India can avert 71% of an estimated 6 lakh neonatal deaths each year if all mothers deliver at a healthcare facility, have access to caesarean section services, safe blood and if special care for sick newborns are available, according to United Nations International Children’s Emergency Fund (Unicef) ‘Survive and Thrive’ report released at the Partners’ Forum which concluded on Thursday.
Neonatal deaths take place within the first 28 days of life and account for 62% of all under-5 deaths in India. “It is estimated that about 5.3 million children under the age of 5 died worldwide in 2017, of which 2.5 million were newborns. This means, 45% of all the deaths in children were in zero to 28-day olds. In India, the proportion is higher at 62%,” said Omar Abdi, deputy executive director, Unicef.
This is a quarter of all the global neonatal deaths. Of all the deaths, 80% neonates had low-birth weight and two-thirds were born prematurely, the report revealed.
Between 1990 and 2015, there was a 66% fall in under-five mortality, which was faster than the global reduction of 55%. “During this period, the reduction of deaths in neonates was just 56% in India. This is because even though vaccination and other government programmes were steadily reducing under-five mortality, neonatal mortality remained stagnant between 2002 and 2007,” said Gagan Gupta, chief of health programmes, Unicef-India.
“It was possible after that government’s emphasis on institutional deliveries, providing transport to and from hospitals, provide facility for delivery at doorsteps at sub-centres, conditional transfer of cash and ensuring complementary feeding through visits by Asha (village health-workers),” said Gupta.
An estimated 5 million women still deliver at home each year without any skilled birth attendance, with half the births taking place in Uttar Pradesh and Bihar alone.
Under the Pradhan Mantri Surakshit Matritva Abhiyan launched in 2016, doctors in the private sector are donating one workday every month, which has led 16 million antenatal check-ups over the past two years. With a focus on providing good care to sick newborns, the government has also set up 794 special newborn care units which provided help to 25 million newborns. “These initiatives resulted in saving 840 additional lives of children each day as compared to four years ago,” said prime minister Narendra Modi at the inauguration of the session of the Partners’ Forum at Vigyan Bhavan on Wednesday.
The way forward is to ensure quality. “Now, we have the numbers, but we need to invest in the quality of care to ensure that the burden of mortality is just not shifted from home to hospital. An example would be that eight out of ten women deliver in hospitals, only four out of ten newborns get mother’s milk in the first hour of life,” said Gupta.
Globally, 2.9 million lives of mothers and children can be saved by 2030 by providing pre-conception care during pregnancy, labour and delivery, care of the healthy newborn and help for sick newborns.
“There are two aspects to reducing these deaths. Prevention by providing proper nutrition to mothers, providing ante-natal check-ups, not having babies before the girls are ready, delivering in a proper healthcare facility or with the help of skilled attendants, who should when to refer the women to a higher-facility. Then is also a need to have proper connectivity between primary, secondary and tertiary care facilities so that women and newborns are able to seek and receive appropriate care. The government’s initiative to reduce child marriage will also likely have an impact on the maternal and child health,” Abdi said. Around 8% of adolescent girls in India are already mothers, with rates as high as 18% in West Bengal and Tripura.