A hospital in Srinagar, Kashmir. Credit: Umer Asif/IPS

By Umar Shah
SRINAGAR, India, Dec 18 2015 (IPS)

In an isolated ward of one of Kashmir’s largest government-run hospitals, 54-year-old Ashraf Ali Khan is finding it hard to sleep properly. His 15-year-old son, Asif, is sitting on a bench near the bed staring at his ailing father.

Asif has not been told by his family that his father is suffering from a potentially terminal disease cancer. He knows his father is suffering from a consistent fever which sent him to the hospital, but doesn’t know his father is in the last stage of the crippling disease.

Ashraf Ali, a carpenter, went to the doctor eight months ago after persistent coughing. He had a chest X-ray which then led to further examinations. After series of tests, it was finally he was diagnosed with lung cancer. He has two months to live at best.

Ashraf is among thousands of people who have ben struck down with the disease. In a war-torn Kashmir, about 4000 cases are found every year in this Himalayan region.

Apart from the political uncertainty, which so far has claimed thousands of lives, experts says there is a 20 per cent rise in cancer cases in Kashmir with figures never decreasing. The latest data published by the state’s health department has Kashmir topping the list of cancer cases in India.

The data reveals in the past three years, more than 1,700 people have died due to cancer in Kashmir. It says that since January 2014 there were 12,091 patients who were detected with cancer in various state hospitals. In 2013, 6,300 patients were detected with the killer disease.

The top 10 cancers taking a toll in Kashmir are lung cancer, stomach, colon (large intestine cancers), breast, brain, esophagus (cancer of food pipe), non-Hodgkin’s lymphoma, gastroesophageal, junction cancer (cancer between the stomach and food pipe), ovarian and skin cancers.

Experts say the cancer mortality rate among the people in Kashmir witnessed a sharp increase due to some leading behavioural and dietary risks, including high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use and lack of regular check-ups. Changing lifestyle, environmental degradation and differing food habits are reasons attributed to the surge in all the cancers especially in esophagus, colon and breast cancers.

Kashmir’s leading oncologist Mohammad Maqbool Lone says the situation in Kashmir is becoming more grim every day a with the highest number of lung cancers In the country found in the people of Kashmir.

“The situation is indeed alarming in Kashmir. There are patients hailing from every part of Kashmir including the far flung areas which are diagnosed with such a terminal disease,” says Lone.

Until now no single factor has been identified as the main cause of the rising cancers as compared to other regions of India. As health experts in Kashmir are not certain about the major causes for the rise of the deadly disease, they suspect three main components can trigger the rise of cancer in this Himalayan region.

One is a societal component with poor rural lifestyles and general deprivation, in particular a lack of vitamins and dietary nutrients.

The second reason for rising cancers in Kashmir is the use of copper utensils in cooking, the consumption of spicy, deep fried foodstuffs, and the drinking of hot salty tea which is largely being consumed in every home in Kashmir.

The third factor in rising cancer cases is an environmental issue with exposure to high levels of dietary nitrosamines from diverse sources. Overall, these three components are the general pattern that has led to esophageal and other cancers.

Oncologist Abdul Rashid Lone says that rising numbers of smokers has led to a rise in lung cancers here. He also claims that the detection rate also has increased besides the advancement in medical technologies.

“Earlier, most of the cancer cases in Kashmir used to go unnoticed. At present, the technology has advanced so much that a patient can be diagnosed with the disease. This is the main reason that today we say cancer cases rise in Kashmir,” Dr Lone said.

Oncologist Riyaz Ahmad Shah says that apart from the lung cancer, there are cases of stomach cancer on the rise in Kashmir. He says certain types of cancers are found in children including blood cancers and tumours.

“In case of females, there are cancers related to the reproductive system like cervical cancer, ovarian tumours and breast cancer. In males there are stomach, lung, and esophagus cancers found,” said Dr Shah.

Renowned gastroenterologist, Dr Showkat Ahmad Zargar, says any delay in the detection of cancer could prove fatal for the patient. He says due to the massive adulteration in food items, gastric diseases are on rise in Kashmir.

“Such diseases are killing people slowly. The people here are not very much health conscious which leads to the delay in detecting whether a person is suffering from a cancer or not,” Dr Showkat said.

