CHILD MORTALITY IN INDIA

Venessa Misewe

Introduction

            Child mortality is one of the leading global health issues in the world. It is caused by various factors; malnutrition, common childhood diseases (pneumonia, tetanus, diphtheria, measles and malaria) and poor prenatal care during pregnancy. Looking at the World Health Organization Statistics clearly shows the significance difference in the rate of child mortality between developed and developing nations. Developed nations like America and Germany have a low child mortality rate compared to developing nations like India and Mali, which have a very high child mortality rate (WHO 2012 p.19). Even though the World Health Organization has recognized child mortality as a global health problem, and has really made a great deal of effort in trying to reduce child mortality in many developing nations through providing vaccines against common deadly childhood diseases, educating mothers on the importance of good nutrition for their children, and providing prenatal care to pregnant women and educating them on the importance of prenatal care, a lot of work still needs to be done to reduce child mortality in developing countries.

            In the article entitled, “Causes of neonatal and child mortality in India: a nationally representative mortality survey,” Bassani the main author, talks about neonatal and child mortality in India and delves deep to discuss the main causes of child mortality in the country. He starts off his article by highlighting a shocking fact that states that India is the nation with the highest child mortality rate in the world with about 2.2 million of its children under five years dying each year, which accounts for twenty percent of the 8.8 million child deaths in the world. Bassani is in India and is determined to find out why India has the highest child mortality rate in the world, and through a survey he conducts by mainly asking local Indian people, and doctors about child deaths and health care in India, he is able to find out that the main cause of child mortality in the country is due to common childhood diseases l(pneumonia, diarrhea and malaria), malnutrition and mainly medical tourism which has greatly affected the public health system in India and has resulted in poor health care for the local India people.

Body

            While Bassani conducts his survey in India, going from door to door interviewing families in different parts of India and mainly asking them questions about the number of children they have lost under five years, and the primary cause of their children’s death, he notices that most neonatal and child mortality in India is due to common preventable childhood diseases like pneumonia and diarrhea which are very life threatening in India, and account for ninety percent of all neonatal deaths, and fifty percent of childhood deaths. Furthermore as he conducts interviews with doctors, he notices that many of the infant and child deaths in India are not reported because they mainly occur at home, in rural areas without the medical attention of a health care worker (p.116). He additionally discovers that the key reason why most child deaths are not reported is because of the high corruption rate in the country’s medical system. You basically have to give bribes to local health professionals in order to get treated, vaccinated in public hospitals or even report a death in your family, and that’s why most Indian people don’t feel the need to report a child’s death because it is expensive, and they have far more important things to worry about than spending their time focusing on the death of a child (p.116). At first, when Bassani realized that most child deaths were not reported, he ethnocentrically thought that Indian mothers did not care about their children and that’s why they did not report their deaths or try to seek medical help to save their children’s lives, but after further investigating the issue and using cultural relativism to understand why Indian mothers did this, he was able to sympathize with Indian mothers and understand that poverty and the high corruption in Indian’s health system is the main  reason why they did this. Having grown up in London, in a more developed culture with low child mortality, Bassani was very fortunate as a child to have access to good health care that rarely had corruption in its system. This reminded me of the week 6 article we read in class by Borovoy Hine entitled, “Managing the unmanageable elderly Russian Jews émigrés and the biomedical culture of diabetes care,” in which American doctors ethnocentrically judged Russian Jews as stubborn and non-compliant when dealing with their Diabetes health because they mostly did not follow their prescribed treatment plans (p.18). However further research indicated that Russian Jews seemed non-compliant when dealing with their Diabetes care plan because in Russia, they were used to having their doctors involved in their treatment, on the other hand in America, Diabetes treatment is more of a personal experience with very little doctor involvement. Russian Jews in America were mainly non-compliant in Diabetes management because they felt that American doctors were not as involved in helping them manage their Diabetes, and that is why they were non-compliant. When American doctors finally understood why Russian Jews were acting the way they were, they were able to use cultural relativism, and help Russian Jews better manage their Diabetes which consequently brought peace and understanding among both parties. 

