Key messages
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With 1·8 million deaths among children (age <5 years) and 68 000 deaths among mothers every year, and 52 million children who are stunted, India's burden of reproductive health, and child health and nutrition is greater than that in any other country.
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The pace of improvement has been slow and falls short of the national and Millennium Development Goal targets. For instance, the national goal for 2010—ie, an infant mortality rate of less than 30—will not be attained in rural India as a whole, and all except five states, even in 2015. The reason is that the coverage for priority interventions remains insufficient, and the content and quality of existing programmes suboptimum, further complicated by unacceptable inequities.
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The underlying cause of insufficient progress is weak health systems; substantial inadequacies exist in planning, financing, human resources, infrastructure, supply systems, governance, and monitoring.
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Adequate importance has not been given to the first 2 years of a child's life that are critical for prevention of undernutrition and its consequences; the focus of the nutrition programmes has become supplementary nutrition and preschool education for children aged 3–6 years.
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The only way forward is to transform health systems. Effective stewardship, decentralised planning in districts, effective service delivery in communities and health facilities, a reasoned approach to demand-side financing, a sustained campaign to change household behaviours, and creation of centres of excellence for health and nutrition policy research are essential for change.
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Child nutrition programmes need to be changed with focus on the vulnerable first 2 years of life.
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For long-term gains, investments in sexual and reproductive health of young people are essential.