“There are high chances that a person suffering from cancer can be cured if detected at early,” said Dr Sana-ul-lah who heads the oncology department in one of Kashmir’s leading government run hospitals.

Tobacco use in Kashmir has increased along with unhealthy diets. “If the key risk factors are avoided, Kashmir could be saved from this fatal disease which continues to claim thousands of precious lives every year in the region,” Dr Sana-ul-lah said.

Insha Usman, a research scholar says there are no major steps being taken by the state government to ensure that people are informed and are aware of cancer. She says early symptoms and preventive measures should be made public in far flung areas of Kashmir so that people are conscious of the cancer threat.

“Ironically, there is no comprehensive policy available with the government at the present time that could have made people aware of such a fatal disease. Mass awareness campaigns in villages and towns and people are informed about the symptoms of cancer and early treatment,” she said.

According to the latest study, colorectal cancer (CRC) is the major cause of mortality and morbidity worldwide and in Kashmir, CRC has been found to be the third most common gastrointestinal cancer after esophageal and gastric.

The study says there are certain factors which increase person’s risk of developing CRC. “The most important of these are the age, diet, obesity, diabetes and smoking, personal cancer history, alcohol consumption, large intestinal polyps, family history of colon cancer, race and ethnic background, genetic or family predisposition,” said the finding.

It adds that another major cause of cancer deaths was a late visit to the doctor. “The involvement of quacks, inexperienced medical practitioners and post-referral delays make the situation difficult to handle,” the study concluded.

The steady rise in cancer patients began several decades ago leading to the establishment of an NGO. The Cancer Society of Kashmir, formed in 1999, provides medical and financial help to poor patients suffering from the dreadful disease here.

Masood Ahmad Mir from Cancer Society of Kashmir says that they have started a one-day care centre which runs twice a week. “During this time, doctors from different fields like medical oncology, radio oncology, and gastroenterology sit together and treat patients. We do not charge anything from the people who visit us for the treatment,” he said.

(End)

Prof Grace Irimu shows IPS a drip feed bag and a copy of Kenya’s ‘Basic Paediatric Protocols’ as she explains the importance of intravenous treatment in saving the lives of young children affected by acute watery diarrhoea. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 23 2015 (IPS)

Acute watery diarrhoea is a major killer of young children but misunderstanding over the benefits of fluid treatment is preventing many Kenyan parents from resorting to this life-saving technique and threatening to reverse the strides that the country has made in child health.

The 2014 Kenya Demographic and Health Survey, released in April this year, reports that the country’s under-five mortality rate fell to 52 deaths per 1,000 live births in 2014, down from the 74 deaths in 2008-09, but still far from the 32 per 1,000 live births targeted under the Millennium Development Goals (MDGs).“Parents must … understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea” – Prof Grace Irimu, Associate Professor of Paediatrics, University of Nairobi

The primary treatment for acute watery diarrhoea is rehydration, administered intravenously in the most severe cases of very young children suffering from shock after losing excessively high quantities of body fluids. A fluid bolus – or rapid liquid dose – delivered directly through an intravenous drip allows a much faster delivery than oral rehydration.

However, notes nurse Esther Mayaka at the Jamii Clinic in Mathare, Nairobi, “parents of children brought to hospital with acute watery diarrhoea are refusing to have them put on [drip] fluid treatment and this is a major concern because diarrhoea is a leading killer among children and giving fluids is still the main solution.”

She told IPS that the ongoing rains and floods in many parts of the country “have created a comeback for diseases like cholera whose most telling sign is watery diarrhoea which needs to be managed with fluids.”

In February this year, Kenya’s Director of Medical Services, Dr Nicholas Muraguri, issued a cholera outbreak alert following an increase in cases of acute watery diarrhoea in several counties, including Homa Bay, Migori and Nairobi.

According to Prof Grace Irimu, Associate Professor of Paediatrics at the University of Nairobi, the reluctance to resort to drip fluid treatment has arisen due to misunderstanding generated by a Fluid Expansion As Supportive Therapy (FEAST) study in 2011 to establish whether the bolus technique was the best practice to use among children diagnosed with shock.

The FEAST study, which was conducted among children in Kenya, Tanzania and Uganda, found that fluid boluses increased 48-hour mortality in critically-ill children with poor blood circulation or shock in these resource-limited settings in Africa, but Irimu told IPS that the study excluded diarrhoea and only studied illnesses associated with fever, such malaria and sepsis.

