Levels and Trends in Child Mortality: Global and Indian Perspectives

Overview of Child Mortality Trends

The United Nations Inter-Agency Group for Child Mortality Estimation (UNIGME) Report 2025 estimates that 4.9 million children under five died globally in 2024, including 2.3 million newborns. Neonatal deaths now constitute nearly 47% of under-five mortality, reflecting a slower decline in deaths around birth compared to post-neonatal periods. This shift underscores the need to focus on perinatal care and quality healthcare services during the neonatal period.

• Global under-five mortality rate has declined by about 60% since 1990.
• Neonatal mortality rate has decreased by 45% since 1990 but remains a significant share of child deaths.
• Major causes of neonatal deaths include prematurity, birth complications, and infections.
• Deaths in children aged 1-59 months are mainly due to pneumonia, diarrhoea, malaria, and severe acute malnutrition (SAM).

Constitutional and Legal Framework in India

Article 21 of the Constitution guarantees the right to life, implicitly covering child survival. The National Health Policy 2017 prioritizes reduction of child mortality through improved maternal and child health services. The Integrated Child Development Services (ICDS) Scheme, launched in 1975 under the Ministry of Women and Child Development, targets nutrition and health for children under six years. The National Family Health Survey (NFHS-5, 2019-21) provides critical data for policymaking. The Epidemic Diseases Act, 1897 and the National Rural Health Mission (NRHM, 2005) support healthcare delivery, while the Juvenile Justice (Care and Protection of Children) Act, 2015 addresses child welfare.

• Article 21 ensures child survival as part of the right to life.
• ICDS focuses on nutrition, immunization, and health education.
• NRHM strengthens rural healthcare infrastructure and maternal-child health services.
• NFHS-5 data shows India’s under-five mortality rate at 34 per 1000 live births (2021).

Economic Dimensions of Child Mortality

India allocates approximately 1.5% of its GDP to public health (Economic Survey 2023-24). The National Health Mission (NHM) budget for 2023-24 was ₹37,000 crore, with a substantial portion earmarked for maternal and child health interventions. Preventable child deaths result in significant economic losses, including lost productivity and increased healthcare costs. The World Bank (2023) estimates that scaling up low-cost interventions such as immunization and nutrition programs can yield a 10:1 return on investment.

• Public health spending at 1.5% of GDP remains low compared to global averages.
• NHM budget prioritizes child survival through maternal health and nutrition.
• Preventable deaths cause billions in economic losses annually (WHO estimates).
• Investment in proven interventions offers high economic returns.

Key Institutions Monitoring and Addressing Child Mortality

Internationally, UNIGME provides data and trends on child mortality. The World Health Organization (WHO) sets global health standards and supports child health initiatives. UNICEF implements child survival programs worldwide. In India, the Ministry of Health and Family Welfare (MoHFW) oversees health policies, while ICDS delivers nutrition and health services. NITI Aayog monitors progress towards Sustainable Development Goals (SDGs), including child mortality reduction.

• UNIGME compiles and publishes global child mortality estimates annually.
• WHO provides technical guidance on neonatal and child health.
• UNICEF implements community-based nutrition and immunization programs.
• MoHFW administers national schemes like NHM and ICDS.
• NITI Aayog tracks SDG indicators related to child survival.

Data Insights: India vs. Regional Comparisons

India’s neonatal mortality rate remains significantly higher than Bangladesh and Sri Lanka despite similar economic contexts. This disparity reflects gaps in healthcare access, quality of perinatal care, and nutrition program effectiveness.

Critical Policy Gaps in Neonatal Care

While post-neonatal child health interventions have improved, neonatal care infrastructure and quality remain insufficient. Many neonatal deaths occur within the first week due to prematurity and birth complications, which are often overlooked in favor of broader child health programs. There is a lack of focus on skilled birth attendance, neonatal intensive care units (NICUs), and early detection of neonatal infections.

• Inadequate neonatal care infrastructure in rural and underserved areas.
• Limited availability of trained health personnel for perinatal care.
• Insufficient integration of neonatal care in existing maternal-child health schemes.
• Low community awareness of neonatal danger signs and timely care-seeking.

Significance and Way Forward

• Prioritize strengthening neonatal care services, including expanding NICUs and training skilled birth attendants.
• Integrate neonatal health indicators explicitly into national health monitoring frameworks.
• Enhance community-based interventions targeting newborn care and maternal nutrition.
• Increase public health expenditure to at least 2.5% of GDP to improve healthcare infrastructure.
• Leverage data from NFHS and UNIGME to target high-burden districts with tailored interventions.

Mains Question

Discuss the trends and causes of child mortality in India, highlighting the challenges in reducing neonatal deaths. Suggest policy measures to address these challenges effectively.