Such an unenviable position of India has made the entire Southern Asia to shoulder the heaviest burden of stillbirths, child mortality between 0-5 years, and deaths between 5-15 years of age.

The Report of the United Nations Inter-agency Group for Child Mortality Estimation, 2022 (UNIGME) titled “Never Forgotten: The situation of stillbirth around the globe” has estimated 1.9 million babies still born globally at 28 weeks or more of gestation in 2021, having a rate of 13.9 stillbirths per 1000 births. It must be noted that the report has used a 28-week-or-more definition of stillbirth, so these numbers are considerably underestimated since they exclude stillbirths at earlier gestational ages.

Southern Asia has much higher stillbirth rates at 16.2 per 1000 births. One in 60 births in the regions are likely to be stillbirth. One about 62 women suffers in Central and Southern Asia the risks of stillbirths. Southern Asia was one of the two regions of the world that has been clubbed with Sub-Saharan Africa where more than three quarters of estimated stillbirths occurred in 2021. Southern Asia was burdened with 32 per cent of the stillbirths.

India is not only among the six countries that had gained dubious distinction of altogether accounting for about half (49 per cent) the estimated stillbirths that occurred in 2021, and also 43 per cent of live births, but the country has also the highest number of stillbirths followed by Pakistan, Nigeria, the Democratic Republic of the Congo, Ethiopia and Bangladesh. Over one in three stillbirths (36 per cent) took place in India, Pakistan, and Negeria, which together account for 30 per cent of live births.

Stillbirth during labour is a critical issue for which we have a technical term “intrapartum stillbirths” which require close examinations, sinch these lives could have been saved through improved availability of labour monitoring and timely intervention in case of complications. However, in 2021, there were 853,000 intrapartum stillbirths globally which was 45 per cent of total stillbirths. About 85 per cent, estimated 727,000 of these baby were born in two regions – Sub-Saharan Africa and Central & Southern Asia, where half of the children die during labour. Stillbirth rate (SBR) in India in 2021 was 12.2, which translated into 286,482, the highest number for any country in the world.

The Levels & Trends in Child Mortality Report 2022 by the United Nations Inter-agency Group for Child Mortality Estimation has brought estimation for child (under 5 years of age), adolescent (5-14), and Youth (5-24) mortality. It has estimated in total 5 million global deaths in 2021 under age 5 which included 2.3 million newborns. Additionally, 2.1 million adolescent and youth (5-24 years of age) were also died. This tragic and massive loss of life, most of which was due to preventable or treatable causes, was extremely shocking. These children could have been saved by simple measures such as improved care around the time of birth, vaccination, nutritional supplementation, and water and sanitation programmes.

Even timely and high-quaity and disaggregated data were not available and most vulnerable children could not be identified. For the year 2021, only 36 countries have high-quality nationally representative data on under-five mortality, while about half of the world’s countries have no data in the last five years. India has age-specific data for 2020 only, and hence estimation is just projected.

Under five mortality rate (U5MR) in India in 2021 have been estimated 30.6 per 1000 which was 709,000 with lower limit 640,000 and upper limit 784,000 the highest number for any country in the world. Female death rate is higher at 31 as against male at 30. Infant mortality rate was 25 per thousand which was 587,000 in number. Neonatal mortality rate was 19 per 1000 with number of deaths 442,000.

Number of deaths of children aged 5-14 in India in 2021 was 100,000 at the probability rate of 4 deaths per 1000. A total of 216,000 adolescent and youth between 15-24 died during the year and thus probability of dying was 8 per 1000. Probability of dying among male was 10 and among female was 7 in this age group.

It should be noted that excess mortality after the COVID-19 outbreak in 2020 in India is only an estimation in absence of real-time data for 2021. COVID-19 had disrupted health intervention programmes such as immunization, strained healthcare system and economic contraction among others. There are evidences of a very direct mortality impact for children, adolescents and youth who may be at increased risk of death or ill health.

India was among the 40 countries with the highest burden of under-five deaths in 2020, and among 19 that have provided data for this analysis. However, for 2021, India is not among the 14 countries that provided data for this analysis. UN IGME analysed data from 15 low- and middle-income countries including India having substantial child and youth population on the basis of HMIS or other data collection systems.

Since India is among low- and middle-income countries with emerging to be the highest populated country in the world the situation is alarming especially when it is housings largest number of poor households in the world, who suffer the most from deaths of their children in the womb and after birth until they are likely to celebrate their 24th birthday.