“Parents must therefore understand that rapid fluid treatment is life-saving for children diagnosed with shock or poor blood circulation due to diarrhoea,” she said.

The Kenya Paediatric Association is also trying to set the record straight and, in a statement shared with IPS, the association reiterated that “diarrhoea complicated by severe dehydration is one of the biggest killers of children globally.”

According to the paediatrics association, the FEAST study excluded children with diarrhoea and dehydration because “the value of giving fluids in this group is well known. Giving appropriate fluid therapy is essential.”

Prof Irimu told IPS that the FEAST study had led to a revision of the ‘Basic Paediatric Protocols’, Kenya’s national guidelines for paediatric care, and clauses that address the treatment of diarrhoea were also revised.

Previously, a child diagnosed with shock as a result of diarrhoea would be given fluids in three cycles, every 15 minutes depending on the response. Now, the child receives the fluids in two cycles and if there is no response, health providers are advised to proceed to slower fluid administration where the child is given the amount that the body needs, depending on the level of dehydration.

Meanwhile, the country continues to make strides in dealing with HIV/AIDS – another critical health issue covered by the MDGs – among children. Studies show that the number of children with HIV aged between 18 months and 14 years fell from 184,000 in 2007 to 104,000 in 2012, according to the most recent Kenya Aids Indicator Survey.

However, Prof Joseph Karanja, a reproductive health and HIV/AIDs expert in Nairobi, says that the country can still do better because “through available antiretroviral drugs as a preventive measure among HIV positive mothers, HIV transmission to the infant can be reduced to as low as one percent.”

Dr Pauline Samia, a paediatric neurologist and a board member of the Kenya Paediatric Association, says that there is also a commitment to address conditions that challenge the management of HIV among children such as epilepsy.

“Though research in this area is limited, an estimated 6.7 percent of children with HIV also have epilepsy, with at least 50 percent of children with HIV having central nervous system problems such as delayed development, behavioural challenges and convulsions,” she observes.

Regarding progress in other MDGs, some progress has been made in reducing the prevalence of underweight children less than five years of age, one of the goals set for eradicating extreme hunger and poverty.

The 2014 Kenya Demographic and Health Survey reports that not only has childhood malnutrition declined significantly, from 35 percent in 2008 to the current 26 percent, but the prevalence of underweight children also decreased from 16 percent in 2008 to 11 percent in 2014.

On the front of improving maternal health, the survey says that while maternal mortality remains high at 488 deaths in every 100,000 live births, in the past five years more than three in five births (61 percent) took place in healthcare facilities, a marked improvement compared with the 43 percent in 2008.

Edited by Phil Harris   

She is just 14, but Janida avoids eye contact with others, preferring to look down at the ground and nodding her head if someone tries to engage her in conversation.

Janida (not her real name) was once a sociable and playful child, but that was before she was sexually abused by her stepfather and giving birth to a baby who is now four months old.

Her days marked by trauma and depression, Janida is just one of many girl children in Kenya who have been abused and robbed of their childhood, leaving them emotionally scarred.

“The little girl [Janida] underwent both physical and mental torture,” Teresa Omondi, Deputy Executive Director and Head of Programmes at the Federation of Women Lawyers (FIDA) Kenya, told IPS. ”Her best option was to terminate the pregnancy rather than suffer the mental and physical torture, but she could not afford the cost of a safe abortion.”Many of the induced abortions taking place continue to be unsafe and complications are common” – Teresa Omondi, Federation of Women Lawyers (FIDA) Kenya

Under Article 26 (4) of the Kenyan constitution, “abortion is not permitted unless, in the opinion of a trained health professional, there is need for emergency treatment, or the life or health of the mother is in danger, or if permitted by any other written law.”

In September 2010, Kenya’s Ministry of Health released national guidelines on the medical management of rape or sexual violence – guidelines that allow for termination of pregnancy as an option in the case of conception, but require psychiatric evaluation and recommendation.

Then, in September 2012, the health ministry released standards and guidelines on the prevention and management of unsafe abortions to the extent allowed by Kenyan law, only to withdraw them three months later under unclear circumstances.

