Context
- The UNIGME 2025 report estimates 4.9 million under-5 deaths in 2024, including 2.3 million newborns, highlighting that a large proportion of these deaths remain preventable through low-cost interventions.
- While under-5 mortality declined by over 50% since 2000, progress has slowed by more than 60% since 2015, raising concerns about achieving SDG Target 3.2.
Relevance
- GS 1 (Society):
- Demographic indicators (U5MR, NMR)
- Regional inequalities
- GS 2 (Governance):
- Public health systems, NHM, POSHAN
- State capacity and service delivery
- GS 3 (Economy & Human Development):
- Human capital, nutrition, SDG-3
Practice Question
Q. “Despite significant decline, child mortality remains a challenge due to systemic inequalities.” Analyse with reference to India and global trends.(250 Words)
Key data & global trends
- Under-5 mortality declined from ~9.9 million (2000) to 4.9 million (2024), reflecting success of global health interventions, yet the pace of decline has significantly slowed post-2015.
- Neonatal deaths account for ~47% (2.3 million) of under-5 mortality, indicating slower progress in first 28 days of life, compared to post-neonatal improvements.
- Sub-Saharan Africa accounts for 58% of global under-5 deaths, followed by South Asia (25%), highlighting stark regional inequalities in healthcare access.
- Around 2.1 million deaths in 5–24 age group occurred in 2024, with self-harm leading among girls (15–19) and road accidents among boys.
Causes of child mortality
- Neonatal causes dominate:
- Preterm birth complications (36%)
- Birth asphyxia & delivery complications (21%)
- Post-neonatal causes:
- Malaria (17%), pneumonia, diarrhoea remain major killers, especially in low-income and tropical regions.
- Severe Acute Malnutrition (SAM):
- Causes >1 lakh deaths (5%) directly, with far higher indirect mortality due to weakened immunity.
- Infectious diseases account for ~54% deaths in Sub-Saharan Africa, compared to <10% in developed regions, indicating inequality in healthcare systems.
India’s performance
- Neonatal Mortality Rate (NMR) reduced from 57 (1990) to 17 (2024) per 1,000 live births, reflecting improvements in maternal and neonatal healthcare systems.
- Under-5 Mortality Rate (U5MR) declined from 127 (1990) to 27 (2024), demonstrating significant progress aligned with global trends.
- Gains attributed to:
- Expanded immunisation (Mission Indradhanush)
- Institutional deliveries (JSY, JSSK)
- Primary healthcare strengthening
- However, India still contributes significantly to global mortality due to population size and intra-state disparities.
Constitutional / governance dimension (India focus)
- Article 21 (Right to life) encompasses child survival, making reduction of mortality a core state obligation under welfare governance.
- Public health is a State subject, leading to uneven outcomes across states due to varying administrative capacity and fiscal prioritisation.
- National programmes:
- POSHAN Abhiyaan, NHM, Rashtriya Bal Swasthya Karyakram
- Focus on nutrition, immunisation, maternal care
- Governance challenge lies in last-mile delivery and data gaps, especially in aspirational and tribal districts.
Economic dimension
- Child mortality reduction is among the most cost-effective investments, with UN estimates suggesting $1 invested yields up to $20 in economic returns.
- High mortality leads to:
- Loss of human capital
- Increased healthcare costs
- Lower long-term productivity
- Slowing progress linked to:
- Global funding constraints
- Reduced prioritisation post-COVID recovery phase
Social / ethical dimension
- High mortality reflects structural inequalities based on geography, poverty, gender, and conflict, raising issues of distributive justice and equity.
- Malnutrition-linked deaths highlight intersection of poverty, food insecurity, and maternal health, especially in vulnerable populations.
- Adolescent mortality trends (self-harm among girls) indicate mental health crisis and gendered vulnerabilities.
- Ethical imperative: “No child should die from preventable causes” reflects global commitment to human dignity and rights-based development.
Health / environmental dimension
- Child mortality strongly linked to:
- Primary healthcare access
- Clean water, sanitation (WASH)
- Nutrition security
- Climate change exacerbates risks through:
- Malaria spread (vector expansion)
- Food insecurity → malnutrition
- Conflict-affected regions show 3 times higher mortality risk, due to collapse of healthcare systems and displacement.
Challenges / criticisms
- Slowing progress (post-2015) indicates policy fatigue and insufficient scaling of proven interventions.
- Data limitations:
- Underreporting of malnutrition-related deaths
- Weak civil registration systems in low-income countries
- Persistent regional inequality:
- Sub-Saharan Africa and South Asia disproportionately affected
- Financing constraints:
- Decline in global health aid threatens maternal and child health programmes
- Health system gaps:
- Shortage of skilled birth attendants
- Weak neonatal intensive care infrastructure
Way forward
- Prioritise primary healthcare systems, focusing on maternal care, skilled birth attendance, and neonatal services in high-burden regions.
- Scale up low-cost high-impact interventions:
- Vaccination, ORS, nutrition supplementation, malaria prevention
- Strengthen nutrition programmes, especially targeting Severe Acute Malnutrition (SAM) through community-based management.
- Increase domestic and global financing, ensuring sustained funding for child survival programmes amid shifting global priorities.
- Improve data systems and civil registration, enabling real-time tracking, accountability, and targeted interventions.
- Focus on high-risk geographies (Sub-Saharan Africa, South Asia, conflict zones) through targeted policy and international cooperation.
Prelims pointers
- UNIGME (2004): Led by UNICEF, WHO, World Bank, UN DESA
- SDG Target 3.2: End preventable deaths of children under 5 years by 2030
- Neonatal period: First 28 days of life
- SAM (Severe Acute Malnutrition) newly quantified as direct cause in 2025 report
