India Leads in Reducing Child Mortality: A UN Assessment

Global child mortality trends: The UN report ‘Levels and Trends in Child Mortality’ highlights a significant long-term decline in under-five mortality, with deaths falling by more than half since 2000. However, this progress has slowed considerably after 2015, with the pace of reduction declining by over 60%. In 2024, approximately 4.9 million children died before the age of five, including 2.3 million newborns, indicating that neonatal mortality remains a major concern.

Key structural shifts:

• Newborn deaths now account for nearly half of all under-five mortality.
• Preventable causes such as infections, preterm birth complications, and malnutrition dominate.
• Geographical concentration is high, with sub-Saharan Africa accounting for 58% of deaths.

This reflects inequality in healthcare access and development levels.

Emerging concerns: While earlier gains were driven by immunisation and disease control, recent stagnation is linked to funding constraints, health system weaknesses, and emerging risks such as malnutrition and conflict. The report emphasizes that most deaths are preventable through low-cost interventions, highlighting a gap between knowledge and implementation. Thus, the global challenge is no longer about discovering solutions but ensuring their universal delivery.

Slowing progress explained: The deceleration in reducing child mortality post-2015 is attributed to a combination of systemic, financial, and epidemiological factors. While early gains were achieved through vaccination drives, sanitation improvements, and basic healthcare expansion, further reductions require more complex and resource-intensive interventions.

Key reasons include:

• Health system limitations: Weak infrastructure in low-income countries limits access to skilled birth care and neonatal services.
• Funding constraints: Global health financing has plateaued, affecting maternal and child health programmes.
• Persistent inequalities: Rural, conflict-affected, and marginalized populations remain underserved.
• Malnutrition burden: Severe acute malnutrition directly and indirectly increases mortality risks.

Changing disease profile: Earlier, infectious diseases like measles saw dramatic declines due to vaccines. However, current challenges include neonatal complications and non-communicable risks, which require advanced healthcare systems. For example, managing preterm births demands neonatal intensive care units, which are scarce in developing regions.

Conclusion: The slowdown reflects a transition from “low-hanging fruit” interventions to more complex health challenges. Addressing this requires systemic reforms, targeted investments, and equity-focused policies.

India’s progress: India has made substantial strides in reducing child mortality over the past three decades. The Neonatal Mortality Rate (NMR) declined from 57 per 1,000 live births in 1990 to 17 in 2024, while the Under-5 Mortality Rate (U5MR) dropped from 127 to 27. These achievements reflect sustained public health interventions and policy prioritisation.

Key strategies:

• Expanded immunisation: Programmes like Mission Indradhanush improved vaccine coverage.
• Institutional deliveries: Schemes such as Janani Suraksha Yojana increased hospital births.
• Nutrition programmes: POSHAN Abhiyaan targeted malnutrition reduction.
• Primary healthcare strengthening: Ayushman Bharat and Health and Wellness Centres improved access.

Case study: States like Kerala and Tamil Nadu have achieved low mortality rates through robust public health systems, high literacy, and effective decentralised governance. Their success demonstrates the importance of state capacity and social development in health outcomes.

Way forward: Despite progress, challenges remain in addressing neonatal mortality and regional disparities. India must focus on quality of care, rural healthcare access, and addressing malnutrition to sustain gains.

Neonatal mortality causes: Newborn deaths (first 28 days) account for nearly half of under-five mortality. The leading causes include:

• Preterm birth complications (36%)
• Birth-related complications (21%)
• Infections such as neonatal sepsis
• Congenital anomalies

These causes are closely linked to maternal health and quality of care during childbirth.

Post-neonatal causes: Beyond the first month, infectious diseases dominate:

• Malaria (largest contributor globally)
• Pneumonia
• Diarrhoeal diseases

These are largely preventable through vaccines, sanitation, and timely treatment.

Adolescent mortality: The risk profile changes significantly in older children and adolescents:

• Girls (15–19 years): Self-harm is a leading cause
• Boys: Road traffic accidents dominate

Underlying factor: Malnutrition plays a critical indirect role by weakening immunity, increasing susceptibility to infections. For instance, severe acute malnutrition contributed directly to over 1 lakh deaths in 2024.

Conclusion: The variation in causes highlights the need for age-specific interventions, ranging from maternal care to adolescent mental health and injury prevention strategies.

Effectiveness of low-cost interventions: The UN report underscores that most child deaths are preventable through affordable measures such as vaccination, oral rehydration therapy, breastfeeding promotion, and skilled birth attendance. These interventions have historically driven major declines in mortality, especially between 2000 and 2015.

Advantages:

• High cost-effectiveness and scalability
• Immediate impact on common causes like infections
• Feasible in low-resource settings

Limitations: However, these interventions alone may not suffice for future challenges:

• Neonatal care requires advanced infrastructure like NICUs.
• Malnutrition requires multi-sectoral solutions involving food security and sanitation.
• Health inequities limit access even to basic services.

Case example: Sub-Saharan Africa, despite access to vaccines, continues to face high mortality due to weak health systems and poverty, illustrating that interventions must be complemented by systemic reforms.

Conclusion: While low-cost interventions remain foundational, achieving Sustainable Development Goals requires integrated health systems, better financing, and addressing social determinants of health.

India as a model: India’s success in reducing child mortality offers valuable lessons for other developing nations. The country combined policy commitment, large-scale programmes, and community-level interventions to achieve measurable outcomes.

Key lessons:

• Integrated approach: Combining health, nutrition, and sanitation initiatives (e.g., Swachh Bharat, POSHAN Abhiyaan).
• Decentralisation: Empowering states to innovate based on local needs.
• Targeted schemes: Focused programmes for maternal and child health.
• Data-driven governance: Use of surveys and health data for monitoring progress.

Example: Tamil Nadu’s focus on primary healthcare and institutional deliveries significantly reduced maternal and child mortality, demonstrating the importance of state-level governance capacity.

Challenges and caution: India still faces regional disparities, with poorer states lagging behind. This highlights that economic inequality and governance gaps can limit progress.

Conclusion: The key takeaway is that reducing child mortality requires political will, sustained investment, and community engagement. Other countries can adapt these strategies while tailoring them to local contexts.