Child Healthcare:
Neonatal mortality Rate (NMR):
The number of neonatal deaths per 1000 live births. A neonatal death is defined as a death during the first 28 days of life (0-27 days).

Infant mortality rate (IMR):
It is the number of deaths per 1,000 live births of children under one year of age.

Under-five mortality rate:
The under-five mortality rate is the probability (expressed as a rate per 1,000 live births) of a child born in a specified year dying before reaching the age of  five if subject to  current age - specific mortality rates.

Causes of Child Mortality in India:
•The major causes of child mortality in India (as per WHO, 2012) are -Neonatal causes (53%), Pneumonia (15%), Diarrhoeal diseases (12%), Measles (3%) and others.
•Besides these, malnutrition is a contributory factor in 33% child deaths.
•The prevention and management of common neonatal and childhood illnesses is critical for breaking the vicious cycle of malnutrition and infection,wherein infections such as diarrhea, acute respiratory infections and measles adversely impacting nutrition status and undernutrition increases susceptibility to infections, perpetuating this cycle.
•Effectively managing the onset of infections such as diarrhea and acute respiratory infections, adequate care and referral of severely undernourished and sick children remains a challenge.

Immunization rates:
• NFHS 4 (2015-16) shows that there have been promising gains in child health care.
•The immunization rates have gone up. The number of children aged 12-23 months who were fully immunized (BCG, measles and 3 doses each of Polio and DPT) has gone up from 43.5% in NFHS-3 to 62% in NFHS-4.
•In terms of percentage points, maximum increase is seen in Punjab, Bihar, Meghalaya, Rajasthan and Uttar Pradesh.
•However, the number of children receiving full immunization has gone down in Tamil Nadu, Himachal Pradesh, Haryana, Maharashtra and Uttarakhand.

Current Status of Malnutrition in India:
What is malnutrition?
•Malnutrition indicates that children are either too short for their age or too thin.
•Children whose height is below the average for their age are considered to be stunted.
•Similarly, children whose weight is below the average for their age are considered thin for their height or wasted.
•Together,the stunted and wasted children are considered to be underweight–indicating a lack of proper nutritional intake and inadequate care post childbirth.

What is the extent of malnutrition in India?
•India’s performance on key malnutrition indicators is poor according to national and international studies.
•According to UNICEF, India was at the 10th spot among countries with the highest number of underweight children, and at the 17th spot for the highest number of stunted children in the world.
•Malnutrition affects chances of survival for children, increases their susceptibility to illness, reduces their ability to learn, and makes them less productive in later life.
•It is estimated that malnutrition is a contributing factor in about one-third of all deaths of children under the age of 5.

•Over the decade between 2005 and 2015, there has been an overall reduction in the proportion of underweight children in India, mainly on account of an improvement in stunting.
•While the percentage of stunted children under 5 reduced from 48% in 2005-06 to 38.4% in 2015-16, there has been a rise in the percentage of children who are wasted from 19.8% to 21% during this period.
•A high increase in the incidence of wasting was noted in Punjab, Goa, Maharashtra, Karnataka, and Sikkim.
•The prevalence of underweight children was found to be higher in rural areas (38%) than urban areas (29%).
•According to WHO, infants weighing less than 2.5 Kg are 20 times more likely to die than heavier babies.
•In India, the national average weight at birth is less than 2.5 Kg for 19% of the children.
•The incidence of low birth-weight babies varied across different states, with Madhya Pradesh, Rajasthan and Uttar Pradesh witnessing the highest number of underweight childbirths at 23%.
•Further, more than half of India’s children are anaemic (58%), indicating an inadequate amount of haemoglobin in the blood.
•This is caused by a nutritional deficiency of iron and other essential minerals, and vitamins in the body.