According to Omondi, “the law has not yet been fully put into operation and many providers have not been trained to provide safe abortion, meaning many of the induced abortions taking place continue to be unsafe and complications are common.”

The health ministry is responsible for doctors and nurses not being permitted to be trained on providing safe abortion, said Omondi, so “it is ridiculous that while Kenya’s Ministry of Health accepts that post-abortion care is a public health issue regarding numbers, practitioners have their hands tied.”

The issue of unsafe abortions in Kenya hit the headlines in September last year, when Jackson Namunya Tali, a 41-year-old nurse, was sentenced to death by the high court in Nairobi for murder, after the death of both Christine Atieno and her unborn baby in a botched illegal abortion.

Various inter-African meetings attended by Kenya have been held on reducing maternal mortality rates by providing safe abortions, with health ministers agreeing that statistics show that countries that do provide safe abortions have reduced their maternal mortality rates.

In a recent analysis, Saoyo Tabitha Griffith, Reproductive Health Rights Officer at FIDA and an advocate at the High Court of Kenya, said that despite Kenya having adopted a Constitution that affirms among others, women’s rights to reproductive health and access to safe abortion, Kenyan women continue to die from unsafe abortion – a preventable cause of maternal mortality.

For Dr Ong’ech John, a health specialist in Nairobi, perforated uteruses and intestines, heart and kidney failures, anaemia requiring blood transfusion as well as renal problems are just a few of the health complications arising from an abortion that goes wrong.

“Unsafe abortion complications are not just about removal of the products of conception that were not completely removed. One can evacuate but the perforated uterus has to be repaired, or you remove the uterus and it is rotten,” Dr Ong’ech told IPS.

“When the health ministry issued a directive in February this year instructing all health workers, whether from public, private or faith-based organisations, not to participate in any training on safe abortion practices and the use of the medication abortion, many questions were left unanswered,” said Omondi.

A highly respected Kenyan doctor, Dr John Nyamu, spent one year in prison in 2004 after his clinic was raided following the discovery of 15 foetuses on major roads together with planted documents from a hospital he had worked for but had since closed.

Speaking of his ordeal with Mary Fjerstand, a senior clinical advisor at Ipas, a global non-governmental organisation dedicated to ending preventable deaths and disabilities from unsafe abortion, Nyamu said that the publicity surrounding his imprisonment helped people to “realise the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public.”

He went on to say that Kenya wants to achieve the Millennium Development Goal of a 75 percent reduction in maternal mortality, but that “it can’t be achieved if safe abortion is not available.”

A May 2014 World Health Organisation (WHO) updated fact sheet indicates that every day, approximately 800 women die worldwide from preventable causes related to pregnancy and childbirth, with 99 percent of all maternal deaths occurring in developing countries.

Edited by Phil Harris   

Zimbabwe struggles to contain maternity deaths. Here in this southern African nation, the number of women dying in childbirth continues to rise. Credit: Jeffrey Moyo/ IPS

By Jeffrey Moyo
HARARE, Jan 30 2015 (IPS)

For 47-year-old Albert Mangwendere from Mutoko, a district 143 kilometres east of Harare, the Zimbabwean capital, transporting his three pregnant wives using a wheelbarrow to a local clinic has become routine, with his wives delivering babies one after the other.

But these routines have not always been a source of joy for Mangwendere.

“Over the past twenty years, I have been ferrying my pregnant wives to a local clinic using a wheelbarrow because I have no (full size) scotch cart and we have lost 12 babies in total while traveling to the clinic,” Mangwendere told IPS.

Mangwendere’s case typifies the deepening maternity crisis in this Southern African nation.An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications – United Nations issue paper on 'Maternal Mortality in Zimbabwe', 2013

An estimated 3,000 women die every year in Zimbabwe during childbirth and at least 1.23 percent of gross domestic product (GDP) is lost annually due to maternal complications, according to Maternal Mortality in Zimbabwe, a United Nations issue paper released in 2013.

In fact, the United Nations found that maternal mortality worsened by 28 percent between 1990 and 2010. The major causes were bacterial infection, uterine rupture (scar from a previous caesarean section tearing during an attempt at birth), renal and cardiac failure, as well as hyperemesis gravidarum (condition characterised by severe nausea, vomiting and weight loss during pregnancy).

