**Table 5: Conceptual Framework – Correlates of Child Mortality**<sup>**12**</sup>

|**Domain ofVariables**|**Factors to consider**|
|---|---|
|**A. Individual**|Parents’ education (particularly mother’s education); mother’s age at first<br>pregnancy; birth order; birth spacing or birth interval; mother’s nutrition and<br>health status (measured through indicators like the body mass index); use of pre-<br>natal, ante-natal and post-natal services (whether received tetanus injections/iron<br>supplements during pregnancy); care during the first few years of life<br>(immunization, breast feeding, incidence of disease, prevention and treatment of<br>illness);location of last birth and whether attended bydoctor/trained mid-wife|
|**B. Women’s agency**|Knowledge and use of modern contraceptives and feeding and childcare practices;<br>women’s access to media (through radio, television or newspaper readership);<br>abilitytogo to health facilities alone|
|**C. Household**|Household resources (assets, income, savings, availability of food); type of<br>housing; availability of clean drinking water; sanitation; intra-household<br>distribution of resources (especially food) by gender and age; household behaviors<br>(migration, attitudes to pregnancy, child bearing and norms about seeking<br>“modern” health care etc)|
|**D. Community**|Access to infrastructure (roads, water, sanitation, electricity); transport<br>(public/private); financial services; education and training; community institutions;<br>gender and socio-cultural norms; community attitudes to pregnancy, child bearing<br>and seeking“modern” health care|
|**E. Service Provision**|Availability of and access to health facilities; staffing; quality of service;<br>availability of medicines/drugs, blood, etc; (formal and informal) cost of using<br>service;availabilityof and access to largepublic assistanceprograms(e.g. ICDS)|
|**F. Voice and participation**|Access to information, participation in local governance (gram sabhas), ability to<br>seek redress togrievances against serviceproviders.|

**Tribal children are at much greater risk of malnutrition.** Malnutrition in India is widespread, with 48 percent of Indian children showing signs of long-term malnutrition (i.e. stunting, a deficit in height-for-age), 24 percent of severe stunting and 42 percent of being under-weight<sup>13</sup> . Even worse than the population averages are outcomes for tribal children, among whom 53 percent are stunted, 29 percent are severely stunted and 55 percent are under-weight.  The gap between the Adivasi children and those from other groups appears within the first 10 months of birth and persists – with some variation throughout early childhood.  The rise in severe wasting among ST children during the first 10 months of life is particularly alarming (Figure 3).

> 12 Adapted from World Bank (2006) _Achieving the MDGs in India’s Poor States: Reducing Child Mortality in Orissa and_ from extant demographic literature on child mortality.

> 13  Malnutrition is usually measured along three dimensions: stunting (deficit in height-for-age), wasting (deficit in weight-for-height), and under-weight (deficit in weight-for-age). Stunting reflects long-term effects of malnutrition; while wasting measures the current nutritional status of the subject, i.e. his/her food intake immediately prior to the survey. The ‘under-weight’ indicator is a combination of the former two and captures both long-term and short-term effects of deficient food intake.  A child is considered to be malnourished with respect to each of these measures, if his/her indicator falls below -2 standard deviations from the median (defined for 2006 WHO international reference population).  Falling below -3 standard deviations signals severe malnutrition.

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