NSSO: Key Indications of Social Consumption in India: Health
The National Sample Survey Office (NSSO), Ministry of Statistics and Programme Implementation  has released the key indicators of Social Consumption in India: Health, generated from the data collected during the period January to June 2014 in its 71st round survey.
The salient features of the report are:
•Urban India is sicker than the rural hinterland despite the mushrooming of health and wellness clinics and super-specialty hospitals, besides better per capita earnings.
•And this could well be attributed to increasing pollution levels and unhealthy dietary habits.
•A government health survey has revealed that around 11.8% of urban and 8.9% of rural population reported ailments during a 15-day reference period.
•Women were found to be more vulnerable to diseases in both cities and villages.
•The survey found that 13.5% of women, as compared to 10.1% of men, fell sick in urban areas, while the figures were 9.9% and 8%, respectively, in rural India.
•What's worrisome is that a high chunk of the population (86% in rural and 82% in urban areas) remains outside any scheme of health expenditure support.
•The NSSO survey reiterates that people rely more on private hospitals, with over 70% spells of ailment (72% in rural areas and 79% in urban areas) being treated in the private sector.
•It shows that higher amount was spent for treatment per hospitalized case by people in the private hospitals (Rs. 25,850) than in the public hospitals (Rs. 6,120).
•The highest expenditure was recorded for treatment of Cancer Rs. 56,712) followed by that for Cardio-vascular diseases (Rs. 31,647).
•Also, private institutions dominated both rural (58%) and urban areas (68%) in treating inpatients. Allopathy remains the preferred treatment in rural as well as urban areas.
•The survey found that over 90% of rural and urban population relies on allopathic treatment despite the government's efforts to promote alternative medicine.

Hidden Hunger
Hidden hunger is also known as micronutrient deficiency. It is a form of under nutrition that occurs when intake or absorption of Vitamins, Proteins and Mineral is too low to sustain good health and development in children & normal physical and mental functions in adults.

According to Global Hunger Index report 2014, the challenge of malnutrition is not just one of lack of food (hunger) but also of micro-nutrients (hidden hunger) and these two problems are not unrelated.
- The report questions the overall benefits of green revolution in India, due to which the staple cereals became more affordable and part of dietary cycle, making micronutrients rich foods costly and unaffordable to consume.
- The report has recommended dietary diversity as the most effective way of preventing hidden hunger, which entails a return to the traditional foods and fruits and vegetables sourced from kitchen gardens, which people in developing economies are abandoning.
- The report points to threats to traditional diets in rural areas of India, which included all types of millets, pulses, oilseeds and local seasonal vegetables andfruits butare disappearing from the plates and are being increasingly replaced by government-subsidized rice and wheat, supplied through public distribution system (PDS).

However, in the last 10 years there has been lot of improvements in government schemes. A massive expansion in ICDS and PDS under the National food security act and inclusionof pulses and cooking oils in food baskets in many states are good signs to improve micro-nutrient deficiency.

Challenges in Reducing Hidden Hunger
- There are hugegaps in implementation of theprogrammes like ICDS, PDS, and Food Security, e.g., there is a massive shortage of paediatriciron syrups for children in most states which need to be corrected.
- Universal maternity entitlements have been promised under NFSA, but there is no sign of it actually being implemented.
- We don’t have the latest data which show the current level of mal-nutrition and this is a serious gap in the efforts of tackling malnutrition. The latest available nationally representative data is of 2005-06.9.

Suggestions to Improve the Current Situation
- There are already institutional supports present in the form of Sarv Siksha Abhiyan, Midday Meal Scheme, National Rural health mission to tackle hidden hunger, we need to strengthen them.
- Weekly Iron Folic acids supplementation to reduce anemia among girls is a good step to tackle hidden hunger.
- India has a universal supplementation programmes for Iron and Vitamin A.
- Also, in order to combat widespread deficiencies in iron, India is promoting iron rich crops such as pearl millet,which is high in vitamin B, calcium, iron, potassium, magnesium and zinc.
- Innovative agricultural processes like fortification and biofortification aiming at improving the specific micronutrient deficiencies of a target population should be promoted.

 Food fortification and Bio-fortification
- Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food. Addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases.
- Biofortification is the idea of breeding crops to increase their nutritional value. This can be done either through conventional selective breeding, or through genetic engineering.
- Biofortification differs from ordinary fortification as it focuses on making plant foods more nutritious as the plants are growing, rather than having nutrients added to the foods when they are being processed.