This year, the government has allocated 301 million dollars to the health sector for a country of 13.5 million, according to the local NewsDay publication, which concluded: “This is to say that the government intends to spend on average just over 22 dollars on an individual this year. Compare this with 650 dollars for South Africa, 90 dollars for Botswana, 390 dollars for Botswana and 200 dollars for Angola.”

On top of a barely adequate public transportation system, user fees for delivering pregnant women that are charged in healthcare centres are also at fault, say civil society activists.

“In 2012, the government crafted and adopted a policy that saw user fees for maternity services being scrapped,” Catherine Mukwapati, director of the Youth Dialogue Action Network, a grassroots organisation, told IPS.

“But despite this policy, some facilities still charge indirect service fees, which is scaring away many pregnant women from hospitals and clinics, leaving them in the hands of less skilled midwives.”

Zimbabwe’s local authority clinics say they have resisted scrapping maternity fees despite the official directive, claiming that they are not reimbursed as promised by the government.

28-year-old Chipo Shumba pictured here holds her only child after she lost six others while giving birth over the past few years, a crisis health experts in Zimbabwe say is on the rise. Credit: Jeffrey Moyo/IPS

“Council clinics have no choice but to charge the council-subsidised 25 dollars for maternity since they haven’t received money from government,” Harare city director of health services, Stanley Mungofa, told IPS.

The actual cost of providing maternity services in council clinics has been pegged at 152 dollars, Mungofa said. At public hospitals like Parirenyatwa in Harare, the cost of a normal delivery is 150 dollars while a caesarean section costs as much as 450 dollars.

In a bid to lower the high maternity fees of public hospitals and council clinics, a group of donors pledged 435 million dollars for the nation’s health system for the period 2011-2015. The fund – the so-called Health Transition Fund – was led by the health ministry and managed by the U.N. Children’s Fund (UNICEF).

Importantly, the Health Transition Fund is helping to retain skilled workers by raising low wages. Underpaid doctors make up a large part of the country’s “brain drain” and there are now just 1.6 doctors for every 10,000 people.

Maternal fees may not apply in Zimbabwe’s countryside, where many like Mangwendere and his wives live, but other obstacles present an equally insurmountable barrier to obtaining care. Clinics and referral hospitals are often far away from people needing help, a major cause of maternity deaths there.

Finally, the tentacles of systemic corruption have reached into the health care systems. According to Transparency International, one local hospital was found to be charging mothers-to-be five dollars every time they screamed while giving birth.

A staggering 62 percent of Zimbabweans reported having paid a bribe in the previous year, the group stated in its 2013 report on global corruption.

Zimbabwe’s health sector was one of the best in sub-Saharan Africa in the 1980s, but it nearly collapsed when an economic crisis caused hyper-inflation of more than 230 million percent in 2008. Over the following years, chronic under-investment made a bad situation worse.

The increase in maternal mortality is being witnessed despite the U.N. Millennium Development Goal (MDG) for maternal health, under which countries should reduce the maternal mortality ratio by three-quarters between 1990 and 2015.

A 2012 status report on the MDGs asserted that Zimbabwe was unlikely to meet its mandate of reducing the maternal mortality ratio to 174 per 100,000 live births.

In research conducted in 2013 to address causes of maternal death, Zimbabwe’s Ministry of Health and Child Care blamed excessive bleeding after childbirth and unsafe abortion as the major causes of death, although no information was provided to back the claim.

“Statistics on maternal deaths often leave out sad realities of these similar deaths in unreachable remote areas where pregnant women and infants die daily without these cases being recorded anywhere,” said Helen Watungwa, a midwife at a council clinic in Gweru, the capital of the Midlands province, 222 kilometres outside the capital.

“But in any case, with the limited resources we have as nurses, we are doing all we can to save lives both of delivering mothers and infants,” Watungwa told IPS.

“It is truly a miracle that we continue to survive a series of pregnancies while battling to give birth often on the way to the clinic, bleeding heavily without any skilled persons to attend to us, with only our husband tottering with each one of us to the village healthcare centre using a wheelbarrow,” 28-year-old Mavis Handa, one of Mangwendere’s wives, told IPS.

