A single death is a tragedy. A million deaths is a statistic. It was Joseph Stalin, Georgian revolutionary-turned-Soviet premier who said this. In India, a single death is a personal tragedy, a hundred deaths attract headlines, and a million deaths would be filed as part of public policy statistic.
Last week, the death of over 100 children at J K Lon hospital in Kota captured news headlines. The children were brought into the hospital by parents, mostly from economically weaker sections, from surrounding rural areas. As is the case with such tragedies, the children were critically ill. The hospital suffers from gaps in infrastructure. There was equipment malfunction. Naturally, allegations of negligence followed.
What is chilling is that infant deaths seem to be par for the course at the hospital. What raised the alarm is the quantum of deaths, 10 children in 48 hours. It is a testimony to the state of apathy that over 1,000 children died every year in the past six years in the hospital. Indeed, the state government claimed that the death toll was the lowest since 2011. Of such small mercies rests political claims of good governance in India.
The saga is not very different from what happened in Gorakhpur in August 2017. In just 24 hours, 23 infants died in the Baba Raghav Das Medical College Hospital. In a five-day period, over 70 infants admitted in to the hospital’s in the neo-natal ward and for treatment died. In 2020, it is still a mystery as to what caused the tragedy and who was responsible. As in Kota, the state government had claimed the death toll had come down.
The tragic phenomenon of untimely deaths of infants and their cause is typically trapped in the rising fog of political whataboutery. At Gorakhpur, it was the Congress and the Opposition who were attacking the Yogi Adityanath government. In Kota, it was the BJP which targeted the Ashok Gehlot government. The systemic inadequacies are swept under high decibel sloganeering and calls for resignations.
Amidst ricocheting rhetoric, little has changed over the years. In a five-year period between 2008 and 2012, a total of 10,081 children had died in the Kalawati Saran Hospital in Delhi. Three years later in 2015, an Right to Information (RTI) query revealed that 34,000 children admitted to neo-natal wards and paediatric intensive care unit in Delhi’s hospitals had died in 19 hospitals — effectively over 12 per cent of children admitted for treatment.
It is not just Kota, Gorakhpur or Delhi. A recent UNICEF report revealed that over 882,000 children under the age of five died in 2018 — that is over 100 children every hour, or a child every minute. And the average camouflages the poor state of affairs in the states – in Uttar Pradesh, Odisha and Madhya Pradesh. Indeed, life expectancy at birth is better in Sri Lanka, Indonesia and Kazakhstan than in India.
Successive governments have claimed improvement. Comparison over a time frame may sound good but how has India done compared to others. Data with the UN Inter-agency Group for Child Mortality Estimation spells out improvement a little more explicitly. In 1990, India’s under-5 mortality was at 126 per 1,000 births and Bangladesh at 144 per 1,000 births. In 2018, India’s under-5 mortality is at 36 per 1,000 births and that of Bangladesh is better at 30 per 1000 births.
Sure, India is dogged by sheer scale of births. But the size of population hasn’t deterred China ostensibly an authoritarian regime compared to democratic India. The Integrated Child Development Services (ICDS), the nodal programme for fighting infant mortality, was set up in 1975 and is focussed on the first 1,000 days of a child’s life. The data is eloquent. Between 1970 and 2018, India brought down under-five mortality from 213 to 36 per 1,000 births. China, just as haunted by scale, brought it down from 112 to 9 per 1,000 births.
It is not that money is not available, although it is arguable that more must be spent. Allocations for ICDS in the past three years averaged at Rs 20,000 crore, and allocation this year is at Rs 27,000 crore in 2019-20. Child care is about nutrition — about 35 per cent of the children suffer from anaemia and low birth weight. In 2018, the government expanded the nutrition programme (Poshan Abhiyan) under ICDS.
Better nutrition does help. But more needs to be done. Improving child care and fixing infant mortality demands an alignment of public policy. There is a correlation between the environment and mortality. Availability and quality of water matters — and yet over 1.5 Anganwadi centres, the contact point for healthcare, do not have drinking water supplies.
Over 17 per cent of the deaths are caused by pneumonia, 9 per cent by diarrhoea and around 5 per cent by bacterial infections. Over 3.6 lakh Anganwadi centres lack toilets in the country despite the fact that a big cause of deaths is poor sanitation and waste management.
An African proverb says it takes a village to raise a child. The bottom line is a nation capable of launching lunar and solar space missions must do better to stop the death of over 100 children every hour.
Shankkar Aiyar (Author of Aadhaar: A Biometric History of India’s 12 Digit Revolution, and Accidental India)