In 2006, India and China accounted for 2.5 million child deaths, nearly a third of the worldwide total, UNICEF said. India alone accounted for one fifth of all under-five deaths, with 2.1 million.
Unless India improves its record on child survival, the world is unlikely to achieve the Millennium Development Goals (MDGs) to eradicate poverty, reduce child and maternal mortality, fight disease and achieve environmental sustainability by 2015, UNICEF said.
The United Nations' Children Fund also said China needed to regain early progress it had made in bringing down child mortality.
"Global attainment of the health-related MDGs will depend, in no small part, on India's achievements in improving health, nutrition, water and sanitation, education and child protection, gender equality and women's empowerment in the coming years," said the report, entitled The State of the Asia Pacific's Children 2008.
Although India succeeded in reducing its under-five mortality rate by 60 per cent between 1970 and 2006, "the infant mortality rate is 50 per cent higher in rural areas than in urban locations," the report said.
In China, although child mortality rates fell sharply between 1970 and 1990, reductions had since slowed, the report said, and "inequities in access to quality health care and huge disparities in health outcomes remain prevalent and entrenched."