Edited by Lisa Vives/Phil Harris    

By Julitta Onabanjo, Benoit Kalasa, and Mohamed Abdel-Ahad
JOHANNESBURG, Sep 21 2014 (IPS)

Different issues will be competing for the attention of different African leaders attending the 69th United Nations General Assembly Special Session on International Conference on Population and Development (ICPD) Beyond 2014 in New York on Sep 22.

But the central question for Africa’s development today is this: How do we harness the dividend from the continent’s current youthful population?

Solving this issue has never been more fundamental to Africa’s development than it is today.

For decades many, African countries have come up with a variety of ‘development’ plans. But often missing in these documents is how best to harness the potential of the youthful population for the transformation of the continent.

Therefore, strategic investment to harness the potential of the youth population can no longer wait.“African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights”

The groundswell for change

Africa is undergoing important demographic changes, which provide immense economic opportunities. Currently, there are 251 million adolescents aged 10-19 years in Africa compared with 1.2 billion worldwide, which means that around one in five adolescents in the world comes from Africa.

Africa’s working age population is growing and increasing the continent’s productive potential. If mortality continues to decline and fertility declines rapidly, the current high child dependency burden will reduce drastically. The result of such change is an opportunity for the active and employed youth to invest more.  With declining death rates, the working age population in Africa will increase from about 54 percent of the population in 2010 to a peak of about 64 percent in 2090.

This increase in the working age population will also create a window of opportunity  that, if properly harnessed, should translate into higher economic growth for Africa, yielding what is now termed a ‘demographic dividend’ – or accelerated economic growth spurred by a change in the age structure of the population.

Reaping the demographic dividend requires investments in job creation, health including sexual and reproductive health and family planning, education and skill and development, which would lead to increasing per capita income.

Due to low dependency ratio, individuals and families will be able to make savings, which translate into investment and boost economic growth. This is how East Asian countries (Asian Tigers) were able to capitalise on their demographic window during the period 1965 and 1990.

The impact of such a demographic transition on economic growth is no longer questionable – it is simply a fact.

But this transformation requires that appropriate policies, strategies, programs and projects are in place to ensure that a demographic dividend can be reaped from the youth bulge.

Seizing the moment

Without concerted action, many African countries could instead face a backlash from the growing numbers of disgruntled and unemployed youth that will emerge.

In the worst-case scenario, such a demographic transition could translate into an army of unemployed youth and significantly increase social risks and tensions.

To seize the opportunity, African states will need to focus their investments in a number of critical areas. A priority will be the education and training of their youth.

African governments must know that efforts to create a demographic dividend are likely to fail as long as vast portions of young females are denied their rights, including their right to education, health and civil participation, and their reproductive rights.

If these efforts are to succeed, this will demand addressing gender disparities between today’s boys and girls especially, but more specifically, addressing the vulnerabilities of the adolescent girl.

Beyond rhetoric

As we move toward the post-2015 development agenda, unleashing the potential and power of Africa’s youth should be a critical component of the continent’s developmental strategies, as reflected in the Addis Ababa Declaration on Population and Development – the regional outcome of ICPD beyond 2014 – and the Common African Position on the post-2015 development agenda.

This can no longer be reduced to election or political polemics. It requires urgent action.

Young people are central to the realisation of the demographic dividend. It is therefore important to protect and fulfil the rights of adolescents and youth to accurate information, comprehensive sexuality education, and health services for sexual and reproductive well-being and lifelong health, to ensure a productive and competitive labour force.

Africa cannot afford to squander the potential gains of the 21st Century offered by such an important demographic asset:  its youthful population.

Edited by Ronald Joshua

Excerpt:

The death of a 10-day-old girl last November in the Attappadi tribal belt of Kerala, one of India’s best performing states in terms of human development indices, shows how the country’s battle against child mortality is far from won.

The infant’s mother, Saraswathy, a 20-year-old from the Kurumba tribe, was admitted to a government hospital, and delivered the next day. At 1.8 kg, the child was underweight. The mother was discharged but the infant was kept at the hospital, where she died.Experts say the strides taken by India in the 21st century mask its failure to contain infant deaths among the poorest.

Saraswathy told local health workers who visited her tribal area that she left the hospital because she was starving. “The mother was malnourished and this was her third delivery,” Nalini, a health worker, told the local media.

In 2013, over 50 tribal infant deaths were reported in the media from Attappadi, which falls in Palakkad district. This year three tribal infant deaths have been recorded from the area, district medical authorities said Apr. 24.

