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Though the number of children who die before age 5 has declined significantly in the last two decades, the path to ending child mortality is long and hard to navigate. Nearly 7 million young children still die yearly, largely from preventable causes. What works and what doesn’t in the fight against child mortality? What will it take to go the last mile, and end preventable child deaths?  

India lags behind neighboring Bangladesh in reducing child mortality

India represents a fifth of the world's under-5 deaths and is considered unlikely to hit its UN Millennium Development Goal — while the story is very different in Bangladesh, as GlobalPost's AMY YEE reports.

LUCKNOW, India — In this busy, run-down government hospital in India’s northern hinterland, ceiling fans stop whirring in the stifling pre-monsoon heat. Examination rooms descend into darkness. And as patients crowd the corridors, a large puddle seeps across the floor from a leaky ceiling.

Then, as the lights flicker back on, diesel generators in the hallways make a chopper-like ruckus. It is a common sound in this poor district, which gets only six to eight hours of electricity a day.

Before 2005, conditions at this hospital in the town of Colonelganj — about 70 miles from the state capital, Lucknow, in India’s Uttar Pradesh State — were much worse. There was hardly any furniture, equipment, or medicine in the many rooms of this two-story facility, which serves a population of 200,000.

Back then the delivery ward featured only one table, so if more than one woman was in labor at a time, the baby was delivered on the floor. Colonelganj has three nurses and one doctor to deliver babies, but most rural government hospitals in Uttar Pradesh have just one nurse or midwife. Some have none at all.

But as part of the Indian government’s National Rural Health Mission, launched in 2005 to shore up rural health care, generators and medical supplies were added to Colonelganj Community Health Center, wards were renovated, and protocols for vaccinations and new medical training were started. Newborn care launched here in 2011 taught medical staff best practices like cutting umbilical cords with clean blades and keeping infants warm by placing them on their mothers’ abdomens, instead of washing or rubbing them with oil as per folk traditions. This basic “kangaroo mother care” can save babies from dying of hypothermia.

“Child survival is symptomatic of the rest of the system.”
~Ramanan Laxminarayan

“Even if electricity is not there, the baby can be warm,” says Husnada Khatoon, a 45-year-old nurse. As if on cue, another power cut plunges the room into darkness.

THE BIGGER PICTURE

India is one of the world’s fast-growing economies, but it still claims a staggering 21 percent — or 1.7 million — of the world’s under-5 deaths. Facing the challenge of reaching an enormous, diverse population of 1.2 billion people over a vast area with generally weak governance, India, with a death rate for children under 5 of 61 per 1,000 live births, is widely considered unlikely to meet the UN Millennium Development Goal to reduce that figure to 38 by 2015.

In contrast, neighboring Bangladesh, one of the world’s poorest countries, is on track to reach its UN goal of reducing under-5 deaths by two-thirds from 1990 levels. Global health experts point out that Bangladesh is far smaller than India, more homogenous, and does not have so many layers of fragmented government. They also note that Bangladesh has extensive grassroots networks to reach people. But to many observers, Bangladesh’s success in lowering its child mortality rate provides a stark comparison with its bigger neighbor.

A mother with her 3-year-old daughter, who suffers from chronic diarrhea and tuberculosis, at the District Hospital, Panna, Madhya Pradesh in Central India.

(Harman Boparai/GlobalPost)

A closer look at India’s struggle to reduce child deaths reveals a mixed picture. In this huge, diverse, and complex country, different states have vastly different social conditions, ranging from dire to impressive.

Six of India’s 28 states and its capital city, Delhi, are on track to meet or have already reached the UN target to reduce child mortality by two-thirds from 1990 levels, according to UNICEF’s Infant and Child Mortality in India report. Added together, the population of these states — Kerala, Tamil Nadu, Punjab, Himachal Pradesh, West Bengal, and Maharashtra — is larger than that of the United States.

Child deaths in the tropical southern state of Kerala, the standout among them, is 15 deaths per 1,000 live births — on par with the rates in Turkey and Venezuela.

But other states, including Uttar Pradesh, are lagging behind in the fight against child mortality. With a population of 200 million, Uttar Pradesh is far larger than the entire country of Bangladesh. Uttar Pradesh's population is even slightly larger than that of Brazil.

Uttar Pradesh is also infamous for corruption, poor governance, and troubling social indicators. Deaths of children under age 5 in the state is 79 per 1,000 live births, according to India’s 2010 Sample Registration System.

And as India’s most populous state, Uttar Pradesh embodies the many challenges — from demographics to governance — that the country faces in combating deaths of children under age 5.

More from GlobalPost: Defying the odds: Bangladesh makes strides in child health

http://www.globalpost.com/dispatch/news/regions/asia-pacific/india/130816/india-child-mortality-bangladesh-un-millennium-development-goal