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Abstract

About 128 million of India?s 1.2 billion populations are aged less than 5 years. India?s under-five mortality rate fell from 2.2 million (123/1000 live births) in 1990 to 1.726 million (63/1000 live birth) in 2010. Based on current trends, India is unlikely to meet the 67% reduction in under-five mortality rate by 2015, compared with 1990 baseline (i.e. less than 41/1000 live births), as stipulated in Millennium Development Goal (MDG) 4, Target 4A. This article examines six major factors encumbering efforts to reduce India?s under-five mortality: poorly delivered antenatal and obstetric care; inadequacy of well-resourced birthing resources; weak immunisation programs, particularly for measles and pneumonia, inadequate prevention and treatment of pneumococcal infections, and; chronic childhood under nutrition. Initiatives to address these obstacles are suggested. The authors posit that a well-resourced and efficiently managed continuum of care approach operated within a strong Indian health system, extending from Pre-pregnancy, Pregnancy, Birth, Postnatal, and Childhood is more likely to accelerate progress towards sustainable reductions in India?s under five mortality compared with the status quo. Particular emphasis should be focused on improving child care during the neonatal period, given the rising proportion of under-five deaths as percentage of total deaths prior to age 5 years.

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