[Answered]Examine the progress made so far by India, in achieving Sustainable Development Goal of reducing infant mortality.

Infant mortality rate means the number of deaths of children below one year of age in a given year per 1,000 live births in the same year. This rate is often used as an indicator of the level of health in a country.  Although India has made some progress in reducing infant mortality, it is still high in the world.

Progress made regarding infant mortality:

1. Fast decline: India has attained impressive achievements in child survival. A fast decline in Infant mortality rate (IMR) of the country has been observed in recent past. The IMR has dropped by an average rate of 4.56% per year over the last five years.
2. Low infant deaths: According to the United Nations Inter-agency Group for Child Mortality Estimation (UNIGME) about 8 lakh infant deaths were reported in India in 2017, the lowest in five years.
3. Significant reduction: The majority of the states have witnessed over 50% reduction in both infant and under-5 mortality rates from National Family Health Survey (NFHS)-1 to NFHS-4.
4. Reduced gender gap: A female infant is more likely to survive, according to the 2017 Sample Registration Survey (SRS), with the Infant Mortality Rate (IMR) at 33 in 2017.

Challenges in reducing infant mortality rate:

1. High State variations: In India there is a high Intra-State and Inter-State variations in IMR, such variations receive less attention from policymakers. The settlements intra state have higher While Kerala, Punjab and Tamil Nadu were the top performing States, Uttar Pradesh, Rajasthan, Bihar, Odisha and Madhya Pradesh were the bottom five.
2. Poverty: A major factor believed to influence the rate of infant mortality is poverty. Official estimates place 21.9% of Indians below the poverty line (BPL). This hinders access to quality healthcare especially in rural areas.
3. Premature deaths. Premature births account for over 80% of new-born deaths. It is a big challenge to reduce premature deaths as it is due to various reasons like poor maternal health and inter-generational poverty in families.
4. Illiteracy: Female literacy rates are less (65.46%), thus leading to less awareness regarding nutrition needed. Babies born to mothers with no education face nearly twice the risk of early death as babies whose mothers have at least a secondary education.
5. Shortage of trained health workers: There is shortage of trained workers especially in rural areas. NSSO data found the density of the total health workforce, at 29 per 10,000 population.

Way forward:

1. Private sector involvement: The health outcomes cannot be achieved by the government institutions alone and the private sector health facilities have to supplement governmental efforts. The private sector must ensure that the treatment provided by them is not only accessible but also affordable.
2. Specialized children’s hospitals: A majority of these deaths are preventable. There is a need for setting up more specialized children’s hospitals. More such state-of-the-art healthcare facilities have to be set up in rural areas, particularly in remote areas, may be even through public-private partnership.
3. Removing gaps: Addressing gaps in quality of health care is the need of the hour in India. Hospitals should ensure that the critical products to save the new-borns are available.
4. Awareness: Education campaign should be taken up to aware the mother of the merits of antenatal care, institutional delivery, importance of exclusive breastfeeding, immunisation is important.
5. Investment: India continues to show impressive decline in child deaths. The investment on ensuring holistic nutrition under the POSHAN campaign and national commitment to make India open defecation-free by 2019 are steps that will help in accelerating progress further.

SDG goal 3 calls for an end to preventable deaths of new-borns and children under 5 years of age. It is a daunting challenge for India to achieve the Sustainable Development Goals of bringing neonatal mortality from the current level of 25 to 12 per 1,000 live births and under five mortality rate from 43 to 25 per 1,000 live births by 2030. The uptake of the Janani Suraksha Yojana and NRHM needs to be ensured across the states it could address some of the variations in IMR across India.