Reduction of infant mortality in India.

Abstract

In India the infant mortality rate (IMR) registered an impressive decline during the first 5-6 decades of the 20th century but in the last 30 years a significant decline has not been documented. The IMR continues to be in the range of 120-130/1000. In many developed countries it is reported as less than 20/1000. The World Health Organization (WHO) has recommended that by the year 2000 the IMR should be reduced to below 50/1000. Indias government has set a target of 60/1000 to be reached by 2000. In Kerala this target has already been achieved. Several projects throughout India have indicated that this task can be accomplished. Many lessons can be learned from Kerala and the successful projects. 1 major constraint in information on IMR in India is the lack of uniformity and reliability in the system of recording vital events. Mere knowledge of IMR is insufficient for planning and execution of an appropriate intervention strategy. It is also important to understand the various causes of death. Based on the available information and a review of the literature it is clear that 50% of the deaths in infancy occurred during the neonatal period. The common preventable causes of death in infancy identified are acute respiratory infections acute diarrheal disease low birth weight protein energy malnutrition tetanus neonatorum and communicable diseases like measles whooping cough and typhoid. The high IMR can be reduced by general measures which can only be recommended as medium-term and longterm plans. These include an increase in the gross national product and female literacy a decreasing birthrate and an increasing capita food intake. At this time India is not experiencing rapid gains in any of these areas. Many of the strategies to reduce IMR have been reviewed objectively by Bhargava et al. Each strategy has merit but due to limited resources it is essential to set priorities. The selection of priorities should be based on 4 basic questions: how common is the problem; is it technically feasible to introduce an intervention program; is it inexpensive; and is the intervention culturally and socially acceptable. Careful consideration of the questions can aid in deciding the proper channeling of the available resources. Many conditions responsible for the high mortality are sensitive to simple and inexpensive interventions which can be quickly introduced. Thus the reduction of infant mortality deserves to be a high priority issue.