In India, the general population which is mostly living below the poverty line mostly relies on public hospitals for their health care. Health care is free in India, but in public hospitals, people have to wait in long lines, for hours in order to be treated by very few doctors. The average doctor to patient ratio is 1 to 30, which means that in a public hospital a doctor has to work on so many patients in a very short time, which also affects the level and quality of health care the patients get. Bassani also found out that most people are expected to offer bribes to local nurses and hospital staff in order to be moved to the front of the line and access care in public hospitals, and when patients do get to be treated, the level of treatment is very quick and poor which subsequently makes patients hesitate to rely on public hospitals during emergency situations. Likewise when it comes to offering vaccines to most toddlers and infants in public hospitals most mothers have to give bribes in order to get their children vaccinated, or ends up waiting for long hours in line for free vaccination which normally takes months (p.117). Vaccines in India are supposed to be free and accessible to all people, but public health workers are taking advantage of the vulnerability of the Indian people, and making them pay in order to access what they are rightfully entitled to (p.3). This made Bassani able to understand that eradicating and preventing common childhood diseases like diarrhea and pneumonia will be a long struggle in India because corruption in India’s health system has made it hard to help save lives of children through the existence of poor management in health care which results in high neonatal and child mortality rates in the long run. Most Indian mothers have no choice but to watch their infant and toddlers die in front of their eyes from preventable diseases because of their health system’s corruption and poor governance, and it’s sad because there is nothing they can do about it.

In addition to childhood vaccination in India, Bassani found out that Indian’s cultural preference of boys to girls affected the quality of health care that a child got. Indian people were three times likely to vaccinate boys than girls because in India girls are considered less important than boys. Boys are seen as future sources of wealth and power to their families, and that’s why mothers in India struggle to make sure their infant sons are vaccinated and well fed compared to their daughters (p.3). Even though both sexes experience child mortality, the rate at which boys die is lower than girls. Women in India also practice selective abortion to make sure that they have more boys than girls (p.117). Even though many boys are vaccinated compared to girls the overall child mortality rate due to common preventable diseases in both sexes is still very high. Bassani says that in India four children die every thirty seconds from preventable diseases like pneumonia (p.118).

Bassani was still determined to know what caused corruption in the health system in India. He was able to find out from his survey participants that the growth of medical tourism in India was the main cause of corruption and poor health care in India’s public health institutions. This was happening because the rapid growth of medical tourism in India made more doctors hungry for more money which in turn made them focus more on private vs. public health care in India which made them make six times the profit they would make working in public hospitals. The focus on private health care by many doctors in India (especially to cater to medical tourists around the world), put a strain on public health care in India, by reducing the number of physicians available to patients (p.119). Bassani states that as medical tourism continues booming in India, more physicians are becoming selfish and neglecting their oath to care for other, and are more driven to use their skills to benefit themselves (p.119). The problem is that more and more Indian people relying on public health care in India, especially children and infants are suffering and dying because of shortage of physicians, corruption and poor health care in India’s public health system (p.119). This reminded me of the medical tourism in India video we watched in week eight of lecture that showed how medical tourism in India benefited the rest of the world (the tourists seeking cheap medical procedures) but hurt the public health system in India through reducing the number of physicians available to work in public hospitals.  Likewise this reminded me of neoliberalism, a term we discussed on November 5^th during quiz section which basically shows the effect of free market and its long term result in privatization of health care. This just shows that medical tourism in India leads to health inequality in India by privatizing health care (making good health care only available for the wealthy, and thus neglecting the poor).

