Reproductive health, and child health and nutrition in India: meeting the challenge

Abstract

India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.

Figure 1. Trends and projections in maternal mortality ratio (A) and child (age <5 years) mortality rate (B) in India

(A) Data from the Registrar General of India;^, projection to 2015 is based on the average annual rate of reduction from 1997–98 to 2004–06. MDG=Millennium Development Goal. (B) Data from the Institute for Health Metrics and Evaluation; the projection to 2015 is based on the average annual rate of reduction since 1990.

Figure 2. Causes of maternal deaths in India (1997–2003)

Data from the Registrar General of India.

Figure 3. Causes of deaths among children (age <5 years) in India (2008)

Data from Black and colleagues.

Figure 4. Prevalence of stunting, underweight, and wasting in children (age <5 years)

Reproduced with permission from International Institute for Population Sciences.

Figure 5. Coverage of key interventions for reproductive and child health in different states of India (2007–08)

(A) Women given complete antenatal check-ups. (B) Women who delivered in institutions. (C) Children (aged 12–23 months) given complete immunisation. (D) Use of any method for family planning. Reproduced with permission from International Institute for Population Sciences.