Child Health Initiatives in India: Key Programmes and Their Impacts

India is home to one of the largest populations of children in the world, and keeping them healthy has long been a national priority. Over the past several decades, the government has built a layered system of programmes that protect children from preventable diseases, support their nutrition, and reduce the deaths of mothers and newborns. These initiatives have steadily transformed child health outcomes, and the numbers tell a powerful story. Understanding how these programmes work, why they were created, and what they have achieved helps explain one of the most significant public health journeys of modern times.

Immunization: the first line of defence
How the UIP began and grew
Mission Indradhanush and the push for full coverage
Integrated programmes for survival
The Child Survival and Safe Motherhood Programme
From CSSM to the Reproductive and Child Health Programme
Reducing fertility, mortality, and gaps in care
Nutrition and education support
Integrated Child Development Services
The Mid-Day Meal Programme, now PM POSHAN
The impact on child health

Immunization: the first line of defence

Vaccination remains one of the most cost-effective ways to protect children from life-threatening illnesses. At the centre of this effort is the Universal Immunization Programme (UIP), which provides free vaccines to children and pregnant women against a range of preventable diseases.

How the UIP began and grew

The programme traces its roots to the Expanded Programme on Immunization, which India adopted in 1978. It was expanded and renamed the Universal Immunization Programme in 1985 when coverage was extended beyond urban centres into rural areas. Today it operates under the National Health Mission and is run by the Ministry of Health and Family Welfare. The scale is enormous: the UIP reaches roughly 2.9 crore pregnant women and 2.54 crore newborns every year, entirely free of cost.

Children are protected against twelve vaccine-preventable diseases including diphtheria, pertussis, tetanus, polio, measles, rubella, severe childhood tuberculosis, hepatitis B, rotavirus diarrhoea, pneumococcal pneumonia, and Japanese encephalitis. Delivering these vaccines depends on a vast network of primary health centres, community health centres, sub-centres, and village-level outreach sessions, all supported by a cold-chain system that keeps vaccines potent.

Mission Indradhanush and the push for full coverage

Despite the UIP’s reach, many children remained unvaccinated or partially vaccinated, especially in hard-to-reach areas. To close this gap, the government launched Mission Indradhanush in December 2014. The mission targeted unvaccinated and partially vaccinated children and pregnant women, aiming to push full immunization coverage above 90 percent. In 2017, the Intensified Mission Indradhanush placed special focus on urban slums and low-coverage regions to accelerate progress further. Later rounds of the mission have continued this targeted, campaign-style approach.

The results have been striking. Full immunization coverage rose from 62 percent in 2015 to 98.4 percent by January 2026, while the share of zero-dose children fell sharply. India’s vaccination system also proved resilient during the COVID-19 pandemic, when it sustained routine immunization while simultaneously running one of the world’s largest vaccination drives.

Integrated programmes for survival

Protecting children cannot be separated from protecting mothers. Recognising this, India moved away from narrow, single-issue health campaigns towards integrated programmes that addressed maternal and child health together.

The Child Survival and Safe Motherhood Programme

In the early 1990s, the country faced a serious public health crisis. Infant mortality hovered around 80 deaths per 1,000 live births and maternal mortality exceeded 400 per 100,000 live births. The Child Survival and Safe Motherhood (CSSM) Programme, launched in 1992 with World Bank and UNICEF support, was India’s response. It ran from 1992 to 1997 and bundled together immunization, oral rehydration therapy for diarrhoea, control of acute respiratory infections, and Vitamin A supplementation, alongside safe motherhood measures such as antenatal care and tetanus immunization for pregnant women.

The CSSM Programme introduced a major shift in thinking. It moved beyond the old high-risk approach of the 1970s and built the foundation for later initiatives, including the deployment of community health workers and cash incentives for institutional deliveries.

From CSSM to the Reproductive and Child Health Programme

Building on this foundation, the government launched the Reproductive and Child Health (RCH) Programme on 15 October 1997. The RCH approach was broader and more integrated, treating reproductive health, maternal care, child survival, family planning, and the management of reproductive tract infections as parts of a single, client-centred system. This followed India’s commitments at the 1994 International Conference on Population and Development in Cairo, which encouraged a holistic reproductive health approach rather than a focus on population control alone.

RCH Phase I introduced a target-free approach that replaced earlier family planning targets with an emphasis on quality of care and client satisfaction. RCH Phase II, beginning in 2005, deepened the focus on reducing maternal and child mortality through essential and emergency obstetric care, First Referral Units staffed with specialists, and a stronger referral system.

