maximum drop–

outs in this age group are after class two.26

The survey also reveals that poverty or economic

constraints are the main reasons for dropping out of

school. In urban areas a higher proportion of the children

(28.67%) are out of school because of poverty or

economic reasons as compared to rural areas (22.33%).

A gender–wise disaggregation of the reasons reveal

that a higher proportion of the girls are out of school

as they are engaged in domestic work or do not go to

school to take care of the younger children. A marginally

higher proportion of boys are also out of school than

girls as they work to supplement household income. An

estimated 28.07 per cent children with special needs are

out of school. Out of the total children living in slums in

the urban areas, 2.14 per cent are out of school. Slums
from states such as Uttarakhand (20.34%), Punjab (13.25

%), Bihar (11.71%), Assam (8.08%), Madhya Pradesh

(7.46%), Andaman and Nicobar Islands (6.16%), NCT

of Delhi (5.79%), Odisha (4.05%), and West Bengal

(3.13%) report a higher proportion of children to be out of

school than the national average of 28.67 per cent. With

2.70 per cent female children from slums not attending

school, the proportion of out of school females within

slum areas is higher than males (2.14%).27

3.2 Health status of urban children

Ensuring children’s right to life requires early preventive

action and recognisition of the fact that most child deaths

are preventable. A continuum of care is needed, across

the life cycle linking the family, community, anganwadis,

health centres and facilities converging health and child

care services.28
3.2.1 Infant Mortality Rate (IMR)

Infant mortality is defined as infant (less than one year)

deaths per thousand live births. The level of mortality

is very high in the first few hours, days and weeks of

a child being born. The reasons for infant deaths at

the earlier and later stages of infancy differ to a certain

extent. Hence, infant deaths are carefully grouped in two

categories according to the age of death:

• Neonatal death: death ocurs before completing four

weeks of life.

• Post neonatal death: death occurs between 28 and

365 days.

Both of these taken together constitute the Infant Mortality

Rate (IMR). Early neonatal mortality rate (number of

infant deaths less than 7 days of life per 1000 live births)

forms an important component of the infant mortality rate

and more specifically of the neonatal mortality rate. Most

post neonatal deaths can be attributed to faulty feeding

practices, poor hygiene and communicable diseases

related to the digestive system such as diarrhoea and

enteritis, and respiratory system such as bronchitis and

pneumonia.29

IMR at the national level is 40 and varies from 44 in rural

areas to 27 in urban areas. Assam and Madhya Pradesh

have the highest IMR (54) and Kerala has the lowest IMR

(12). IMR for female infants is higher than male infants

across all states. During the last decade from 2001–03 to

2011–13, IMR at the national level declined by 33.3 per

cent. Among the bigger states, the decline varied from

52.9 per cent in Tamil Nadu to 22.3 per cent in Assam. In

the rural areas, decline in IMR varied from 52.9 per cent

in Tamil Nadu to 21.8 per cent in Assam. The decline in

IMR varied from 46.8 per cent in Maharashtra to 7.5 per

cent in urban areas of Assam. Neo–natal mortality at the

national level was 28 and ranged from 15 in urban areas

to 31 in rural areas. Among the bigger states, neo–natal

mortality ranges from 37 in Odisha to 6 in Kerala. The

percentage of neo–natal deaths to total infant deaths

is 68.0 per cent at the national level and varied from

56.4 per cent in urban areas to 69.9 per cent in rural