A progress report does not always bring cheer. A Lancet study showed that death of children under five in India went down from 2.5 million in the year 2000 to 1.2 million in 2015. Unfortunately, this still meant that India had the highest child mortality rate in the world in 2015. The study also found big disparities among states — Assam reported nearly eight times the number of deaths as Goa — and among districts within the same state. What is most worrying is that some of the top causes of these deaths were preventable infectious diseases such as pneumonia and diarrhoea. This highlights, once again, the need to increase India’s paltry health budget. But richer states fared better than poorer ones. Health is a state subject, and political differences between dispensations at the Centre and the state often mean that even the meagre sum allocated in the budget is not fully utilized. For example, the decision of many states to pull out of the Centrally-funded Ayushman Bharat scheme. An increased health budget and better coordination among the Centre and the states would also help in dealing with other causes of child mortality like measles and meningitis that would require greater vaccine coverage.

The leading cause of infant mortality, though, was complications arising from premature birth, which makes babies more susceptible to infections. A healthy baby is the result of a healthy pregnancy. Proper care of an expectant mother is thus key to a child’s survival. This, in turn, leads to India’s inability to root out child marriages — 40 per cent women between the ages of 20 and 49 are married before the legal age according to the National Family Health Survey. Underage mothers stand less chance of carrying their babies to full term. Post-natal care is as crucial. Longer periods of breastfeeding, better sanitation, access to healthcare facilities are some steps that could improve the rate of survival of infants. But here, too, gender is a deciding factor. Even though girls have a better biological survival rate, 131 of them die for every 100 male infants — victims of neglect, poorer nutrition and second-rate medical care. The 2018 Economic Survey put the number of ‘unwanted girls’ — born to parents trying to have boys — in India at 21 million. They are weaned off earlier so that their mothers can have children again, leaving them more vulnerable than boys. But this trend can be broken. Districts with a strong network of Asha workers to educate mothers about ante- and post-natal care in Jharkhand bear proof of this. Recognizing these hidden links may be the first step to reducing child mortality.