The report consists of five chapters, numerous panels, charts, graphs and detailed regional and country-wise statistics on health, survival, nutrition, child protection, women, economic and demographic indicators, education, and HIV(1). Over the last several years improvements have been made in child survival rates, but maternal mortality continues to be a major issue, according to the report. The current statistics surrounding maternal and newborn health are quite shocking (Box).

The report cites weak health systems and a shortage of trained health workers as two of the biggest obstacles to reducing maternal mortality rates in Asia and Africa. The health worker shortage is felt most acutely in Africa, which has 24% of the global disease burden but only 3% of the global health workforce(1). In countries where fertility rates are high and where women are not empowered to make decisions about their healthcare, these problems are compounded.

India may well be ‘shining’ to the world at large but when it comes to its children’s health, the picture is far from glossy. India’s progress is critical to improving maternal and newborn health on a regional and global scale. India’s maternal mortality ratio stood at 450 per 100,000 live births in 2005, and the neonatal mortality rate at 39 per 1,000 live births in 2004(1). Though institutional deliveries have increased over previous years, 60% women still deliver their babies at home. More than two-thirds of all maternal deaths occur in a handful of states – Uttar Pradesh (UP), Uttarakhand, Bihar, Jharkhand, Orissa, Madhya Pradesh (MP), Chhattisgarh, Rajasthan and Assam. Disparity in the health indicators is clearly evident. Only 11% of population of UP receives antenatal care compared to 85% in Kerala and only 11% are institutional deliveries for UP compared to 97% for Kerala. In UP, one in every 42 women faces risk of maternal death compared to 1 in 500 women in Kerala. As far as neonatal deaths are concerned, the worst-off states include Orissa, MP, UP, Rajasthan and Chhattisgarh.

India is failing to provide basic healthcare for its poorest children - despite robust economic growth. Widening disparities are prevalent in health outcomes between income groups and between social and caste groups. These inequities combined with shortages in the provision of primary health care and the rising cost of care, are complicating the country’s efforts to meet the health related Millennium Development Goals (MDGs). It is a "fundamental truth" that unless India achieves major improvements in health, nutrition, water and sanitation, education, gender equality and child protection, global efforts to reach the MDGs will fail.

The report focuses on the importance of basic healthcare provision which is often taken for granted in the Western world.  This includes increasing access to family planning, antenatal and postnatal services, improving access to clean water, sanitation, adequate nutrition and routine immunization, ensuring a skill health personnel is present at every delivery and ensuring that every newborn infant receives immediate care after birth as necessary.  The report also highlights the need to prevent mother-to-child transmission of diseases, distribution of insecticide treated mosquito nets and oral rehydration salt, and the need to ensure that basic emergency obstetric care is available. It also recommends need to educate girls and young women, and provide essential services through health systems that integrate home, community and facility-based care(1). These are realistic aims as research indicates that around 80 per cent of maternal deaths could be prevented if women had access to essential maternity and basic health care services.

Strengthening of public health system with urgent investments in improving infrastructure, supplies, planning, management, supervision, and monitoring along with better integration of health initiatives and programs are the need of the hour. Improving quality of care, not merely the coverage of interventions should hold the key to achieve better end results. Political will, and the translation of that will in to political and legislative action, is essential to ensure maternal and child survival (2). Future child health policies should build on past lessons from child health programs, sustain the achievements that have already been made, enhance quality and efficiency and address specific gaps in neonatal care.

Funding: None

Competing interests: None stated.

1. UNICEF: The State of the World’s Children 2009: Maternal and Newborn Health. Available from: URL: http://www.unicef.org/sowc09/docs/ SOW C09-FullReport-EN.pdf. Accessed January 29, 2009.