Overview of Child Mortality: Global and Indian Context

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. Newborn deaths constitute nearly 47% of all under-five mortality, highlighting the stagnation in reducing neonatal deaths compared to post-neonatal mortality. India’s under-five mortality rate (U5MR) declined from 43 per 1000 live births in 2015-16 (NFHS-4) to 32 per 1000 in 2019-21 (NFHS-5), while neonatal mortality rate (NMR) stands at 24 per 1000 live births, indicating persistent challenges in neonatal survival. Despite progress, preventable causes such as prematurity, infections, and malnutrition remain dominant contributors to child deaths worldwide and in India.

Constitutional and Legal Framework Governing Child Health in India

Article 21 of the Constitution guarantees the right to life and health, underpinning state responsibility for child survival. The National Health Mission (NHM) operationalizes child health programs, including immunization and neonatal care. The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 regulates infant nutrition to combat malnutrition. The Prohibition of Child Marriage Act, 2006 indirectly improves child health by delaying motherhood, reducing risks associated with adolescent pregnancies. The Juvenile Justice (Care and Protection of Children) Act, 2015 safeguards vulnerable children. The Supreme Court’s ruling in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996) emphasized state accountability in child welfare.

Economic Dimensions of Child Mortality and Health Interventions

India allocates approximately 2.5% of GDP to health (Economic Survey 2023-24), with NHM receiving ₹35,000 crore in 2023-24. Malnutrition and child mortality cause an estimated 3% GDP loss annually due to diminished future productivity (World Bank 2022). Evidence shows that low-cost interventions like immunization and neonatal care can reduce child mortality by up to 40%, yielding substantial economic returns. The pediatric healthcare market in India is projected to grow at 15% CAGR, driven by government schemes and private sector expansion.

Key Institutions Monitoring and Implementing Child Health Policies

• UNIGME: Provides global child mortality data and trend analysis.
• Ministry of Health and Family Welfare (MoHFW): Formulates and implements child health policies.
• National Health Mission (NHM): Executes maternal and child health programs at the grassroots.
• NITI Aayog: Monitors Sustainable Development Goal (SDG) targets related to child mortality.
• World Health Organization (WHO): Offers technical guidance on child survival strategies.
• UNICEF: Supports child survival and nutrition programs globally and in India.

Causes and Trends in Child Mortality

Neonatal deaths primarily result from prematurity, birth complications, and neonatal infections. Among children aged 1-59 months, pneumonia, diarrhoea, and malaria are leading causes, often exacerbated by malnutrition. The 2025 UNIGME report estimates over 100,000 deaths directly attributable to severe acute malnutrition (SAM) in children aged 1-59 months, marking the first global quantification of SAM as a direct cause of death. Since 1990, global under-five mortality declined by about 60%, neonatal mortality by 45%, but neonatal deaths now form nearly half of under-five deaths, indicating slower progress in neonatal survival.

Critical Gaps in Child Mortality Reduction Efforts

India’s child survival programs inadequately integrate neonatal care with community health services, limiting outreach and early intervention. Severe acute malnutrition remains under-addressed as a direct cause of death, despite its significant mortality burden. Fragmentation between maternal health, nutrition, and child health programs reduces efficiency. Additionally, disparities in healthcare access persist between urban and rural areas and among socio-economic groups, impeding equitable progress.

Way Forward: Strengthening Child Survival Interventions

• Integrate neonatal care with community health workers (ASHAs) to ensure timely identification and referral of at-risk newborns.
• Scale up treatment of severe acute malnutrition through community-based management and facility-based care.
• Enhance maternal nutrition and antenatal care to reduce prematurity and low birth weight.
• Expand universal immunization coverage and promote hygiene to reduce pneumonia and diarrhoea deaths.
• Leverage digital health technologies for real-time monitoring of child health indicators.
• Address socio-economic and regional disparities by targeting vulnerable populations.

Jharkhand & JPSC Relevance

• JPSC Paper: Paper 2 (Health and Social Welfare), Paper 3 (Economic Development)
• Jharkhand Angle: Jharkhand has a high under-five mortality rate (around 38 per 1000 live births as per NFHS-5), with significant neonatal mortality and malnutrition prevalence, reflecting challenges in healthcare access and nutrition.
• Mains Pointer: Frame answers by linking state-specific data to national trends, highlight NHM’s role in tribal and rural areas, and suggest strengthening community health worker networks and nutrition interventions.