Reducing fertility, mortality, and gaps in care

The RCH framework set out to tackle three connected challenges at once: high fertility, high mortality among mothers and children, and uneven access to immunization services. Its intermediate goals were to reduce both infant and maternal mortality rates, with the longer-term aim of stabilising population growth through informed and voluntary reproductive choices.

Over time, this framework evolved into the Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy adopted in 2013, which is now part of the National Health Mission. New initiatives layered on top of this structure, such as the Janani Suraksha Yojana, which offers cash incentives for institutional deliveries, and the Janani Shishu Suraksha Karyakram, which provides free care to pregnant women and sick newborns in public health facilities. Mission Indradhanush, discussed earlier, slots directly into this strategy by ensuring that immunization coverage keeps pace with the broader push to reduce child deaths.

Nutrition and education support

Good health depends on more than vaccines and medical care. Nutrition, early childhood development, and education all shape how children grow. Two flagship programmes address these needs directly.

Integrated Child Development Services

The Integrated Child Development Services (ICDS) scheme, launched on 2 October 1975, is one of the world’s largest programmes for early childhood development. It delivers a package of six services to children under six years of age, pregnant women, and nursing mothers: supplementary nutrition, immunization, health check-ups, referral services, pre-school education, and nutrition and health education.

The heart of the scheme is the anganwadi centre, a child-care centre located within the village or slum it serves. There are over 1.4 million anganwadi centres in operation, each run by an anganwadi worker and a helper drawn from the local community. These workers monitor child growth, provide supplementary food, support immunization, and link families to the nearest primary health sub-centre.

In 2018, the scheme was strengthened by the launch of POSHAN Abhiyaan, which universalised ICDS and integrated it with other nutrition-focused programmes. POSHAN Abhiyaan focuses on reducing undernutrition and anaemia among children, pregnant women, and lactating mothers through convergence between schemes, better growth monitoring, and the use of technology for tracking outcomes.

The Mid-Day Meal Programme, now PM POSHAN

School-going children are supported through the Mid-Day Meal Programme, which provides a hot cooked meal on every school day. The programme was launched nationally in 1995 as the National Programme of Nutritional Support to Primary Education. A landmark Supreme Court directive in 2001 made cooked meals mandatory nationwide, shifting the scheme from dry rations to hot, prepared food.

In September 2021, the scheme was renamed Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) and extended to include pre-primary children in balvatikas. Today it is the world’s largest school feeding programme, serving over 118 million children daily across roughly 1.12 million schools. The meals are designed to meet specific nutritional norms, providing 450 calories and 12 grams of protein for primary children and 700 calories and 20 grams of protein for upper primary children.

The programme has a dual purpose. It tackles classroom hunger and malnutrition while also encouraging school enrolment, retention, and attendance, particularly among poorer children. Many schools also run health check-ups and distribute supplements such as iron and folic acid tablets alongside the meals.

The impact on child health

Decades of sustained effort have produced measurable gains. According to the United Nations child mortality estimates, India’s under-five mortality rate declined to 27 deaths per 1,000 live births in 2024, a dramatic long-term improvement. The Sample Registration System reported that the infant mortality rate fell to 24 per 1,000 live births, down from 30 earlier.

The pace of progress has outstripped global averages. India achieved a 78 percent decline in under-five mortality, compared with a global reduction of 61 percent, while its neonatal mortality rate fell by 70 percent against a global figure of 54 percent. These improvements reflect the combined effect of immunization, nutrition support, safe deliveries, and better access to care.

Yet challenges remain. Neonatal deaths from prematurity and birth complications, along with infectious diseases such as pneumonia and diarrhoea, continue to drive child mortality. Coverage is uneven, with some states and tribal communities lagging behind. Recent data also showed a notable drop in the number of children covered by school meals in several states, prompting reviews. Sustaining the gains will require continued investment, better data systems, and renewed attention to the communities still left out.

What is clear is that no single programme works in isolation. Immunization protects against disease, integrated programmes link mothers and children, and nutrition schemes build the strength children need to survive and thrive. Together they form a connected web of support that has reshaped the early years of life for millions.

What do you think? Which of these programmes do you believe deserves the most attention and funding in the years ahead, and how might the persistent gaps between states and communities be closed most effectively?

References

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Table of Contents

Immunization: the first line of defence 🔗

How the UIP began and grew 🔗

Mission Indradhanush and the push for full coverage 🔗

Integrated programmes for survival 🔗

The Child Survival and Safe Motherhood Programme 🔗

From CSSM to the Reproductive and Child Health Programme 🔗

Reducing fertility, mortality, and gaps in care 🔗

Nutrition and education support 🔗

Integrated Child Development Services 🔗

The Mid-Day Meal Programme, now PM POSHAN 🔗

The impact on child health 🔗