The fate of children's health in India is nothing to write home about in general barring a few honourable exceptions, according to recent studies carried out by United Nations in the last couple of months. The struggle for survival begins before birth and remains an uphill task, especially so if the child happens to be a girl - born or unborn.
The recent Mumbai High Court judgment disallowing the abortion of a 26 week old foetus sparked off a nationwide debate on abortion and a woman's right of choice. But, it is very clear that for a majority of Indian women, medical termination of pregnancy (MTP) or abortions remains largely unsafe.
Unsafe abortions are those performed illegally, by untrained practitioners with faulty equipment, leading to injuries, infections and even death. India has the highest number of unsafe abortions in the world. According to government estimates 8.9 percent of maternal deaths in India every year - around 15,000 are caused by unsafe abortions. This happens despite doctors' claims that MTP, if done according to procedure and in sanitized conditions, is among the safest medical procedures.
Of the 6.4 million abortions performed in India in 2002 and 2003, more than 55 percent or about 3.6 million were unsafe, according to findings of Abortions Assessment Project I, 2004. It also pointed out problems of reach and access with public investment in abortion facilities being woefully inadequate. Only 25 percent of abortion facilities in the public sector are government owned, the rest are private clinics and almost always out of reach of the poor.
According to doctors of MTP committee at Federation of Obstetric and Gynecological Societies of India, they are inadequate and inequitable distribution of facilities for safe abortions add to the problem. Contraceptive usage is low in India hence the need for safe abortions services. Besides, only six percent of India's 23,000 primary health centers provide abortion services. So, while the need for abortions is important, it is clear that many, unborn children are destined to die even before they are born. Global experts on management of severe and acute malnutrition in country have said that there are over a million children in Madhya Pradesh who are severely wasted or under nourished and the hospitals, health centers and nutrition rehabilitation centers donot have the capacity to treat such large number of children.
The experts made this observation while talking to senior state government officials' doctors and media persons after concluding a week-long visit to Shivpuri in Madhya Pradesh during early August 08. They had studied the nutrition rehabilitation centers in the district. They were accompanied by UNICEF-India's section chief for nutrition Dr. Victor Aguayo, who praised the commitment of the doctors, nurses and aganwadi workers but they also pointed out that since the undernourishment prevalence figures were too high, it was not hospitals, health centers or nutrition rehabilitation centers alone that could tackle the crisis. The problem would have to be dealt with at the community level.
Dr. Aguayo said about 80 percent of his organization's efforts go into prevention of malnutrition. However, their priority was also to provide quality care for children with severe acute malnutrition, he added. On the gravity of the problem of malnutrition, Dr. Aguayo said 60 percent of the wasted children in India live in six states. In each of three states Uttar Pradesh, Madhya Pradesh and Bihar. UNICEF's mission was to support and scale up facility and community based care for children suffering from severe acute malnutrition. The experts collectively pointed that about 40 percent of Indian children have a deficit in the growth nutrients that needs to be corrected. Some have such severe deficits that they are at immediate risk of death.
Two NGOs in Madhya Pradesh, on the eve of Independence Day have claimed that 21 children died of malnutrition in the past two months. The deaths took place in 11 villages of two blocks in Satna district bordering Uttar Pradesh. These deaths came within two months of a Supreme Court order asking the Satna district Collector to file an action taken report after seven children were believed to have died of malnutrition. These children too had died in the same district. The order had come on June 21 from a commissioner appointed by the court after an NGO Right to Food Campaign - one of the organizations that have claimed the 21 deaths - sought its intervention. The Collector was told to file his report by 15 July and in it outline immediate steps to tackle the situation as well as long term measures to prevent recurrence of malnutrition deaths. However, the Collector was unable to file the report within the deadline but hopes to do so within a month. Meanwhile the state's Women and Child Development Minister has denied that there were so many malnutrition deaths, even children of well to do families fell sick during the monsoon and die.
Calling it a fundamental truth the UNICEF in its latest report' State of Asia Pacific's children 2008, which examines the latest trends in child and maternal health said unless India achieves major improvements in health, nutrition, water and sanitation, education and gender equality and child protection, global efforts to reach health related Millennium Development goals would fail.
According to UNICEF, in 2006 2.5 million child deaths took place in India (2.1 million) and china 415,000, according for nearly a third of all child deaths in the world. While child mortality rates have declined in both countries, the report added, there are massive disparities in the availability of healthcare across different socio economic strata.
The divide between rich and poor is rising at a troubling rate leaving vast numbers of mothers and children at risk of increasing relative poverty and continued exclusion from quality primary health care services, the report said, adding that pneumonia, diarrhea and malnutrition are major causes of child death in the region. Also in India one out of every three women is underweight, putting them at risk of having low birth weight babies, who are 20 times more likely to die in infancy than healthy babies. The need is to increase public health expenditure, which at present is well below the world average of 5.1.
Shibani Dasgupta, NPA
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