Child mortality trends and determinants – policy implications for child survival in India

In 2003, about 2.2 million children under age 5 died in India which is the highest total of any country and about 20 percent of all child deaths globally. Where most children die is shown in Figure 1. Recent years have shown a slowing down in the decline in infant mortality rates in India, resulting in a departure from the longer-term trends (Claeson, Bos, et al 1999, 2000) . The slowing down in child mortality decline in India has called for new approaches that go beyond diseaseprogramand sector – specific approaches. This paper provides an input to the debate about what, why and how to speed up the rate of decline and accelerate progress towards the child mortality Millennium Development Goal of India. This is a synthesis of analytical work done by the World Bank-WHO Child Health and Poverty Working Group, the Bellagio study group on child survival, the recent MDG analysis of trends and determinants discussed in the Millennium Development Goals for Health; Rising to the Challenges and on Bank analysis of child mortality in India (Victora, Wagstaff 2003; World Bank, 2004; Claeson, Bos 2000). Three issues are discussed: