Reproductive health, and child health and nutrition in India: meeting the challenge

Abstract

India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to Correspondence to: Prof Vinod Kumar Paul, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi 110029, India vinodkpaul@hotmail.com. Contributors DG did the secondary analyses of the NFHS data. All other authors contributed to the conceptualisation, contents, and writing of the report.Conflicts of interest DO was originally a reviewer of this report and was requested to join as a co-author after the first draft; he has received payment for employment from the University College London Institute of Child Health, grants from a Wellcome Trust Fellowship, and payment for visiting lectures at the London School of Hygiene and Tropical Medicine.The other authors declare that they have no conflicts of interest. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.

Characterisation of anaemia and associated factors among infants and pre-schoolers from rural India

“…Activities to improve food security and dietary diversity are complementary to provision of Fe, although they may be longer-term strategies. Currently, global nutrition efforts have a strong focus on the first 1000 d of life, and while this is a critical period for growth and development (39) , our findings also highlight that malnutrition continues to be a major issue in the pre-school years in this setting. Because anaemia and Fe deficiency are related to cognitive and socio-emotional development and learning ability beyond infancy, it is essential that control strategies also include the pre-school years.…”

A retrospective analysis of the risk factors leading to perinatal mortality at a tertiary care hospital of Sikkim, India

“…6 It is estimated that neonatal mortality rate would reduce by 9.4% if age at childbirth is raised to above 20. 7,8 Women with age more than 35 in our study suffered from various medical disorders of pregnancy like thyroid disorder, essential hypertension, diabetes which amounted to greater perinatal loss.…”

Dietary diversity among women in the reproductive age group in a rural field practice area of a medical college in Mandya district, Karnataka, India

“…The reason for this difference might be the fact that the most of the women in our study belonged to the nuclear family and hence a better standard of living. 8 In a study by Goswami et al, the mean height, weight and BMI was 152.88cm, 52.88kg and 22.36kg/mt 2 . These findings are similar to the results in our study.…”