This year’s World Health Day theme—preventing maternal and newborn deaths and promoting women’s health across the lifecycle—is deeply significant. We’re pleased that attention is once again centred on women, maternal health, and newborn care. As a paediatrician, my academic and professional journey has been rooted in newborn care, which is intrinsically linked to maternal care. I’ve had the opportunity to work on this both nationally and globally, including with WHO. It’s encouraging to see this renewed focus.
Progress from MDGs to SDGs
Under the Millennium Development Goals (MDGs), there was a systematic global and national focus on reducing maternal and child mortality between 2000 and 2015. India achieved both related MDGs—halving under-five mortality and reducing maternal mortality by three-fourths compared to 1990 levels. These were significant milestones in child and maternal survival and it’s promising that this agenda is once again visible.
India’s Path to Achieving SDG3
The Sustainable Development Goals (SDGs) expand the scope, now targeting absolute reductions rather than relative ones. Three key indicators under SDG3 relate to maternal and child health:
· Maternal mortality ratio (MMR) to be below 70 per 100,000 live births
· Under-five mortality rate to be below 25 per 1,000 live births
· Neonatal mortality rate to be below 12 per 1,000 live births
Maternal Mortality Ratio
The latest estimate (2018–2020) puts India’s MMR at 97. From 556 in 1990, this marks an 83% reduction. The SDG target is below 70 by 2030, and nine states have already met this goal, including Kerala (1, Maharashtra (33), Telangana (43), Andhra Pradesh (45), Tamil Nadu (54), Jharkhand (56), Gujarat (57), and Karnataka (69). This is a national success story, especially considering the global reduction in the same period was just 42%.
Under-Five Mortality Rate
In 2020, India’s under-five mortality rate was 32 per 1,000 live births. The SDG target is 25, and India is set to meet this ahead of 2030. Even as of 2020, 11 states and union territories had already achieved this goal—Kerala, Tamil Nadu, Delhi, Maharashtra, Jammu & Kashmir, Karnataka, Punjab, West Bengal, Telangana, Gujarat, and Himachal Pradesh. Since 1990, the under-five mortality rate in India has fallen by 73%, compared to 58% globally.
Neonatal Mortality Rate
India’s neonatal mortality rate was 20 per 1,000 live births in 2020, with a target of 12 by 2030. Urban India has already met this target, and six states along with Delhi have also achieved it. From 35 lakh under-five deaths annually in 1990, the figure has dropped to between 6–7 lakh today. This is due to stronger health systems, high institutional delivery rates (around 90%), better-trained staff, and programmes like Ayushman Bharat (PMJAY).
Addressing Stunting
Stunting—low height for age—has declined from 58–59% in 1990 to around 35%, according to the latest NFHS survey. The trend is downward, and efforts are intensifying. Poor sanitation and infections contribute significantly to stunting, but initiatives like Swachh Bharat have led to a reduction in diarrhoeal diseases. Vaccine coverage and access to ORS and zinc also play a major role.
To accelerate progress, several areas need focus:
Early initiation of breastfeeding: Only 42% of newborns begin breastfeeding within an hour; this should be 100%.
Exclusive breastfeeding: Currently at 65%, but needs to reach 100% for the first six months.
Care for small babies: Including kangaroo mother care and expressed breast milk.
Timely complementary feeding: Only half of children aged 6–8 months receive complementary foods. This should be universal.
A 14-month-old child needs nearly 50% of an adult’s energy intake, so feeding must be energy-dense and frequent. Common household foods—lentils, rice, soft chapati, milk, potatoes—can meet this need if given appropriately.
Maternal Nutrition and Health Are Critical
A mother’s health before and during pregnancy determines birth outcomes. Women with low BMI or height need extra nutrition, which is supported through government dietary programmes. Take-home rations must be consumed regularly. Tackling maternal anaemia and infections is also vital for preventing stunting and wasting at birth.
Sustained Action Post-Birth
After birth, nutrition, illness prevention, timely treatment, and full vaccination coverage are essential. With better awareness, education, and access to services, India is poised to accelerate progress on child growth and nutrition. Programmes like Poshan Abhiyaanand the National Health Mission are central to this strategy.
NCDs: The Next Big Challenge
While progress on communicable diseases is commendable, non-communicable diseases (NCDs)—particularly cardiovascular diseases—pose a growing threat. Hypertension, diabetes, cancer, kidney, and liver diseases are increasingly prevalent. Prevention is key:
· Maintain healthy weight
· Avoid tobacco and alcohol
· Stay physically active
· Adopt a stress-free, balanced lifestyle
