India Can Radically Improve Its Child Survival Rates 
By Carol Bellamy 

Children in India, who represent one in five of the world’s children, and children across the world, are better off than a decade ago. Globally, 400 million more children have access to safe drinking water and improved sanitation facilities and 25 million children have been saved due to immunisation. 
But for every child who now has access to a secure and healthy future, several remain marginalised and underserved by their governments and the global development community. At least one billion are under siege to desperate poverty, deprived of such basic tools of life as water, sanitation, education, nutrition, shelter and protection from exploitation. One quarter of all poor children have no protection against infectious disease. Fifteen million have been orphaned by HIV/AIDS and many more seen their communities founder as doctors, teachers and religious leaders are lost to the epidemic. 
With 414 million children, India has a unique responsibility. The fate of these children will inevitably be a major factor in determining our collective future. The fate of the 26 million children born here annually will be as diverse as the nation itself. Out of every 100 children born, 35 of those births will be registered, 93 will make it to their first birthday, 59 will be fully immunised against the six basic childhood diseases, three will die of malnutrition, 47 will remain underweight, which will affect their performance throughout their lives, and 25 will complete primary school. 
Of all the assaults on the security of childhood, early death from an easily preventable cause is the most tragic. Over the last decade, child mortality has been in slow but steady decline, with global rates falling 18% from 1990 figures. But Thursday’s launch, on the occasion of World Health Day, of the 2005 World Health Report on Maternal and Child Health reminds us that there are still 10 million children under five (two million of whom are in India) dying every year from common childhood diseases, unsafe water, unhygienic environments and inadequate diets, for want of a basic package of help. 
In March 2005, a UNICEF co-authored paper published in Lancet detailed a handful of high-impact, strategic interventions that could prevent three out of four newborn deaths, saving three million lives per year. Support for exclusive breastfeeding or teaching a young mother to keep her baby warm, routine immunisation, in particular measles immunisation, infant bed nets to protect against malaria, and zinc tablets and new oral rehydration salt formula in the management of diarrhoea — for a child born into a poor family these low cost, lowtechnology and innovative solutions can mean the difference between life and death. These specific health interventions, combined with a social context in which girls as well as boys are educated, girls marry later, women enter their pregnancy healthy and equipped with the tools to raise families safely, can lead to breaking the intergenerational cycle of poverty and early death. 
India stands poised to lead the world in realising child survival. An integrated approach to neonatal and childhood illnesses would ensure that every birth is attended by a skilled worker, and that mothers receive adequate information and support from their communities and health services on caring for themselves and their newborns, including routine immunisation and injection safety. This approach is operational with UNICEF support in 50 of India’s most marginalised districts, covering over 90 million people. 
India is on the verge of ensuring that every child grows up in a safe, healthy and protected environment. And given an economic growth rate of 8% last year, its substantial foreign currency reserves and important role as a leading player in the global technology revolution, India has the resources to achieve it. The government’s increased public sector spending on health and education is a clear indication that India is committed to seeing its children thrive, but this trend has to address the huge disparities that exist across the country. 
Strong partnerships between governments, development agencies and community leaders such as the Child Survival Partnership in which India has taken such a strong lead, can work. 
We also know that saving lives means breaking through political discrimination, and social and gender inequities. In India as elsewhere, the highest child mortality rates are found amongst the poor and the politically marginalised or geographically isolated families that are always the last in line for any basic services. 
India has made great strides in child survival, in education and water management in the last 20 years through innovative programmes, strong partnerships and increased investment. India has taken on education, and specifically the education of its girls, as one of the cornerstones of a long-term development vision that would see the next generation born to better educated parents. 
Over the last 10 years I have seen a tremendous surge in global willingness to talk about children’s rights and embrace the special entitlements of childhood. The Millennium Development Goals set targets for the welfare of children that every country must strive to fulfil. I hope India blazes a trail bright enough for other nations to follow. 
The writer till recently was Executive Director, 
UNICEF . 

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