In a country like India, where nearly two children below five die every minute, dismissing the problem of child mortality as one that plagues only the under-privileged sections of the country is akin to turning a blind eye to it.
But whether we choose to accept it or not, child mortality is still a serious issue in India even after 72 years of independence, and one that is high across socioeconomic backgrounds.
“Especially in the Indian context, it needs to be noted that even the relatively privileged – the urban, those with secondary or higher education, those in the highest wealth index – have had substantial U5 (Under Five) mortality rate (U5MR) since the first round of National Family Health Survey (NFHS) in 1992-93 up to the recent fourth round in 2015-16,” observes Ali Mehdi, senior fellow of Health Policy Initiative at Indian Council for Research on International Economic Relations (ICRIER).
Mehdi, who is the author of ‘A Shot Of Justice’ that was recently released, argues in his book that all children have ‘the inherent right to life’, not just those from a socioeconomically advanced background. And hence, our pursuit of justice has to focus primarily on the individual - cutting across caste, religion - rather than solely addressing the larger population or community level injustice.
“If child deaths are happening on a scale that of India’s (India has been the world’s largest contributor to U5 deaths since 1953), it means there has been a systemic failure (of the Indian State), not that of particular individuals, parents or families,” Mehdi stresses.
If a child below five years of age dies due to some action of their own, we cannot hold them responsible for their own death – because clearly someone should have kept a vigilant eye on them or taken care of them. But if the death was not preventable by anyone, Mehdi says it would be termed as “unfortunate rather an unjust”.
“But most parents would have tried their best to save their children – if they weren’t, the State is not just responsible for not having stepped in to offer appropriate assistance as required, but also for the lack of capacity of parents to take care of their children,” he stresses.
For long the medical system has borne the blame of child mortality. But Mehdi argues that it is unfair to blame the medical system alone for child deaths.
“The healthcare system could have prevented many child deaths if it was not beset by challenges of financing, governance, manpower and infrastructure,” he says. “But the medical system is not the only determinant of child survival. The proper nutrition of child and his / her mother plays a central role in a child’s health and development.”
If the ability to afford healthcare is considered the basis on which the government likes to assume the responsibility for child mortality – as it does in the case of Ayushman Bharat and other healthcare schemes– how do we explain the deaths of children from socioeconomically privileged parents?
“There is a problem in larger ecosystem which needs to be understood and addressed. For example, air pollution affects people across socioeconomic backgrounds. Although the privileged might be able to buy air purifiers, they are still affected since they cannot carry air purifiers everywhere or be completely immune to its effects.”
He adds that India’s healthcare policies largely adopts a curative rather than a preventive approach and that’s part of the problem.
One would assume that child mortality would be naturally high in marginalised communities who have been discriminated at various levels and have lesser access to modern healthcare than their privileged counterparts.
But believe it or not, several statistics have shown that the minority Muslim groups have had an advantage in child survival despite widespread discrimination against them.
Mehdi outlines several factors explaining lower child mortality among Muslims, such as higher urbanization among them; taller stature, non-vegetarian diet, lower employment levels among Muslim mothers; higher treatment-seeking behaviour during diarrhoea, lesser son-preference vis-à-vis Hindus; much less likelihood of open defecation among Muslims vis-à-vis Hindus.
“Almost all these factors have more to do with internal community characteristics rather than public interventions. When it comes to healthcare, the situation of Muslims is usually comparable with that of worst groups – STs and SCs,” he points out, re-affirming the fact that child mortality is independent of factors such as wealth, class, caste and religion.
Therefore, the solution of the problem, as Mehdi explains, lies in developing policies and programs to deal with the “apathy and discrimination” as well as – and more importantly, in developing “the political will to implement them.”