New data released by the United Nations Organisation show that under-five mortality rates have dropped by 49 per cent between 1990 and 2013. There has been accelerated average annual reduction during this period but the overall progress is still short of meeting the global target of two-thirds decrease in under-five mortality by 2015.
New estimates in Levels and Trends in Child Mortality 2014 show that in 2013, globally, 6.3 million children under five years of age died from mostly preventable causes. Compared with 2012, the 2013 numbers show a reduction of 200,000 deaths. The reduction is only marginal as there are still 17,000 child deaths every day in the world. The neonatal period (0-27 days) is the most vulnerable period for a newborn. It is therefore not surprising that in 2013, 2.8 million babies across the world died during this period. The 2.8 million neonatal deaths account for 44 per cent of all under-five deaths in children.
Key facts about India
- India has the highest number of neonatal deaths in the world. Of the three million neonatal deaths globally in 2012, 779,000 took place in India.
- If the neonatal period is vulnerable, the first day of life is even more critical. Of the 2.8 million babies dying across the world during the first 27 days, death during the first day of birth alone accounts for one million. What is poignant is that over 300,000 newborn deaths in India are on the very first day of birth. Thus, India accounts for about one-third of all babies dying globally on the first day of birth.
- “Fifty-six per cent of under-five child mortality in India is from neonatal mortality. Neonatal mortality had remained stable in India for a long time,” said Dr. Ajay Khera. He is the Deputy Commissioner and Public Health Expert, Child Health Programme, Ministry of Health and Family Affairs, India. According to him the neonatal mortality rate was 37 per 1,000 live births in 2003 and by 2009 it dropped to 34. But from 2009 to 2012 the rate dropped from 34 to 29.” “There was a decline of five points in three years from 2009 to 2012, while it dropped only three points in six years from 2003 to 2009.
According to this article, there has been a global stagnation in neonatal mortality for a long period and India’s stable condition has been due to the Millennium Development Goals.
There have been four major interventions in India to reduce neonatal mortality:
- promotion of institutional deliveries- (a)providing conditional cash transfer to pregnant women (b) women delivering in government institutions are guaranteed free drugs, diagnostic tests, diet and free transport to the healthcare centre
- establishment of newborn care corners- there are currently 14,000 such care corners, roughly three or four per district and they provide immediate care for newborns to further improve their chances of survival
- establishment of special newborn care units- currently, there are 548 such units across the country for babies that have very serious conditions
- home visits of newborns by nine lakh (900,000) ASHA workers to educate the mothers on breastfeeding and identify sick newborns and refer them to units where they can get admitted
Areas of concern
There are still some critical areas where more action has to be taken to further reduce newborn and neonatal mortality. For instance, of the 2.6 million stillbirths in the world, 600,000 are in India. Another area that needs focus is the reduction in preterm births. According to a 2012 WHO report, there were 100,000 to 250,000 preterm births in India. Premature birth is one that takes place more than three weeks before the baby (after less than 37 weeks of pregnancy) is due for normal delivery. Preterm births cause about 50 per cent of neonatal mortality and the precise reasons are not known. However, increasing the spacing between two births, preventing adolescent pregnancy and providing medical care will go a long way in reducing the number of preterm births.