There is decline in infant and under-five mortality rates in India along with a simultaneous increase in undernutrition.
This calls for adopting a holistic approach in child healthcare and addressing the root causes for undernutrition.
What is the undernutrition scenario?
Through the interaction of the indices of height, weight and age, undernutrition takes the form of -
stunting (low height-for-age)
wasting (low weight-for-height)
underweight (low weight-for-age)
As opposed to macroeconomic indicators, social development indicators change gradually over a longer period of time.
Accordingly, the results of these interventions are reflected with a lag.
Despite an understanding on this fact, the incidence of undernutrition in children in India is high.
The proportion of children under 5 years of age in the stunted and underweight category has witnessed only a marginal decline in the previous decade.
On the other hand, wasting and severe wasting have increased significantly.
What is the infant mortality scenario?
Historically, childbirth has been dangerous for both women and infants, despite largely preventable causal factors.
But, the government interventions in recent years in healthcare in terms of budget allocation, healthcare schemes and health outcomes have helped significantly.
Sustained efforts at addressing the causal factors of high infant mortality rate (IMR) have resulted in its consistent decline from 55.7 (2005) to 32 (2017).
The percentage of institutional deliveries has nearly doubled from around 38% (2005-06) to 78% (2015-16) through initiatives such as Janani Suraksha Yojana.
Interventions in neonatal (first 28 days of birth) and post-neonatal healthcare (first 28 days of birth to 1 year) have played a pivotal role in bringing down child mortality.
Furthermore, schemes such as the National Rural Health Mission and the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy have helped much.
India is thus moving closer to the Sustainable Development Goals (SDGs) target of ending preventable deaths of infants and mothers by 2030.
Meanwhile, the commensurate decline in under-five mortality rate (U5MR) has taken place at a visibly faster pace than IMR.
U5MR for India is now almost at par with the global average of 39.
This is a result of measures and efforts in immunisation coverage and other factors.
What do these imply?
Clearly, on one hand, IMR and U5MR are declining, and on the other, the burden of undernutrition in children in absolute numbers is on the rise.
Undernutrition certainly indicates the much-to-be-desired nutritional status of the country.
The nascent stages of policy intervention towards addressing moratlity rates have prioritised the survival of children.
It reflects the principle of "first ‘survive’ and then ‘thrive’", as advocated by the World Health Organisation (WHO).
What is the policy shortfall?
The government policy has focused on significant causal factors of IMR and U5MR, like postnatal healthcare.
However, other important factors like nutritional status of adolescent girls (future mothers) and prenatal nutrition have received scant attention.
But notably, nutritional status runs in a viscous intergenerational cycle.
The adolescent girls with poor nutritional status later become undernourished pregnant women.
They, in turn, are likely to give birth to children who are stunted, wasted or underweight.
What lies ahead?
A lower IMR and U5MR means that the total population of surviving children has increased in absolute numbers.
As a consequence, the total proportion of undernourished children has also increased in absolute numbers.
The next logical step would thus involve shifting focus of government policy towards tackling the incidence of undernutrition.
Any attempt to reduce undernutrition in India should address the root causes.
Policy intervention should now focus on bringing down the incidence of undernutrition in adolescent girls, pregnant women and young children.