Experts say the strides taken by India in the 21^st century mask its failure to contain infant deaths among the poorest. Planning Commission figures for 2011-2012 state that around 22 percent of India’s 1.2 billion population is classified as poor.

According to a report of the Registrar General and Census Commissioner of India, the country’s infant mortality rate (IMR) was 42 per 1,000 live births in 2012. IMR refers to the number of newborns who die before reaching one year of age.

Dr. S. Sachidananda Kamath, national executive member of the Indian Academy of Pediatrics, told IPS that a combination of causes like low awareness of health and reproductive rights, maternal anaemia and the burden of malnutrition carried over generations traditionally contribute to India’s high child mortality rate.

“The IMR was 148 in 1971 and decreased to 44 in 2011. There has been a consistent decline in IMR. The rate of decline in the current decade is higher than in the previous one. For further reduction of IMR, we have to adopt different strategies for better child health care,” he said.

Health activists say the IMR varies among different states within India, but what is much less known is that within states like Maharashtra, Karnataka, Madhya Pradesh and Gujarat, there are wide and astonishing IMR variations.

Dr. Mohan Rao, professor at the Centre of Social Medicine and Community Health in Jawaharlal Nehru University, New Delhi, admitted that there were regional inequalities in health indicators such as IMR, U5MR (mortality rate of children under five) and MMR (maternal mortality rate).

“There are inter-state inequalities. Equally true are intra-state inequalities. What is not, however, receiving adequate attention is that the poor – and the Scheduled Castes, Scheduled Tribes and Muslims among them – bear the highest rates of ill-health and disease. And of course are neglected by the state,” he told IPS. Scheduled Castes and Scheduled Tribes are India’s most socially underprivileged communities.

A study by the international NGO Save the Children, published in 2014, finds that despite a decade of rapid economic growth, India accounts for an astounding 29 percent of the global deaths of newborns on their very first day of birth.

The report also highlights that equity is a critical factor – the newborn mortality rate among the wealthiest 20 percent of India’s population is 26 per 1,000 live births, while among the poorest households it is 56 per 1,000 live births, with the infants dying in the very first month of life.

With 30 newborns dying per 1,000 live births, national capital Delhi, which has a large proportion of slums and poor areas, has the worst IMR among the four metropolitan cities that also include Chennai, Mumbai and Kolkata, the study says.

Such deaths can be prevented with better access to healthcare and the presence of qualified birth attendants, say experts.

Anuradha Gupta, Additional Secretary in the Ministry of Health and Family Welfare, said that though India has made a lot of progress in terms of child survival, there is a need to ensure that every child is saved.

“The country has made dramatic progress in bringing the under-five mortality from 114 in 1990 to 52 per 1,000 live births in 2012, a reduction of more than 54.4 percent, while the global reduction is at 44.8 percent,” she told a gathering in New Delhi in February.

However, dearth of funding could prove to be an obstacle.

Analysts calculate that by 2020, India needs more than 10 billion dollars for public health expenditure to meet the future health objectives for women and children, including slashing maternal and child mortality rates.

A study by Indian and foreign academic institutes, published in the international journal Lancet in 2013, said child mortality in 597 districts of India was astonishing because it indicated that some parts of the country had not benefited from the government’s intervention to reduce under-five child mortality.

In 2012, 1.5 million under-five deaths were reported in 597 districts, of which 71 percent were in the nine poorer states, which accounted for half of India’s population, the study said.

Govindan Jayakumar, a health activist in Mangalore, told IPS that both private and public funding were essential to meet future health expenses, mainly targeting women and children.

“The government cannot meet all the expenditure in the health sector. Therefore, private philanthropy has a big role in the development of a vibrant healthcare ecosystem and in the enhancement of health delivery and support systems,” he said.

Doctors suggest that the promotion of institutional and safe deliveries along with increasing the coverage and quality of community-based interventions should continue.

Explaining the co-relation between infant and maternal deaths, Dr. Parameswaranpillai Jayadevan, a paediatrician at a government hospital in Kochi in Kerala, said the security of infants is equal to safe motherhood during the delivery period.

“India is not on track to reach the Millennium Development Goal-5 (MDG-5), which is to reduce the number of maternal deaths by 75 percent between 1990 and 2015,” he told IPS.