title: Reproductive health, and child health and nutrition in India: meeting the challenge.
abstract: India, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. In 2005, India embarked on the National Rural Health Mission, an extraordinary effort to strengthen the health systems. However, coverage of priority interventions remains insufficient, and the content and quality of existing interventions are suboptimum. Substantial unmet need for contraception remains, adolescent pregnancies are common, and access to safe abortion is inadequate. Increases in the numbers of deliveries in institutions have not been matched by improvements in the quality of intrapartum and neonatal care. Infants and young children do not get the health care they need; access to effective treatment for neonatal illness, diarrhoea, and pneumonia shows little improvement; and the coverage of nutrition programmes is inadequate. Absence of well functioning health systems is indicated by the inadequacies related to planning, financing, human resources, infrastructure, supply systems, governance, information, and monitoring. We provide a case for transformation of health systems through effective stewardship, decentralised planning in districts, a reasoned approach to financing that affects demand for health care, a campaign to create awareness and change health and nutrition behaviour, and revision of programmes for child nutrition on the basis of evidence. This agenda needs political commitment of the highest order and the development of a people's movement.
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India. vinodkpaul@hotmail.com
authors.forename: Vinod Kumar
authors.initials: VK
authors.lastname: Paul
authors.forename: Harshpal Singh
authors.initials: HS
authors.lastname: Sachdev
authors.forename: Dileep
authors.initials: D
authors.lastname: Mavalankar
authors.forename: Prema
authors.initials: P
authors.lastname: Ramachandran
authors.forename: Mari Jeeva
authors.initials: MJ
authors.lastname: Sankar
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
authors.forename: Vishnubhatla
authors.initials: V
authors.lastname: Sreenivas
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Sundararaman
authors.forename: Dipti
authors.initials: D
authors.lastname: Govil
authors.forename: David
authors.initials: D
authors.lastname: Osrin
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
mesh_terms: D000028:Abortion, Induced; D001724:Birth Weight; D002017:Budgets; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D046688:Child Mortality; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D002664:Child Nutritional Physiological Phenomena; D002669:Child Welfare; D003151:Community Health Centers; D003469:Culture; D003906:Developing Countries; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D005380:Financing, Government; D006292:Health Priorities; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006306:Health Surveys; D006280:Health Workforce; D006801:Humans; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008423:Maternal Age; D008428:Maternal Mortality; D008429:Maternal Welfare; D008485:Medical Audit; D009752:Nutritional Status; D011050:Policy Making; D011051:Poliomyelitis / Q000517:prevention & control; D011247:Pregnancy; D011635:Public Health Administration; D019035:Rural Health Services; D012743:Sex Preselection; D019037:Urban Health Services