Malnutrition, which is one of the main causes of child mortality rate in India, is actually experienced by low income populations living under the poverty line who account for 70% of India’s population (p.118). Malnutrion has nothing to do with corruption or health care in the country, but the simple fact that most mothers are poor and struggle to provide adequate nutrition for themselves and their children. While interviewing local Indian people, Bassani found out that providing good nutritious food for their families is a problem for most mothers in India because they simply don’t have the money to do so. They in turn have to feed their infants and children very little wheat porridge twice a day which is very little food for a growing child. Malnutrition is a very big issue in India and the government has really tried to help out, but the number of children dying from malnutrition keeps rising rapidly each year (p.118). However the government has done little to resolve the corruption and health inequality affecting Indian people. The government has basically sat back and watched its people suffer, and its children die from diseases that can be prevented by better health care in public hospitals. The Indian government has allowed medical tourism and neoliberalism to kill its own people by denying them the most basic thing they need; healthcare. What’s happening in India just reminded me of the term bio politics which we talked about in week 8 of lecture, which basically shows the power that the government has on people’s lives. A government’s involvement and good governance in a country’ health care system through distribution of vaccines and quality treatment to its people can positively affect people’s lives. On the other hand, a governments ignorance and lack of good governance in a country’s health care, causes health inequality and poor healthcare which negatively affects people’s lives.

Conclusion

Reading this article and applying medical anthropology concepts to child mortality in India such as bio politics (effect that the Indian governments non-involvement in the nation’s healthcare has ultimately led to poor health care and rise in child mortality caused by preventable diseases), neoliberalism (has given rise to medical tourism in India and privatized health care and consequently caused shortage of physicians in public hospitals in India which directly affects child mortality in the long run), and governance in healthcare (corruption in India’s public health system) helped me shed light on child mortality in India by looking into rise in medical tourism in India as one of the main factors that affect it. I actually never thought that medical tourism had a negative impact on India’s health care by ultimately reducing physicians in the public hospitals and fueling corruption, cheapening the quality of health care and directly affecting the prevention and treatment of common childhood diseases that lead to child mortality. My understanding of the above medical anthropology concepts I have talked about has just helped me understand child mortality in India and see that Indian children are dying in high numbers because their government and health system is failing them by placing medical tourism above the interests of their own people. Bassani just showed me the power that the government has in our lives and ultimately the health and future of our children.

My prior understanding of child mortality in India was that it was due to chronic malnutrition, but I had no idea that medical tourism would have any effect in accelerating child mortality in India. To just be clear, Bassani did not say that child mortality was not an issue before medical tourism began in India, but all he is saying is that his survey results showed that increase in medical tourism consequently increased child mortality in the country. In summary, my final practical perspective is that child mortality in India needs to be approached by the World Health Organization differently because providing India with vaccines against common childhood diseases and offering education on good nutrition to Indian mother is not really helping the problem. The main problem is the corruption in the public health system that is causing many children who can’t afford to access vaccination against preventable diseases and quality health care to die rapidly. I strongly feel that the World Health Organization has done its best to help India deal with child mortality, and the only way child mortality will decrease in India is if the government solves the health inequality issue caused by medical tourism and fueled by neoliberalism in India which has led to the privatization of health care in the country. Indian people and ultimately children are suffering because of the selfish doings of few people (doctors tending to medical tourists by focusing on private health care and neglecting public hospitals and resulting in health inequality and poor health care for Indian people). I think the government should place some kind of restrictions on neoliberalism in India which will lessen the privatization of health care in the country and provide better care to the majority of Indian citizens in public hospitals, and ultimately save lives of Indian children by reducing child mortality rates in the nation.

Bibliography

• ·         Bassani, D. G., Kumar, R., Awasthi, S., Morris, S. K., Paul, V. K., Shet, A., Ram, U., Million Death Study Collaborators. (January 01, 2010). “Causes of neonatal and child mortality in India: a nationally representative mortality survey.” Medical Anthropology Quartely.18.2 (2005):116-20.Print.
• ·         Borovoy A, Hine J.

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            The Biomedical Culture of Diabetes Care. Mar; 22(1): 1-26.

• ·         World Health Organization. World Health Statistics 2012.

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• ·         Cerón, Alejandro. 30 Nov. 2012. Class Lecture.